Utility of overnight pulse oximetry and heart rate variability analysis to screen for sleep-disordered breathing in chronic heart failure
Open accessAbstract
BACKGROUND: Sleep-disordered breathing (SDB) is under diagnosed in chronic heart failure (CHF). Screening with simple monitors may increase detection of SDB in a cardiology setting. This study aimed to evaluate the accuracy of heart rate variability analysis and overnight pulse oximetry for diagnosis of SDB in patients with CHF. METHODS: 180 patients with CHF underwent simultaneous polysomnography, ambulatory electrocardiography and wrist-worn overnight pulse oximetry. SDB was defined as an apnoea-hypopnoea index ≥15/h. To identify SDB from the screening tests, the per cent very low frequency increment (%VLFI) component of heart rate variability was measured with a pre-specified cutoff ≥2.23%, and the 3% oxygen desaturation index was measured with a pre-specified cutoff >7.5 desaturations/h. RESULTS: 173 patients with CHF had adequate sleep study data; SDB occurred in 77 (45%) patients. Heart rate variability was measurable in 78 (45%) patients with area under the %VLFI receiver operating characteristic curve of 0.50. At the ≥2.23% cutoff, %VLFI sensitivity was 58% and specificity was 48%. The 3% oxygen desaturation index was measurable in 171 (99%) patients with area under the curve of 0.92. At the pre-specified cutoff of >7.5 desaturations/h, the 3% oxygen desaturation index had a sensitivity of 97%, specificity of 32%, negative likelihood ratio of 0.08 and positive likelihood ratio of 1.42. Diagnostic accuracy was increased using a cutoff of 12.5 desaturations/h, with sensitivity of 93% and specificity of 73%. CONCLUSIONS: The high sensitivity and low negative likelihood ratio of the 3% oxygen desaturation index indicates that pulse oximetry would be of use as a simple screening test to rule out SDB in patients with CHF in a cardiology setting. The %VLFI component of heart rate variability is not suitable for detection of SDB in CHF.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In 173 CHF patients, at an ODI3% cutoff >7.5 desaturations/h, sensitivity was 97%, specificity 32%, negative likelihood ratio 0.08, and positive likelihood ratio 1.42.
“The results demonstrated that at the cutoff of >7.5 desaturations/h, the ODI3% had a sensitivity 97%, a specificity 32%, a negative likelihood ratio 0.08, and a positive likelihood ratio 1.42.”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [623]
The Diagnostic accuracy of overnight pulse oximetry section reports all four figures at the >7.5 desaturations/h cutoff. The Abstract distinguishes the 173 patients with adequate sleep-study data from the 171 whose ODI could be analysed, so the claim's sample size for these test results is imprecise. (LLM, conf=0.90)
Experimental — accuracy not yet measuredIn the Ward et al. CHF study, diagnostic accuracy increased at an ODI3% cutoff of 12.5 desaturations/h, with sensitivity 93% and specificity 73%.
“The diagnostic accuracy increased using a cutoff of 12.5 desaturations/h, with a sensitivity 93% and a specificity 73%.”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [623]
In the Ward et al. CHF study, ODI3% had an AUC of 0.92 (95% CI 0.88-0.96) for detecting SDB in CHF at a cutoff >7.5 desaturations/h.
“The ODI3% had an AUC of 0.92 (95% C.I. 0.88–0.96) for the detection of SDB in CHF, at the cutoff of >7.5 desaturations/h.”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [623]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
The Hospital Anxiety and Depression Scale
Zigmond, A. S., & Snaith, R. P. (1983) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1983.tb09716.x · Cited by 47,139 · see citing works
A New Method for Measuring Daytime Sleepiness: The Epworth Sleepiness Scale
Johns, M. W. (1991) · Sleep · doi:10.1093/sleep/14.6.540 · Cited by 17,364 · see citing works
Heart Rate Variability: Standards of Measurement, Physiological Interpretation, and Clinical Use
Electrophysiology, T. F. O. T. E. S. O. C. T. N. A. (1996) · Circulation · doi:10.1161/01.cir.93.5.1043 · Cited by 17,159 · see citing works
Heart rate variability: Standards of measurement, physiological interpretation, and clinical use
Malik, M., Bigger, J. T., Camm, A. J., Kleiger, R. E., Malliani, A., Moss, A. J., & Schwartz, P. J. (1996) · European Heart Journal · doi:10.1093/oxfordjournals.eurheartj.a014868 · Cited by 15,289 · see citing works
(2007) · Cited by 6,530 · see citing works
Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005)
Swedberg, K. B., Cleland, J. G. F., Dargie, H., Drexler, H., Folláth, F., Michel Komajda, N., Tavazzi, L., Smiseth, O. A., Gavazzi, A., Haverich, A., et al. (2005) · European Heart Journal · doi:10.1093/eurheartj/ehi204 · Cited by 2,243 · see citing works
Kushida, C. A., Littner, M. R., Morgenthaler, T., Alessi, C. A., Bailey, D., Coleman, J., Friedman, L., Hirshkowitz, M., Kapen, S., Kramer, M., et al. (2005) · Sleep · doi:10.1093/sleep/28.4.499 · Cited by 2,054 · see citing works
Collop, N. A., Anderson, W. M., Boehlecke, B., Claman, D., Goldberg, R., Gottlieb, D. J., Hudgel, D., Sateia, M., Schwab, R., & Portable Monitoring Task Force of the American Academy of Sleep Medicine (2007) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.27032 · Cited by 1,550 · see citing works
Collop, N. A., Anderson, W. M., Boehlecke, B. A., Claman, D. M., Goldberg, R., Gottlieb, D. J., Hudgel, D. W., Sateia, M. J., & Schwab, R. (2007) · PubMed Central · Cited by 1,082 · see citing works
Heart failure with preserved left ventricular systolic function
Hogg, K. J., Swedberg, K. B., & McMurray, J. J. V. (2004) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2003.07.046 · Cited by 927 · see citing works
Influence of Obstructive Sleep Apnea on Mortality in Patients With Heart Failure
Wang, H., Parker, J. D., Newton, G. E., Floras, J. S., Mak, S., Chiu, K.-L., Ruttanaumpawan, P., Tomlinson, G., & Bradley, T. D. (2007) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2006.12.046 · Cited by 616 · see citing works
CYCLICAL VARIATION OF THE HEART RATE IN SLEEP APNOEA SYNDROME
Guilleminault, C., Winkle, R. A., Connolly, S. J., Melvin, K., & Tilkian, A. G. (1984) · The Lancet · doi:10.1016/s0140-6736(84)90062-x · Cited by 578 · see citing works
Heart rate variability, sleep and sleep disorders
Stein, P. K., & Pu, Y. (2011) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2011.02.005 · Cited by 528 · see citing works
Javaheri, S., Shukla, R., Zeigler, H., & WEXLER, L. F. (2007) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.01.084 · Cited by 443 · see citing works
Javaheri, S. (2005) · International Journal of Cardiology · doi:10.1016/j.ijcard.2004.12.068 · Cited by 363 · see citing works
Erman, M. K., Stewart, D. A., EINHORN, D. F., Gordon, N. D., & Casal, E. (2007) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.26861 · Cited by 326 · see citing works
The Scoring of Respiratory Events in Sleep: Reliability and Validity
Redline, S. S., Budhiraja, R., Kapur, V. K., Marcus, C. L., Mateika, J. H., Mehra, R., Parthasarthy, S., Somers, V. K., Strohl, K. P., Gozal, D., et al. (2007) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.26818 · Cited by 303 · see citing works
Automated analysis of digital oximetry in the diagnosis of obstructive sleep apnoea
Vázquez-García, J. C. (2000) · Thorax · doi:10.1136/thorax.55.4.302 · Cited by 254 · see citing works
Binkley, P. F., Haas, G. J., Starling, R. C., Nunziata, E., Hatton, P. A., Leier, C. V., & Cody, R. J. (1993) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(93)90098-l · Cited by 232 · see citing works
A behavioural test to assess daytime sleepiness in obstructive sleep apnoea
BENNETT, L. S., Stradling, J. R., & DAVIES, R. (1997) · Journal of Sleep Research · doi:10.1046/j.1365-2869.1997.00039.x · Cited by 221 · see citing works
Javaheri, S., Caref, E. B., Chen, E., Tong, K. B., & Abraham, W. T. (2010) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201003-0406oc · Cited by 208 · see citing works
Vazir, A., Hastings, P. C., Dayer, M., McIntyre, H. F., Henein, M. Y., Poole-Wilson, P. A., Cowie, M., Morrell, M. J., & Simonds, A. K. (2006) · European Journal of Heart Failure · doi:10.1016/j.ejheart.2006.08.001 · Cited by 183 · see citing works
Self-citationThe University of North Carolina at Chapel Hill University Libraries (2020) · Carolina Digital Repository (University of North Carolina at Chapel Hill) · doi:10.17615/7194-mb44 · Cited by 163 · see citing works
Huml, R. A. (2012) · Springer eBooks · doi:10.1007/978-1-4614-3682-9_6 · Cited by 162 · see citing works
Augmented Very Low Frequency Component of Heart Rate Variability During Obstructive Sleep Apnea
Shiomi, T., Guilleminault, C., Sasanabe, R., Hirota, I., Maekawa, M., & Kobayashi, T. (1996) · SLEEP · doi:10.1093/sleep/19.5.370 · Cited by 146 · see citing works
Mortara, A., Rovere, M. T. L., Pinna, G. D., Maestri, R., Capomolla, S., & Cobelli, F. (2000) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(00)00900-1 · Cited by 122 · see citing works
Assessment of the primary effect of aging on heart rate variability in humans
Fukusaki, C., Kawakubo, K., & Yamamoto, Y. (2000) · Clinical Autonomic Research · doi:10.1007/bf02278016 · Cited by 112 · see citing works
Adaptive servoventilation in diastolic heart failure and Cheyne–Stokes respiration
Bitter, T., Westerheide, N., Faber, L., Hering, D., Prinz, C., Langer, C., Horstkotte, D., & Oldenburg, O. (2009) · European Respiratory Journal · doi:10.1183/09031936.00045609 · Cited by 101 · see citing works
Symptom burden of sleep-disordered breathing in mild-to-moderate congestive heart failure patients
Hastings, P. C., Vazir, A., O’Driscoll, D. M., Morrell, M. J., & Simonds, A. K. (2006) · European Respiratory Journal · doi:10.1183/09031936.06.00063005 · Cited by 88 · see citing works
Self-citationKuna, S. T., Badr, M. S., Kimoff, R. J., Kushida, C. A., Lee-Chiong, T. L., Levy, P. A., McNicholas, W. T., & Strollo, P. J. (2011) · Proceedings of the American Thoracic Society · doi:10.1513/pats.2009-042ws · Cited by 85 · see citing works
Sériès, F., Kimoff, R. J., Morrison, D., Leblanc, M. H., Smilovitch, M., Howlett, J., Logan, A. G., Floras, J. S., & Bradley, T. D. (2005) · Chest · doi:10.1378/chest.127.5.1507 · Cited by 83 · see citing works
Influence of Cheyne-Stokes Respiration on Cardiovascular Oscillations in Heart Failure
Leung, R. S. T., Floras, J. S., Lorenzi‐Filho, G., Rankin, F., Picton, P. E., & Bradley, T. D. (2003) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200208-793oc · Cited by 81 · see citing works
Sforza, E. A., Pichot, V., Červená, K., Barthélemy, J., & Roche, F. (2007) · SLEEP · doi:10.1093/sleep/30.1.43 · Cited by 76 · see citing works
Sleep Apnea in Heart Failure Increases Heart Rate Variability and Sympathetic Dominance
Szollosi, I., Krum, H., Kaye, D. M., et al. (2007) · SLEEP · doi:10.1093/sleep/30.11.1509 · Cited by 74 · see citing works
Cardiac Interbeat Interval Increment for the Identification of Obstructive Sleep Apnea
Roche, F., Duverney, D., Court‐Fortune, I., Pichot, V., Costes, F., Lacour, J.-R., Antoniadis, A., Gaspoz, J., & Barthélemy, J. (2002) · Pacing and Clinical Electrophysiology · doi:10.1046/j.1460-9592.2002.01192.x · Cited by 52 · see citing works
Nocturnal desaturation in patients with stable heart failure
Staniforth, A., Kinnear, W. J. M., Starling, R. C., et al. (1998) · Heart · doi:10.1136/hrt.79.4.394 · Cited by 47 · see citing works
Can heart rate variation rule out sleep-disordered breathing in heart failure?
Vazir, A., Dayer, M., Hastings, P. C., McIntyre, H. F., Henein, M. Y., Poole-Wilson, P. A., Cowie, M., Morrell, M. J., & Simonds, A. K. (2006) · European Respiratory Journal · doi:10.1183/09031936.06.00130904 · Cited by 32 · see citing works
Self-citationAnalysis of the interbeat interval increment to detect obstructive sleep apnoea/hypopnoea
Roche, F., Celle, S., Pichot, V., Barthélemy, J., & Sforza, E. A. (2007) · European Respiratory Journal · doi:10.1183/09031936.00042606 · Cited by 31 · see citing works
Leung, R. S. T., Bowman, M. E., Diep, T. M., et al. (2005) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00027.2005 · Cited by 29 · see citing works
Roche, F., Sforza, É., Duverney, D., et al. (2004) · Clinical Science · doi:10.1042/cs20040036 · Cited by 27 · see citing works
Patel, H. C., Ozdemir, B. A., Patel, M., Xiao, H., Poole-Wilson, P. A., & Rosen, S. D. (2010) · International Journal of Cardiology · doi:10.1016/j.ijcard.2010.04.054 · Cited by 24 · see citing works
Self-citationDamy, T., d’Ortho, M., Estrugo, B., Margarit, L., Mouillet, G., MAHFOUD, M., Roudot‐Thoraval, F., Vermès, E., Hittinger, L., Roche, F., et al. (2009) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2009.00779.x · Cited by 11 · see citing works
Phillips, B. A. (2008) · Yearbook of Pulmonary Disease · doi:10.1016/s8756-3452(08)70704-7 · Cited by 11 · see citing works
Nocturnal desaturation in patients with stable heart failure
Ritter, G. (1998) · Heart · doi:10.1136/hrt.80.6.633b · Cited by 6 · see citing works
Ward, N. R., Cowie, M., Rosen, S. D., Roldao, V., Hooper, J., McDonagh, T. A., Simonds, A. K., & Morrell, M. J. (2010) · Thorax · doi:10.1136/thx.2010.150912.16 · Cited by 1 · see citing works
Self-citationWard, N. R., Roldao, V., Cowie, M., et al. (2011) · doi:10.1164/ajrccm-conference.2011.183.1_meetingabstracts.a6321 · Cited by 1 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
International Consensus Statement on Obstructive Sleep Apnea
Chang, J. L., Goldberg, A. N., Alt, J. A., Mohammed, A., Ashbrook, L., Auckley, D., Ayappa, I., Bakhtiar, H., Barrera, J. E., Bartley, B. L., et al. (2023) · International Forum of Allergy & Rhinology · doi:10.1002/alr.23079 · Cited by 350 · see citing works
O’Mahony, A. M., Garvey, J. F., & McNicholas, W. T. (2020) · Journal of Thoracic Disease · doi:10.21037/jtd-sleep-2020-003 · Cited by 45 · see citing works
Savage, H. O., Khushaba, R. N., Zaffaroni, A., Colefax, M., Farrugia, S., Schindhelm, K., Teschler, H., Weinreich, G., Grueger, H., Neddermann, M., et al. (2016) · ESC Heart Failure · doi:10.1002/ehf2.12086 · Cited by 30 · see citing works
Self-citation
- Authors
- Ward, N. R., Cowie, M. R., Rosen, S. D., Roldao, V., De Villa, M., McDonagh, T. A., Simonds, A., & Morrell, M. J.
- Affiliations
- Royal Brompton Hospital (GB)
- Corresponding author
- Ward, Neil R
- Venue
- Thorax
- Publisher
- BMJ
- Published
- 2012-07-17
- Volume
- 67
- Issue
- 11
- Pages
- 1000-1005
- ISSN
- 0040-6376 (ISSN-L)
- 1468-3296
- OpenAlex
- W2115592583
- Semantic Scholar
- 69c1c050eca7f8571b8d7e260c758a5c895110a1
- Cited by
- 38
- References
- 47
- Citations by year
- 2026: 2 · 2024: 2 · 2023: 3 · 2022: 5 · 2021: 4 · 2020: 1 · 2019: 3 · 2018: 2 · 2016: 7 · 2015: 5 · 2014: 1 · 2013: 2 · 2012: 1
- FWCI
- 1.93
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Thorax (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Royal Brompton and Harefield NHS Foundation Trust
- National Institute for Health and Care Research
- British Heart Foundation
- Imperial College London
- National Heart and Lung Institute
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Keywords
- sleep-disordered breathing, chronic heart failure, overnight pulse oximetry, heart rate variability, oxygen desaturation index, screening, diagnostic accuracy, apnea-hypopnea index, polysomnography
- MeSH terms
- Aged, Algorithms, Chronic Disease, Female, United Kingdom, Heart Failure, Heart Rate, Humans, Male, Mass Screening, Middle Aged, Oximetry, Predictive Value of Tests, Sensitivity and Specificity, Severity of Illness Index, Sleep Apnea Syndromes, Electrocardiography, Ambulatory, Polysomnography
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
