using holter ecg and heart rate variability to detect sleep-disordered breathing phyllis k stein,...
TRANSCRIPT
![Page 1: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/1.jpg)
Using Holter ECG and Heart Rate Variability to Detect
Sleep-Disordered Breathing
Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory
Washington University School of Medicine
St. Louis, MO
![Page 2: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/2.jpg)
Background
When patients with sleep-disordered breathing have an event, there is an autonomic arousal associated with a brief awakening, they then resume normal breathing, and fall back asleep.
This repeated awakening is associated with a repeated increase in heart rate which return to baseline when the patient falls back asleep.
![Page 3: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/3.jpg)
Sleep Apnea Clarified
![Page 4: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/4.jpg)
1. Sequence of unedited beat-to-beat R-R (or preferable edited N-N) intervals.
2. Convert R-R intervals to instantaneous HR (60,000/R-R interval in ms).
3. Plot tachogram of HR vs. time on 6 parallel 10-min plots (one hr/page).
Heart-Rate-Based Graphical Method for Detecting Sleep-Disordered Breathing
![Page 5: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/5.jpg)
• x-axis = time in minutes (0-10 minutes)
• y-axis for each 10-min plot is H (0-100 bpm in 5 cm)
• “x-axis” is mean HR for that 10-min segment
Tachogram Axes
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10
Tim e (M in.)
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10
00:09:00
00:19:00
00:29:00
00:39:00
00:49:00
00:59:00
0-100 bpm
“x-axis”
![Page 6: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/6.jpg)
Sleep Onset in a Patient Without OSAHS
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10
Tim e (M in.)
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10
00:09:00
00:19:00
00:29:00
00:39:00
00:49:00
00:59:00
To bed
![Page 7: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/7.jpg)
Onset of OSAHS
00 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10
HR1 Time (Min.)
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10
01:59:00
02:09:00
02:19:00
02:29:00
02:39:00
02:49:00
Patient falls asleep
![Page 8: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/8.jpg)
• Data based on R-R intervals using simple
QRS detection algorithm and not edited.• 35 tachograms blindly scored for OSA, no
OSA and indeterminate. # each category known.
• Graphical method, 1 pair wrong, severe sleep-disordered breathing but hypopneas not OSA.
Tachograms From the Computers In Cardiology Sleep Apnea Contest
![Page 9: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/9.jpg)
CVHR Subject 2
Brady-tachy pattern not seen
![Page 10: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/10.jpg)
CVHR Subject 5
Tachycardia during OSA
![Page 11: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/11.jpg)
CVHR Subject 7
![Page 12: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/12.jpg)
CVHR Subject 8
![Page 13: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/13.jpg)
CVHR and Normal Sleep or Quiet Rest Subject 9
Probable change in position resulting in OSA
![Page 14: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/14.jpg)
CVHR Subject 13
![Page 15: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/15.jpg)
CVHR Subject 16 (Hypopneas)
![Page 16: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/16.jpg)
CVHR Subject 19
![Page 17: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/17.jpg)
CVHR Subject 20
![Page 18: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/18.jpg)
CVHR Subject 21
![Page 19: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/19.jpg)
CVHR Subject 23
![Page 20: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/20.jpg)
Apnea Appears to be Positional in Subject 23
Change in position terminates apnea
![Page 21: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/21.jpg)
CVHR Subject 25
![Page 22: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/22.jpg)
CVHR Subject 26
![Page 23: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/23.jpg)
CVHR Subject 27
![Page 24: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/24.jpg)
CVHR Subject 28
![Page 25: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/25.jpg)
CVHR Subject 30
Probable change in position-apnea more severe earlier
![Page 26: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/26.jpg)
Severe Sleep Apnea Subject 31
Magnitude of RSA declines during some but not all events
![Page 27: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/27.jpg)
Severe Sleep Apnea Subject 32
Probable change in position or sleep stage. RSA is reduced.
![Page 28: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/28.jpg)
Tachogram Evaluation
• Identify epochs of CVHR (cyclic variation of heart rate)
• Quantify CVHR by by total number of minutes (to nearest 30s) with CVHR.
• If CVHR is predominant, no need to quantify.
![Page 29: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/29.jpg)
CVHR Definition
• At least 3 consecutive cycles of rising and falling heart rate.
• A visible rise in heart rate (5 bpm).
• A return to baseline.
• Each cycle 10 s duration.
• At least 20s but less than 2 min between cycles.
![Page 30: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/30.jpg)
• 20% of time in CVHR of any type
• High amplitude regular CVHR pathomnemonic for OSA
• Lower amplitude or irregular CVHR may be associated with apneas, hypopneas, periodic limb movements or arousals for no apparent reason.
CVHR Criteria for Significantly Abnormal Sleep
![Page 31: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/31.jpg)
Results of Sleep Lab Validation of CVHR Tachogram Method
• 100% detection of significantly abnormal sleep.
• High amplitude regular CVHR always sleep apnea.
• Lower amplitude or irregular CVHR could be apneas or hypopneas or leg movements, a mixture or arousals for no apparent reason.
• Non-diagnostic for flat tachograms (extremely low HRV) or atrial fibrillation.
![Page 32: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/32.jpg)
Heart Rate Patterns on Tachograms Can Detect More
Than Just Sleep Apnea
![Page 33: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/33.jpg)
HR Patterns During Central Apneas
6000 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10
H R 2 Tim e (M in.)
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10
22:00:00
22:10:00
22:20:00
22:30:00
22:40:00
22:50:00
![Page 34: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/34.jpg)
HR Patterns During Severe De-Saturation
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10
H R 2 Tim e (M in .)
0 0 .5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10
21:59:00
22:09:00
22:19:00
22:29:00
22:39:00
22:49:00
O2 Sat = 65%
Irregular Low Amplitude CVHR
![Page 35: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/35.jpg)
Low Amplitude CVHR Possibly Associated with Mixed Events
![Page 36: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/36.jpg)
HR Patterns Associated with Periodic Limb Movements
12000 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10
HR 3 Tim e (M in.)
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10
01:28:00
01:38:00
01:48:00
01:58:00
02:08:00
02:18:00
![Page 37: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/37.jpg)
Cheyne-Stokes Breathing
![Page 38: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/38.jpg)
Cheyne-Stokes Breathing
![Page 39: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/39.jpg)
Blown Up Section of Prior Tachogram Showing RSA During Cheyne-Stokes
Respiration
![Page 40: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/40.jpg)
Power Spectral Analysis of Heart Rate Variability
to Detect Sleep-Disordered Breathing
![Page 41: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/41.jpg)
• HRV power spectral plot quantifies the underlying periodicities in heart rate.
• CVHR is a periodic change in heart rate which should be reflected in the HRV power spectrum
![Page 42: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/42.jpg)
Normal-Appearing Nighttime Power Spectral Plot
HF Peak Due to RSA
![Page 43: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/43.jpg)
Onset of OSAHS
00 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10
HR1 Time (Min.)
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10
01:59:00
02:09:00
02:19:00
02:29:00
02:39:00
02:49:00
Patient falls asleep
![Page 44: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/44.jpg)
Power Spectral Plot for Previous TachogramShowing OSAHS Pattern
VLF Peak Associated with Sleep Apnea
HF Peak Due to RSA
0.8 Hz0
![Page 45: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/45.jpg)
HR Patterns During Central Apneas
6000 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10
H R 2 Tim e (M in.)
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10
22:00:00
22:10:00
22:20:00
22:30:00
22:40:00
22:50:00
![Page 46: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/46.jpg)
0.8 Hz0
Power Spectral Plot for Previous Tachogram
Showing HRV Pattern for Central Apneas
VLF Peak Associated with Central Apneas
Little or no HF power
![Page 47: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/47.jpg)
HR Patterns During Severe De-Saturation
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10
H R 2 Tim e (M in .)
0 0 .5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10
21:59:00
22:09:00
22:19:00
22:29:00
22:39:00
22:49:00
O2 Sat =65%
Irregular Low Amplitude CVHR
![Page 48: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/48.jpg)
Power Spectral Plot for Previous Tachogram
Diffuse HF Peak Reflecting IrregularRespiration or Heart Rate Pattern
VLF Peak Associated with OSAHS
0.8 Hz0
![Page 49: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/49.jpg)
Cheyne-Stokes Breathing
![Page 50: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/50.jpg)
2-Min Averaged HRV Pattern for Cheyne-Stokes Respiration
Hard to see CSR peak
![Page 51: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/51.jpg)
Hourly HRV Power Spectral Plots for Cheyne-Stokes Breathing
![Page 52: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/52.jpg)
HR Patterns Associated with PLMs
12000 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10
HR3 Tim e (M in.)
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10
01:28:00
01:38:00
01:48:00
01:58:00
02:08:00
02:18:00
![Page 53: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/53.jpg)
Power Spectral Plot for Previous Tachogram
Showing Periodic Limb Movements
VLF Peak Due to PLMS (0.04 Hz)
HF Peak Due to RSA
0 0.8 Hz
![Page 54: Using Holter ECG and Heart Rate Variability to Detect Sleep-Disordered Breathing Phyllis K Stein, Ph.D. Heart Rate Variability Laboratory Washington University](https://reader038.vdocuments.mx/reader038/viewer/2022110321/56649cff5503460f949d1042/html5/thumbnails/54.jpg)
Conclusions1. Sleep apnea and other sleep-disturbing
syndromes can easily be identified from heart rate tachograms generated from routine Holter recordings
2. Visual examination of HRV patterns generated from hourly power spectral plots often available on commercial Holter scanners may help identify patients with CVHR.
3. Method is not valid for patients with significant autonomic dysfunction resulting in flat tachograms or in patients with atrial fibrillation