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Europace Advance Access originally published online on October 29, 2008
Europace 2009 11(1):94-99; doi:10.1093/europace/eun285
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Sleep Apnoea and Arrhythmias

Reliability of a Holter-based methodology for evaluation of sleep apnoea syndrome

Ariel Szyszko1,*, Carlos Franceschini2 and Jorge Gonzalez-Zuelgaray1

1 Service of Arrhythmias and Electrophysiology, Instituto Argentino de Diagnostico y Tratamiento, Marcelo T. de Alvear 2346, 1122 Buenos Aires, Argentina; 2 Department of Medicine, Argerich Hospital, Almirante Brown 250, 1155 Buenos Aires, Argentina

Aims: Sleep apnoea has significant medical implications. A reliable non-invasive method (as a regular Holter system with a specific software) would be valuable for the screening of this condition in ambulatory patients.

Methods and results: A total of 40 patients were divided into two groups: Group I, 20 patients with clinical suspicion of obstructive sleep apnoea (OSA) and Epworth sleepiness score ≥ 10 and Group II, 20 controls. In Group I, polysomnography was performed simultaneously with Holter (specific software to detect sleep apnoea). In Group II, Holter-based detection was utilized. A cutoff value of 10 for the apnoea–hypopnoea index (for polysomnography) or for the respiratory disturbance index (RDI) (for Holter) was considered abnormal. Sleep apnoea was confirmed by polysomnography in 14 patients (70%) in Group I. Holter recordings correctly identified OSA in 11 patients (r = 0.74 with polysomnography; P = 0.0002). Holter showed 78.5% sensitivity, 83.3% specificity, 91.6% positive predictive value, and 62.5% negative predictive value (with polysomnography as the gold standard). The RDI measured by Holter was 19.5 ± 20 in Group I and 3.9 ± 4.4 in controls (P < 0.005). The measurement between Holter and polysomnography (Bland and Altman method) showed good correlation (mean 4.7 with 39.4 and –30.1 SD) and a Pearson correlation coefficient (r) of 0.74 (P = 0.0002, 95% CI: 0.44–0.89).

Conclusion: Holter-based software may constitute an accessible tool on initial suspicion of OSA.

Key Words: Holter, Diagnosis, Sleep apnoea syndrome

* Corresponding author. Tel: +5411 4963 9500 ext. 329. E-mail address: aes1974{at}gmail.com

Manuscript submitted 31 May 2008. Accepted after revision 22 September 2008.


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