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Evaluation of frequency and time-frequency spectral analysis of heart rate variability as a diagnostic marker of the sleep apnoea syndrome

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Abstract

The sleep apnoea/hypopnoea syndrome (SAHS) elicits a unique heart rate rhythm that may provide the basis for an effective screening tool. The study uses the receiver operator characteristic (ROC) to assess the diagnostic potential of spectral analysis of heart rate variability (HRV) using two methods, the discrete Fourier transform (DFT) and the discrete harmonic wavelet transform (DHWT). These two methods are compared over different sleep stages and spectral frequency bands. The HRV results are subsequently compared with those of the current screening method of oximetry. For both the DFT and the DHWT, the most diagnostically accurate frequency range for HRV spectral power calculations is found to be 0.019–0.036 Hz (denoted by AB2). Using AB2, 15 min sections of non-REM sleep data in 40 subjects produce ROC areas, for the DFT, DHWT and oximetry, of 0.94, 0.97 and 0.67, respectively. In REM sleep, ROC areas are 0.78, 0.79 and 0.71, respectively. In non-REM sleep, spectral analysis of HRV appears to be a significantly better indicator of the SAHS than the current screening method of oximetry, and, in REM sleep, it is comparable with oximetry. The advantage of the DHWT over the DFT is that it produces a greater time resolution and is computationally more efficient. The DHWT does not require the precondition of stationarity or interpolation of raw HRV data.

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Abbreviations

AB1 :

apnoea band 1 (0.019–0.071 Hz)

AB2 :

apnoea band 2 (0.019–0.036 Hz)

AHI:

apnoea/hypopnoea index, h−1

HF:

high-frequency band (0.15–0.4 Hz)

References

  • Atlas Task Force (1992): ‘EEG arousals: scoring rules and examples’,Sleep,15, pp. 173–184

    Google Scholar 

  • Bates, R. A., Hilton, M. F., Godfrey, K. R., andChappell, M. J. (1998): ‘Comparison of methods for harmonic wavelet analysis of heart rate variability’,IEEE Proc. Sci. Meas. Technol.,145, pp. 291–300

    Article  Google Scholar 

  • Bonsignore, M. R., Marrone, O., Insalaco, G., andBonsignore, G. (1994): ‘The cardiovascular effects of obstructive sleep apnoeas: analysis of pathogenic mechanisms’,Eur. Respir. J.,7, pp. 786–805

    Article  Google Scholar 

  • Burgess, H. J., Trindler, J., Kim, Y., andLuke, D. (1997): ‘Sleep and circadian influences on cardiac autonomic nervous system activity’,J. Physiol.,273, pp. H1761-H1768

    Google Scholar 

  • Coleman, R. M., Pollack, C. P., andWeitzman, E. D. (1980): ‘Periodic movements in sleep (nocturnal myoclonus): relation to sleep disorders’,Ann. Neurol.,8, pp. 416–421

    Article  Google Scholar 

  • Cooper, B. G., Veale, D., Griffiths, C. J., andGibson, G. J. (1991): ‘Value of nocturnal oxygen saturation as a screening test for sleep apnoea’,Thorax,46, pp. 586–588

    Article  Google Scholar 

  • Daniels, J. E., Chappell, M. J., Tjahjadi, T., andCayton, R. M. (1997): ‘CADOSA: A fuzzy expert system for differential diagnosis of obstructive sleep apnoea and related conditions’,Exp. Syst. Appl.,12, pp. 163–177

    Article  Google Scholar 

  • Deegan, P. C., andMcNicholas, W. T. (1995): ‘Pathophysiology of obstructive sleep apnoea’,Eur. Respir. J.,8, pp. 1161–1178

    Article  Google Scholar 

  • Duglas, N. J., Calverley, P. M. A., Catterall, J. R., Johnson, A. J., Prowse, K., andStradling, J. R. (1990): ‘Facilities for the diagnosis and treatment of abnormal breathing during sleep including nocturnal hypoventilation’,BTS News,5, pp. 7–10

    Google Scholar 

  • Douglas, N. J., Thomas, S., andJan, M. A. (1992): ‘Clinical value of polysomnography’,Lancet,339, pp. 347–350

    Article  Google Scholar 

  • Dutt, A., andRokhlin, V. (1993): ‘Fast Fourier transforms for nonequispaced data’,SIAM J. Sci. Stat. Comp.,14, pp. 1368–1393

    Article  MATH  MathSciNet  Google Scholar 

  • Flemons, W. W., Remmers, J. E., andGillis, A. M. (1993): ‘Sleep apnea and cardiac arrhythmias. Is there a relationship?’,Am. Rev. Respir. Dis.,148, pp. 618–621

    Google Scholar 

  • Gould, G. A., Whyte, K. F., Rhind, G. B., Airlie, M. A., Catterall, J. R., Shapiro, C. M., andDouglas, N. J. (1988): ‘The sleep hypopnoea syndrome’,Am. Rev. Respir. Dis.,137, pp. 895–898

    Google Scholar 

  • Guilleminault, C., Tilkian, A., andDement, W. C. (1976): ‘The sleep apnoean syndromes’,Ann. Rev. Med.,27, pp. 465–484

    Article  Google Scholar 

  • Guilleminault, C., Winkle, R., Connolly, S., Melvin, K., andTilkian, A. (1984): ‘Cyclical variation of the heart rate in sleep apnoea syndrome. Mechanisms and usefulness of 24 hr electrocardiography as a screening technique’,Lancet,1, pp. 126–131

    Article  Google Scholar 

  • Guilleminault, C., Stochs, R., Clerk, A., Cetel, A., andMaistros, P. (1993): ‘A cause of excessive daytime sleepiness: the upper airways resistance syndrome’,Chest,104, pp. 781–787

    Article  Google Scholar 

  • Gyulay, S., Olson, L. G., Hensley, M. J., King, M. T., Allen, K. M., andSaunders, N. A. (1993): ‘A comparison of clincial assessment and home oximetry in the diagnosis of obstructive sleep apnea’,Am. Rev. Respir. Dis.,147, pp. 50–53

    Google Scholar 

  • Hanley, J. A., andMcNeil, B. J. (1982): ‘The meaning and use of the area under a receiver operating characteristic (ROC) curve’,Radiology,143, pp. 29–36

    Google Scholar 

  • Hanley, J. A., andMcNeil, B. J. (1983): ‘A method of comparing the areas under receiver operating characteristic curves derived from the same cases’,Radiology,148, pp. 839–843

    Google Scholar 

  • Hartikainen, J., Tarkiainen, I., Tahvanainen, K., Mantysaari, M., Länsimies, E., andPyörälä, K. (1993): ‘Circadian variation of cardiac autonomic regulation during 24-h bed rest’,Clin. Physiol.,13, pp. 185–196

    Article  Google Scholar 

  • Hayano, J., Skakibara, Y., Yamada, A., Yamada, M., Mukai, S., Fujinami, T., Yokoyama, K., Watanabe, Y., andTakata, K. (1991): ‘Accuracy of assessment of cardiac vagal tone by heart rate variability in normal subjects’,Am. J. Cardiol.,67, pp. 199–204

    Article  Google Scholar 

  • He, J., Kryger, M. H., Zorick, F. J., Conway, W., andRoth, T. (1988): ‘Mortality and apnea index in obstructive sleep apnea. Experience in 385 male patients’,Chest,94, pp. 9–14

    Article  Google Scholar 

  • Hedner, J., Ejnell, H., Sellgren, J., Hedner, T., andWallin, G. (1988): ‘Is high and fluctuating muscle sympathetic nerve activity in the sleep apnoea syndrome of pathogenic importance for the development of hypertension?’,J. Hypertens.,6, pp. 529–531

    Google Scholar 

  • Hla, K. M., Young, T. B., Bidwell, T., Palta, M., Skatrud, J. B., andDempsey, J. (1994): ‘Sleep apnea and hypertension. A population-based study’,Ann. Intern. Med.,120, pp. 382–388

    Google Scholar 

  • Huikuri, H. V., Valkama, J. O., Airaksinen, K. E., Seppanen, T., Kessler, K. M., Takkunen, J. T., andMyerburg, R. J. (1993): ‘Frequency domain measures of heart rate variability before the onset of non-sustained and sustained ventricular tachycardia in patients with coronary artery disease’,Circulation,87, pp. 1220–1228

    Google Scholar 

  • Keyl, C., Lemberger, P., Pfeifer, M., Hochmuth, K., andGeisler, P. (1997): ‘Heart rate variability in patients with daytime sleepiness suspected of having sleep apnoea syndrome: a receiver-operating characteristic andlysis’,Clin. Sci.,92, pp. 335–343

    Google Scholar 

  • Levy, P., Pepin, J. L., Deschaux-Blanc, C., Paramelle, B., andBrambilla, C. (1996): ‘Accuracy of oximetry for detection of respiratory disturbances in sleep apnea syndrome’,Chest,109, pp. 395–399

    Article  Google Scholar 

  • Mansier, P., Clairambault, J., Charlotte, N., Medigue, C., Vermeiren, C., Lepape, G., Carre, F., Gounaropoulou, A., andSwynghedauw, B. (1996): ‘Linear and non-linear analyses of heart rate variability: a minireview’,Cardiovasc. Res.,31, pp. 371–379

    Google Scholar 

  • Newland, D. E. (1995): ‘Discrete wavelet analysis’in ‘Random vibrations, spectral and wavelet analysis, 3rd edn.’ (Longman, Singapore), pp. 295–370

    Google Scholar 

  • Penzel, T. (1993): ‘Spectral analysis of blood pressure in patients with sleep-related breathing disorders during NREM and REM sleep’,Sleep,16, pp. S150-S151

    Google Scholar 

  • Rechtschaffen, A., andKales, A. (1968): ‘A manual of standardised terminology, techniques and scoring system for sleep stages of human subjects’ (Brain Information service/Brain Research Institute, UCLA, Los Angeles)

    Google Scholar 

  • Ryan, P. J., Hilton, M. F., Boldy, D. A. R., Evans, A., Bradbury, S., Sapiano, S., Prowse, K., andCayton, R. M. (1995): ‘Validation of the British Thoracic Society guidelines for the diagnosis of the sleep apnoea/hypopnoea syndrome: can polysomnography be avoided?’,Thorax,50, pp. 972–975

    Article  Google Scholar 

  • Shiomi, T., Guilleminault, C., Sasanabe, R., Hirota, I., Maekawa, M., andKobayashi, T. (1996): ‘Augmented very low frequency component of heart rate variability during obstructive sleep apnea’,Sleep,19, pp. 370–377

    Google Scholar 

  • Sullivan, C. E., Issa, F. G., Berthon-Jones, M., andEves, L. (1981): ‘Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares’,Lancet,1, pp. 862–865

    Article  Google Scholar 

  • Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology (1996): ‘Heart rate variability: standards of measurement, physiological interpretation, and clinical use’,Eur. Heart J.,17, pp. 354–381

    Google Scholar 

  • Tilkian, A. G., Guilleminault, C., Schroeder, J. S., Lehrman, K. L., Simmons, F. B., andDement, W. C. (1976): ‘Hemodynamics in sleep-induced apnea: studies during wakefulness and sleep’,Ann. Intern. Med.,85, pp. 714–719

    Google Scholar 

  • Tilkian, A. G., Guilleminault, C., Schroeder, J. S., Lehrman, K. L., Simmons, F. B., andDement, W. C. (1977): ‘Sleep-induced apnea syndrome. Prevalence of cardiac arrhythmias and their reversal after tracheostomy’,Am. J. Med.,63, pp. 348–358

    Article  Google Scholar 

  • Varoneckas, G., Dauksys, R., Podilpskyte, A., andZemaityte, D. (1999): ‘Sleep structure and restoration of autonomic heart rate control during sleep’,Sleep,22, pp. S309

    Google Scholar 

  • Welch, P. D. (1967): ‘The use of fast Fourier transformation for the estimation of power spectra: a method based on time averaging over short, modified periodograms’,IEEE Trans. Audio Electroacoust.,AU-15, pp. 70–73

    Article  MathSciNet  Google Scholar 

  • Young, T., Palta, M., Dempsey, J., Skatrud, J., Weber, S., andBard, S. (1993): ‘The occurrence of sleep-disordered breathing among middle aged adults’,N. Eng. J. Med.,328, pp. 1230–1235

    Article  Google Scholar 

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Correspondence to M. J. Chappell.

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Hilton, M.F., Bates, R.A., Godfrey, K.R. et al. Evaluation of frequency and time-frequency spectral analysis of heart rate variability as a diagnostic marker of the sleep apnoea syndrome. Med. Biol. Eng. Comput. 37, 760–769 (1999). https://doi.org/10.1007/BF02513379

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