Night-to-night repeatability of measurements of nocturnal breathing disorders in clinically stable chronic heart failure patients

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Abstract

Background: Portable sleep apnea monitors are often used to screen for sleep-disordered breathing in chronic heart failure patients (CHF), but night-to-night repeatability of obtained measurements of nocturnal breathing disorders has not been fully assessed. Methods: Fifty-six stable, moderate-to-severe CHF patients [male, 87%; age, 57±9 years; NYHA class, 2.6±0.6; left ventricular ejection fraction (LVEF), 32%±9%] underwent an unattended in-hospital cardiorespiratory recording using a portable sleep apnea monitor during two consecutive nights. The apnea/hypopnea index (AHI), apnea index (AI), oxygen desaturation index (ODI), and periodic breathing (PB) duration were computed. Intra-subject night-to-night variability was assessed by the 95% limits of random variation (LoV). We also estimated the contribution of intra-rater variability to the overall intra-subject variability. Dichotomizing the AHI and PB duration according to conventional cutoffs of, respectively, ≥5 events per hour, ≥15 events per hour, and ≥120 min, the percentage of patients concordantly classified by the two measurements was finally computed. Results: The 95% LoV were ±10.6, ±7.7, ±11.3 events per hour for AHI, AI and ODI, and ±63.2 min for PB duration, respectively. The contribution of intra-rater variability to total intra-subject variability was 1.7%, 1.4%, 2.5%, and 1.3% for AHI, AI, ODI, and PB duration, respectively. Most patients (85%, 82%, and 95% for AHI≥5, AHI≥15, and PB duration, respectively) were classified concordantly by the two measurements. Conclusions: In patients with heart failure, measurements of severity of sleep-disordered breathing derived from portable sleep apnea monitors show significant night-to-night intrasubject variation with a negligible contribution from intrarater variability; however, using the same measurements for classification purposes, as commonly performed in clinical practice to screen patients for sleep-disordered breathing, very stable results are obtained.

Original languageEnglish
Pages (from-to)673-678
Number of pages6
JournalSleep and Breathing
Volume15
Issue number4
DOIs
Publication statusPublished - Dec 2011

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Apnea
Sleep Apnea Syndromes
Respiration
Heart Failure
Oxygen
Stroke Volume

Keywords

  • Heart failure
  • Repeatability
  • Reproducibility
  • Sleep apnea
  • Sleep apnea monitors
  • Sleep-disordered breathing

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Clinical Neurology
  • Medicine(all)

Cite this

@article{e588829a20684cd1b8b2ca8211e37489,
title = "Night-to-night repeatability of measurements of nocturnal breathing disorders in clinically stable chronic heart failure patients",
abstract = "Background: Portable sleep apnea monitors are often used to screen for sleep-disordered breathing in chronic heart failure patients (CHF), but night-to-night repeatability of obtained measurements of nocturnal breathing disorders has not been fully assessed. Methods: Fifty-six stable, moderate-to-severe CHF patients [male, 87{\%}; age, 57±9 years; NYHA class, 2.6±0.6; left ventricular ejection fraction (LVEF), 32{\%}±9{\%}] underwent an unattended in-hospital cardiorespiratory recording using a portable sleep apnea monitor during two consecutive nights. The apnea/hypopnea index (AHI), apnea index (AI), oxygen desaturation index (ODI), and periodic breathing (PB) duration were computed. Intra-subject night-to-night variability was assessed by the 95{\%} limits of random variation (LoV). We also estimated the contribution of intra-rater variability to the overall intra-subject variability. Dichotomizing the AHI and PB duration according to conventional cutoffs of, respectively, ≥5 events per hour, ≥15 events per hour, and ≥120 min, the percentage of patients concordantly classified by the two measurements was finally computed. Results: The 95{\%} LoV were ±10.6, ±7.7, ±11.3 events per hour for AHI, AI and ODI, and ±63.2 min for PB duration, respectively. The contribution of intra-rater variability to total intra-subject variability was 1.7{\%}, 1.4{\%}, 2.5{\%}, and 1.3{\%} for AHI, AI, ODI, and PB duration, respectively. Most patients (85{\%}, 82{\%}, and 95{\%} for AHI≥5, AHI≥15, and PB duration, respectively) were classified concordantly by the two measurements. Conclusions: In patients with heart failure, measurements of severity of sleep-disordered breathing derived from portable sleep apnea monitors show significant night-to-night intrasubject variation with a negligible contribution from intrarater variability; however, using the same measurements for classification purposes, as commonly performed in clinical practice to screen patients for sleep-disordered breathing, very stable results are obtained.",
keywords = "Heart failure, Repeatability, Reproducibility, Sleep apnea, Sleep apnea monitors, Sleep-disordered breathing",
author = "Roberto Maestri and {La Rovere}, {Maria Teresa} and Elena Robbi and Pinna, {Gian Domenico}",
year = "2011",
month = "12",
doi = "10.1007/s11325-010-0418-4",
language = "English",
volume = "15",
pages = "673--678",
journal = "Sleep and Breathing",
issn = "1520-9512",
publisher = "Springer Verlag",
number = "4",

}

TY - JOUR

T1 - Night-to-night repeatability of measurements of nocturnal breathing disorders in clinically stable chronic heart failure patients

AU - Maestri, Roberto

AU - La Rovere, Maria Teresa

AU - Robbi, Elena

AU - Pinna, Gian Domenico

PY - 2011/12

Y1 - 2011/12

N2 - Background: Portable sleep apnea monitors are often used to screen for sleep-disordered breathing in chronic heart failure patients (CHF), but night-to-night repeatability of obtained measurements of nocturnal breathing disorders has not been fully assessed. Methods: Fifty-six stable, moderate-to-severe CHF patients [male, 87%; age, 57±9 years; NYHA class, 2.6±0.6; left ventricular ejection fraction (LVEF), 32%±9%] underwent an unattended in-hospital cardiorespiratory recording using a portable sleep apnea monitor during two consecutive nights. The apnea/hypopnea index (AHI), apnea index (AI), oxygen desaturation index (ODI), and periodic breathing (PB) duration were computed. Intra-subject night-to-night variability was assessed by the 95% limits of random variation (LoV). We also estimated the contribution of intra-rater variability to the overall intra-subject variability. Dichotomizing the AHI and PB duration according to conventional cutoffs of, respectively, ≥5 events per hour, ≥15 events per hour, and ≥120 min, the percentage of patients concordantly classified by the two measurements was finally computed. Results: The 95% LoV were ±10.6, ±7.7, ±11.3 events per hour for AHI, AI and ODI, and ±63.2 min for PB duration, respectively. The contribution of intra-rater variability to total intra-subject variability was 1.7%, 1.4%, 2.5%, and 1.3% for AHI, AI, ODI, and PB duration, respectively. Most patients (85%, 82%, and 95% for AHI≥5, AHI≥15, and PB duration, respectively) were classified concordantly by the two measurements. Conclusions: In patients with heart failure, measurements of severity of sleep-disordered breathing derived from portable sleep apnea monitors show significant night-to-night intrasubject variation with a negligible contribution from intrarater variability; however, using the same measurements for classification purposes, as commonly performed in clinical practice to screen patients for sleep-disordered breathing, very stable results are obtained.

AB - Background: Portable sleep apnea monitors are often used to screen for sleep-disordered breathing in chronic heart failure patients (CHF), but night-to-night repeatability of obtained measurements of nocturnal breathing disorders has not been fully assessed. Methods: Fifty-six stable, moderate-to-severe CHF patients [male, 87%; age, 57±9 years; NYHA class, 2.6±0.6; left ventricular ejection fraction (LVEF), 32%±9%] underwent an unattended in-hospital cardiorespiratory recording using a portable sleep apnea monitor during two consecutive nights. The apnea/hypopnea index (AHI), apnea index (AI), oxygen desaturation index (ODI), and periodic breathing (PB) duration were computed. Intra-subject night-to-night variability was assessed by the 95% limits of random variation (LoV). We also estimated the contribution of intra-rater variability to the overall intra-subject variability. Dichotomizing the AHI and PB duration according to conventional cutoffs of, respectively, ≥5 events per hour, ≥15 events per hour, and ≥120 min, the percentage of patients concordantly classified by the two measurements was finally computed. Results: The 95% LoV were ±10.6, ±7.7, ±11.3 events per hour for AHI, AI and ODI, and ±63.2 min for PB duration, respectively. The contribution of intra-rater variability to total intra-subject variability was 1.7%, 1.4%, 2.5%, and 1.3% for AHI, AI, ODI, and PB duration, respectively. Most patients (85%, 82%, and 95% for AHI≥5, AHI≥15, and PB duration, respectively) were classified concordantly by the two measurements. Conclusions: In patients with heart failure, measurements of severity of sleep-disordered breathing derived from portable sleep apnea monitors show significant night-to-night intrasubject variation with a negligible contribution from intrarater variability; however, using the same measurements for classification purposes, as commonly performed in clinical practice to screen patients for sleep-disordered breathing, very stable results are obtained.

KW - Heart failure

KW - Repeatability

KW - Reproducibility

KW - Sleep apnea

KW - Sleep apnea monitors

KW - Sleep-disordered breathing

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U2 - 10.1007/s11325-010-0418-4

DO - 10.1007/s11325-010-0418-4

M3 - Article

C2 - 20857338

AN - SCOPUS:84859401091

VL - 15

SP - 673

EP - 678

JO - Sleep and Breathing

JF - Sleep and Breathing

SN - 1520-9512

IS - 4

ER -