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Can heart rate variation rule out sleep-disordered breathing in heart failure?

¹ Clinical and Academic Unit of Sleep and Breathing, and ² Dept of Cardiology, National Heart and Lung Institute, Imperial College, London, UK.

CORRESPONDENCE: A. Simonds, Dept of Sleep and Ventilation, Royal Brompton and Harefield NHS Trust, Fulham Road, London, SW3 6NP, UK. Fax: 44 2073518911. E-mail: a.simonds{at}rbh.nthames.nhs.uk

Keywords: Central sleep apnoea, congestive heart failure, heart rate variation, obstructive sleep apnoea

Received: November 15, 2004
Accepted October 17, 2005

In patients with obstructive sleep apnoea (OSA), the very low frequency power spectral density index (VLFI) derived from analysis of heart rate correlates with the severity of obstructive apnoeas. VLFI is also associated with Cheyne–Stokes respiration/central sleep apnoea (CSR/CSA) in congestive heart failure (CHF). The present authors have tested the hypothesis that per cent VLFI, derived from a standard Holter ECG recording, can be used to detect the presence of OSA and CSR/CSA in patients with mild-to-moderate CHF.

In total, 60 CHF patients underwent polysomnography with monitoring of heart rate. Data from 33 patients were analysed for per cent VLFI. Of the 60 patients, 27 were excluded due to atrial fibrillation, extensive pacing or frequent ventricular extra systoles.

Receiver operator characteristic curves were constructed to establish the per cent VLFI that would optimally identify the presence or absence of sleep-disordered breathing. Using an apnoea–hypopnoea index >20 events·h^–1 and setting the per cent VLFI at 2.23% yielded a sensitivity of 85%, specificity of 65%, positive predictive value of 61% and a negative predictive value of 87%. The latter increased to 100% when using an apnoea–hypopnoea cut-off of 30 events·h^–1.

In conclusion, these results suggest that spectral analysis of heart rate may be useful as a "rule-out test" for sleep-disordered breathing in patients with mild-to-moderate congestive heart failure.

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