Home sleep apnea testing of adults with chronic heart failure

Shengnan Li; Liyue Xu; Xiaosong Dong; Xueli Zhang; Brendan T Keenan; Fang Han; Taoran Bi; Yuan Chang; Yongbo Yu; Bing Zhou; Allan I Pack; Samuel T Kuna

doi:10.5664/jcsm.9224

Home sleep apnea testing of adults with chronic heart failure

J Clin Sleep Med. 2021 Jul 1;17(7):1453-1463. doi: 10.5664/jcsm.9224.

Authors

Shengnan Li^{1

2}, Liyue Xu^{1

3

2}, Xiaosong Dong¹, Xueli Zhang¹, Brendan T Keenan³, Fang Han¹, Taoran Bi¹, Yuan Chang⁴, Yongbo Yu⁵, Bing Zhou¹, Allan I Pack³, Samuel T Kuna^{3

6}

Affiliations

¹ Department of Respiratory Medicine, Peking University People's Hospital, Beijing, China.
² Contributed equally.
³ Department of Medicine and Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania.
⁴ Department of Respiratory Medicine, Peking University International Hospital, Beijing, China.
⁵ PKU-UPenn Sleep Center, Peking University International Hospital, Beijing, China.
⁶ Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.

Abstract

Study objectives: To evaluate home sleep apnea testing (HSAT) using a type 3 portable monitor to help diagnose sleep-disordered breathing (SDB) and identify respiratory events including obstructive sleep apnea, central sleep apnea, and Cheyne-Stokes respiration in adults with stable chronic heart failure.

Methods: Eighty-four adults with chronic heart failure (86.9% males, age [mean ± standard deviation] 58.7 ± 16.3 years, body mass index 29.4 ± 13.0 kg/m², left ventricular ejection fraction 40.3% ± 11.5%) performed unattended HSAT followed by an in-laboratory polysomnography (PSG) with simultaneous portable monitor recording.

Results: The apnea-hypopnea index was 22.0 ± 17.0 events/h according to HSAT, 26.8 ± 20.5 events/h on an in-laboratory portable monitor, and 23.8 ± 21.3 events/h using PSG (P = .373). A Bland-Altman analysis of the apnea-hypopnea index using HSAT vs PSG showed a mean difference (95% confidence interval) of -2.4 (-4.9 to 0.1) events/h and limits of agreement (±2 standard deviations) of -24.1 to 19.2 events/h. HSAT underestimated the apnea-hypopnea index to a greater extent at a higher apnea-hypopnea index (rho = -.358; P < .001). Similar levels of agreement from HSAT vs PSG were observed when comparing the obstructive apnea index, central apnea index, and percentage of time in a Cheyne-Stokes respiration pattern. When we used an apnea-hypopnea index ≥ 5 events/h to diagnose SDB, HSAT had 86.7% sensitivity, 76.5% specificity, 92.9% positive predictive value, and 61.9% negative predictive value compared to PSG. Detection of Cheyne-Stokes respiration using HSAT showed 94.6% sensitivity, 91.1% specificity, 88.6% positive predictive value, and 97.6% negative predictive value compared to PSG.

Conclusions: HSAT with a type 3 portable monitor can help diagnose SDB and identify obstructive sleep apnea, central sleep apnea, and Cheyne-Stokes respiration events in adults with chronic heart failure.

Keywords: apnea-hypopnea index; chronic heart failure; home sleep apnea testing; polysomnogram.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Female
Heart Failure* / complications
Heart Failure* / diagnosis
Humans
Male
Middle Aged
Polysomnography
Sleep Apnea Syndromes* / complications
Sleep Apnea Syndromes* / diagnosis
Stroke Volume
Ventricular Function, Left