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Multi-modal ECG Holter system for sleep-disordered breathing screening

A validation study

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Abstract

Background

The high prevalence of sleep disordered breathing (SDB) among heart diseases patients becomes increasingly recognized. A reliable exploring tool of SDB well adapted to cardiologists practice would be very useful for the management of these patients.

Methods

We assessed a novel multi-modal electrocardiogram (ECG) Holter which incorporated both thoracic impedance and pulse oximetry signals. We compared in a home setting, a standard condition for Holter recordings, results from the novel device to a classical ambulatory polygraph in subjects with suspected SDB. The analysis of cardiac arrhythmias in relationship with SDB is also presented. A total of 118 patients clinically suspected of having SDB were evaluated (mean age 57 ± 14 years, mean body mass index [BMI] 32 ± 6 kg/m2). The new device allows calculating a new index called thoracic impedance (TI) disturbance index (TIDI+) evaluated from TI and SpO2 signals recorded from a Holter monitor.

Results

In the population under study, 93% had more than 70% of usable TI signal and 95% had more than 90% for SpO2 during sleep time recording. Screening performance results based on automatic analysis is accurate: TIDI + demonstrates a high level of sensitivity (96.8%), specificity (72.3%) as well as positive (82.4%) and negative (94.4%) predictive value for the detection of SDB. Moreover, detection of SDB periods permits us to observe a possible respiratory association of several nocturnal arrhythmias.

Conclusions

The multi-modal Holter should be considered as a valuable evaluating tool for SDB screening and as a case selection technique for facilitating access to a full polysomnography for severe cases. Moreover, it offers a unique opportunity to study arrhythmia consequences with both respiratory and hypoxia disturbances.

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Authors and Affiliations

  1. Novacor SA, Rueil Malmaison, France

    Laurent Poupard

  2. Laboratoire d’Explorations Fonctionnelles, Hopital Robert Ballanger, Aulnay sous Bois, France

    Marc Mathieu

  3. College of Health Sciences, University of Texas at El Paso, El Paso, TX, 79968, USA

    Michael Goldman

  4. Physiologie Clinique et de l’Exercice, Centre VISAS, CHU Nord, EA 4607 SNA EPIS, UJM PRES Université de Lyon, 42023, Saint Etienne, France

    Florian Chouchou & Frédéric Roche

  5. Service de Physiologie Clinique, EFCR, CHU Nord — Niveau 6, 42055, Saint-Etienne Cedex 2, France

    Frédéric Roche

Authors
  1. Laurent Poupard
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  2. Marc Mathieu
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  3. Michael Goldman
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  4. Florian Chouchou
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  5. Frédéric Roche
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Correspondence to Frédéric Roche.

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Poupard, L., Mathieu, M., Goldman, M. et al. Multi-modal ECG Holter system for sleep-disordered breathing screening. Sleep Breath 16, 685–693 (2012). https://doi.org/10.1007/s11325-011-0558-1

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  • DOI: https://doi.org/10.1007/s11325-011-0558-1

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