Sleep and Breathing

, Volume 17, Issue 3, pp 1071–1078

An electrocardiogram-based analysis evaluating sleep quality in patients with obstructive sleep apnea

  • John Harrington
  • Preetam J. Schramm
  • Charles R. Davies
  • Teofilo L. Lee-ChiongJr
Original Article

DOI: 10.1007/s11325-013-0804-9

Cite this article as:
Harrington, J., Schramm, P.J., Davies, C.R. et al. Sleep Breath (2013) 17: 1071. doi:10.1007/s11325-013-0804-9

Abstract

Objective

The study compares polysomnography (PSG) and cardiopulmonary coupling (CPC) sleep quality variables in patients with (1) obstructive sleep apnea (OSA) and (2) successful and unsuccessful continuous positive airway pressure (CPAP) response.

Patients/methods

PSGs from 50 subjects (32 F/18 M; mean age 48.4 ± 12.29 years; BMI 34.28 ± 9.33) were evaluated. OSA patients were grouped by no (n = 16), mild (n = 13), and moderate to severe (n = 20) OSA (apnea–hypopnea index (AHI) ≤ 5, >5–15, >15 events/h, respectively). Outcome sleep quality variables were sleep stages in non-rapid eye movement, rapid eye movement sleep, and high (HFC), low (LFC), very low-frequency coupling (VLFC), and elevated LFC broad band (e-LFCBB). An AHI ≤ 5 events/h and HFC ≥ 50 % indicated a successful CPAP response. CPC analysis extracts heart rate variability and QRS amplitude change that corresponds to respiration. CPC-generated spectrograms represent sleep dynamics from calculated coherence product and cross-power of both time series datasets.

Results

T tests differentiated no and moderate to severe OSA groups by REM % (p = 0.003), HFC (p = 0.007), VLFC (p = 0.007), and LFC/HFC ratio (p = 0.038) variables. The successful CPAP therapy group (n = 16) had more HFC (p = 0.003), less LFC (p = 0.003), and e-LFCBB (p = 0.029) compared to the unsuccessful CPAP therapy group (n = 8). PSG sleep quality measures, except the higher arousal index (p = 0.038) in the unsuccessful CPAP group, did not differ between the successful and unsuccessful CPAP groups. HFC ≥ 50 % showed high sensitivity (77.8 %) and specificity (88.9 %) in identifying successful CPAP therapy.

Conclusions

PSG and CPC measures differentiated no from moderate to severe OSA groups and HFC ≥ 50 % discriminated successful from unsuccessful CPAP therapy. The HFC ≥ 50 % cutoff showed clinical value in identifying sleep quality disturbance among CPAP users.

Keywords

Sleep apnea Continuous positive airway pressure Cardiopulmonary coupling 

Abbreviations

AASM

American Academy of Sleep Medicine

CPAP

Continuous positive airway pressure

CPC

Cardiopulmonary coupling

CSA

Central sleep apnea

ECG

Electrocardiography

EDR

ECG-derived respiratory signal

e-LFC BB

Elevated low-frequency coupling broad band

HFC

High-frequency coupling

LFC

Low-frequency coupling

VLFC

Very low-frequency coupling

OSA

Obstructive sleep apnea

PSG

Polysomnography

SD

Sleep disorder

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • John Harrington
    • 1
  • Preetam J. Schramm
    • 2
  • Charles R. Davies
    • 3
  • Teofilo L. Lee-ChiongJr
    • 1
  1. 1.Division of Sleep MedicineNational Jewish HealthDenverUSA
  2. 2.AWP-FreiburgFreiburgGermany
  3. 3.Neurology and Sleep Medicine Carle Physician GroupUrbanaUSA

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