title: Prospective evaluation of a Holter-ECG derived severity index for screening of sleep disordered breathing.
abstract: To prospectively evaluate the applicability of a method to screen overnight Holter-ECGs for sleep disordered breathing (SDB) in an unselected clinical routine Holter sample.
  
  
  
  Holter-ECG recordings in 50 cardiologic inpatients were complemented with nocturnal respiratory polygraphy (PG). The respiratory event index (REI) and apnea/hypopnea index (AHI) from the PG served as a reference for an ECG-derived SDB severity estimate using a previously developed method. Agreement with the PG was investigated using Bland-Altman plots color-coded by ectopy level, and screening accuracy for REI≥15/h and AHI≥15/h was assessed.
  
  
  
  Prevalence for REI≥15/h was 52%, and 32% for AHI≥15/h. We observed better agreement of the ECG-based estimate with the REI compared to the AHI. Ectopy did not limit the detection of SDB. Binary screening for REI≥15/h provided excellent specificity of 0.96 with a sensitivity of 0.77. Ternary screening for AHI≥15/h yielded 16% borderline classifications and specificity/sensitivity of 0.96/0.86 for the remaining data.
  
  
  
  Screening of routine Holter-ECGs for sleep disordered breathing is reasonable and promises earlier identification of a significant part of patients at no additional cost.
authors.affiliation: Faculty of Informatics, Heilbronn University, Heilbronn, Germany. Electronic address: christoph.maier@hs-heilbronn.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Maier
authors.affiliation: Department of Cardiology, Angiology, and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Friedrich
authors.affiliation: Department of Cardiology, Angiology, and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Hugo
authors.initials: H
authors.lastname: Katus
authors.affiliation: Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany.
authors.forename: Hartmut
authors.initials: H
authors.lastname: Dickhaus
mesh_terms: D000368:Aged; D000465:Algorithms; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D015716:Electrocardiography, Ambulatory / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D017286:Polysomnography / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000145:classification / Q000175:diagnosis*
keywords: Apnea/hypopnea index; ECG; Respiration; Respiratory event index; Screening; Sleep apnea