Sleep and Breathing

, Volume 14, Issue 3, pp 233–239 | Cite as

Validation of ECG-derived sleep architecture and ventilation in sleep apnea and chronic fatigue syndrome

  • Michael J. DeckerEmail author
  • Shulamit Eyal
  • Zvika Shinar
  • Yair Fuxman
  • Clement Cahan
  • William C. Reeves
  • Anda Baharav
Original Article



Newly developed algorithms putatively derive measures of sleep, wakefulness, and respiratory disturbance index (RDI) through detailed analysis of heart rate variability (HRV). Here, we establish levels of agreement for one such algorithm through comparative analysis of HRV-derived values of sleep–wake architecture and RDI with those calculated from manually scored polysomnographic (PSG) recordings.


Archived PSG data collected from 234 subjects who participated in a 3-day, 2-night study characterizing polysomnographic traits of chronic fatigue syndrome were scored manually. The electrocardiogram and pulse oximetry channels were scored separately with a novel scoring algorithm to derive values for wakefulness, sleep architecture, and RDI.


Four hundred fifty-four whole-night PSG recordings were acquired, of which, 410 were technically acceptable. Comparative analyses demonstrated no difference for total minutes of sleep, wake, NREM, REM, nor sleep efficiency generated through manual scoring with those derived through HRV analyses. When NREM sleep was further partitioned into slow-wave sleep (stages 3–4) and light sleep (stages 1–2), values calculated through manual scoring differed significantly from those derived through HRV analyses. Levels of agreement between RDIs derived through the two methods revealed an R = 0.89. The Bland–Altman approach for determining levels of agreement between RDIs generated through manual scoring with those derived through HRV analysis revealed a mean difference of −0.7 ± 8.8 (mean ± two standard deviations).


We found no difference between values of wakefulness, sleep, NREM, REM sleep, and RDI calculated from manually scored PSG recordings with those derived through analyses of HRV.


Heart rate variability Electrocardiogram Sleep apnea Sleep architecture Respiratory disturbance index Validation 


The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the funding agency.

Competing interests

The author(s) declare that Michael Decker, Clement Cahan, and William Reeves have no competing interests. Shulamit Eyal, Zvika Shinar, Yair Fuxman, and Anda Baharav were employees or shareholders of Hypnocore during the time of this study.


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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Michael J. Decker
    • 1
    Email author
  • Shulamit Eyal
    • 2
  • Zvika Shinar
    • 2
  • Yair Fuxman
    • 2
  • Clement Cahan
    • 3
  • William C. Reeves
    • 1
  • Anda Baharav
    • 2
  1. 1.Chronic Viral Diseases Branch, National Center for Zoonotic, Vector-borne Enteric DiseasesCenters for Disease Control and PreventionAtlantaUSA
  2. 2.HypnoCoreYehudIsrael
  3. 3.Share Zedek Medical CenterJerusalemIsrael

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