SLEEP 2011 Abstract Supplement

B. Clinical Sleep Science VIII. Medical Disorders and Sleep
0678
ATRIAL FIBRILLATION DETECTION USING A
PHOTOPLETHYSMOGRAPH WAVEFORM
Amir O 1 , Barak-Shinar D 2 , Wolff R 1 , Amos Y 2 , Paz H 1 , Smart F 3 ,
Lewis B 1
1
Division of Cardiology,, Lady Davis Carmel Medical Center, Haifa,
Israel, 2 WideMed Ltd., Herzliya, Israel, 3 Cardiology, Morristown
Memorial Hospital, NJ, USA
Introduction: Atrial fibrillation (AFIB) is the most common sustained
arrhythmia, increases with age, and presents with a wide spectrum of
symptoms and severity. The diagnosis of AFIB is currently based on
either full electrocardiography (ECG) or by Holter ECG device which
is recording one or two ECG leads most commonly over relatively short
periods of time (24-28hr). The photoplethysmograph (PPG) waveform
is used for recording arterial oxygen saturation. However, PPG signals
may also allow obtaining several additional parameters as heart rate and
cardiac cycle, respiration characteristics and even depth of anesthesia
and blood loss. The present research is examining the hypothesis that the
PPG waveform can be referred as a useful tool for screening, detecting
and diagnosing of atrial fibrillation.
Methods: 109 Patients were recruited from HF center, the division of
Cardiology, Lady Davis Carmel Medical Center, Haifa, Israel. Each patient
was detected at home for an entire night with 12 leads ECG and
pulse oximeter for the recording of the PPG signal. Results were automatically
analyzed by a PPG innovative algorithm for AFIB detection
(WideMed Ltd., Herzliya, Israel). The ECG data was given to a technician
for marking the AFIB annotation (gold standard).
Results: The annotations of AFIB from the automatic analysis of the
PPG were compared with the gold standard manual annotations and
achieved a gross duration sensitivity and positive predictive value of
96%.
Conclusion: In this study we found a collaborating support for the potential
usage of the PPG signal to detect irregular heart rate including
episodes of atrial fibrillation. Since this mode of detection is convenient
for the patients, it may allow the treating physician to obtain prolonged
periods of monitoring and give important information for treatment decisions.
Support (If Any): WideMed Ltd.
eases including hypertension, diabetes mellitus, coronary artery disease
and/or cerebrovascular disease worsens the severity of OSA compared
to absence of all the cardiovascular-related diseases. The secondary aim
is to evaluate if the Epworth Sleepiness Scale (ESS) score was different
between these two groups.
Methods: This is a retrospective study where all patients aged ≥ 18
years referred to sleep laboratory for suspected OSA from January, 1st
2010 to June, 30th 2010 were included. The full-night baseline and split
night polysomnographic reports were reviewed. Data was then evaluated
by logistic regression analysis to compare between two groups, the
severity of OSA (RDI < 15 and RDI ≥ 15), other polysomnographic
variables and daytime sleepiness score (ESS 15) with adjusted
odds ratio (OR) of 2.5. The increase in RDI was primarily from increase
in total obstructive apneic index (OAI ≥ 5) and hypopneic index (HI ≥
5) (adjusted OR of 2.6). Sleep efficiency and mean oxygen saturation (≥
95%) were better in the group without any of the cardiovascular-related
diseases (adjusted OR of 2 and adjusted OR of 2.9, respectively). However,
there was no statistically significant difference between the two
groups when compared other polysomnographic variables or ESS score.
Conclusion: Patients with any of the cardiovascular-related diseases are
at a higher risk of having moderate to severe OSA without significant
increase in daytime sleepiness despite adjusting for age, sex and BMI.
Therefore, we suggest that patients with any of the cardiovascular-related
diseases should be screened for OSA even if they are asymptomatic.
0680
OVERNIGHT PHARYNGEAL NARROWING IN PATIENTS
WITH CONGESTIVE HEART FAILURE AND SLEEP
DISORDERED BREATHING
Carlisle TW 3,4 , Sankri-tarbichi A 1,2 , Bascom A 1,2 , Pohlman M 1,2 ,
Morrell M 3,4 , Badr S 1,2
1
John D. Dingell Veterans Affairs Medical Center, Detroit, MI, USA,
2
Wayne State University, Detroit, MI, USA, 3 National Heart and
Lung Institute, Imperial College London, London, United Kingdom,
4
Royal Brompton & Harefield NHS Foundation Trust, London, United
Kingdom
0679
SEVERITY OF OBSTRUCTIVE SLEEP APNEA IN PATIENTS
WITH AND WITHOUT CARDIOVASCULAR-RELATED
DISEASES
Simon R 1,2,5 , Chirakalwasan N 1,4 , Teerapraipruk B 1,3,5 ,
Hirunwiwatkul P 1,5 , Jaimchariyatam N 1,4 , Desudchit T 1,6 , Charakorn N 5 ,
Wanlapakorn C 8 , Krittanupong S 4 , Intarut N 7
1
Excellence Center for Sleep Disorders, King Chulalongkorn Memorial
Hospital/Thai Red Cross Society, Bangkok, Thailand, 2 Department
of Otorhinolaryngology, Hospital Raja Permaisuri Bainun, Ipoh,
Malaysia, 3 Department of Otolaryngology and Opthalmology,
Naresuan University, Phitsanulok, Thailand, 4 Department of Medicine,
Division of Pulmonary and Critical Care Medicine, Chulalongkorn
University, Bangkok, Thailand, 5 Department of Otolaryngology,
Chulalongkorn University, Bangkok, Thailand, 6 Department of
Pediatrics, Division of Pediatric Neurology, Chulalongkorn University,
Bangkok, Thailand, 7 Chulalongkorn Clinical Research Center,
Chulalongkorn University, Bangkok, Thailand, 8 Department of
Medicine, Chulalongkorn Univesity, Bangkok, Thailand
Introduction: Previous studies often investigated association of obstructive
sleep apnea (OSA) with cardiovascular morbidity and mortality,
systemic inflammation and impaired glucose metabolism but the
possibility of reverse causation (i.e., metabolic abnormalities such as
diabetes mellitus leading to sleep apnea) was not clearly defined. Our
aim is to examine if presence of any of the cardiovascular-related dis-
Introduction: The mechanisms of sleep disordered breathing (SDB) in
congestive heart failure (CHF) are not well understood. Lower extremity
oedema may predispose CHF patients to spontaneous fluid displacement
during the night, which may in turn result in an increase in upper airway
collapsibility, and decreased pharyngeal cross-sectional area (XSA) .
The aim of this study was to test the hypothesis that sleeping supine is
associated with pharyngeal narrowing in CHF patients with SDB.
Methods: Overnight visualisation of the upper airway was performed
in 4 CHF patients (3 female; median (range), age: 38.5 (35-43) years;
BMI: 37 (26.4-46.2) kg/m 2 ; neck circumference: 37.3 (34.5-45.5) cm;
LVEF: 27.5 (5-45) %; NYHA I-III) with SDB (AHI: 36.5 (16-46.4)
events/hour), predominantly central sleep apnoea (central apnea index:
10.3 (1.3-20.4) events/hour). The retropalatal XSA was visualised using
a fibreoptic bronchoscope; pharyngeal pressure was measured using
a pressure transducer placed at the palatal rim; airflow was measured
using a pneumotachometer; neck circumference was measured using
inductance plethysmography. Expiratory pharyngeal compliance was
calculated as the slope of the relationship between XSA and pharyngeal
pressure. Patients slept in a supine posture and data was sampled from
periods of stable NREM sleep as close to the beginning and end of the
study as possible. The median (range) time between the start and end of
the night was 2.0 (1.5-3.6) hours.
Results: Neck circumference was unchanged overnight (start of night:
37.1 (32.6-45.8) cm vs. end of night: 37.3 (32.6-44.5) cm), whereas retropalatal
XSA decreased overnight (start of night: 11.6 (5.4-72.9) mm 2
vs. end of night: 6.7 (2.5-67.5) mm 2 ), as did expiratory pharyngeal com-
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