Detection of sleep-disordered breathing with ambulatory Holter monitoring

Ian Grasso, Mark Haigney, David Mortara, Jacob F. Collen*, Jordanna Hostler, Aimee Moores, Karen Sheikh, William Kelly

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Purpose: Obstructive sleep apnea (OSA) syndrome is a common condition that can impact clinical outcomes among patients with cardiovascular disease. Screening all subjects with heart disease via polysomnography (PSG) is costly and resource-limited. We sought to compare a Holter monitor-based algorithm to detect OSA to in-laboratory polysomnography (PSG). Methods: Prospective cohort study of patients undergoing in-laboratory attended PSG for the evaluation of OSA. A standard 12-lead Holter monitor was attached to patients at the initiation of PSG. Holter-derived respiratory disturbance index (HDRDI) was extracted from the respiratory myogram, based on detecting skeletal muscle “noise” detected on the baseline. Apneic and hypopneic episodes were identified by comparing sudden changes in the myogram to abrupt increases in heart rate. The HDRDI was compared with the PSG-derived apnea-hypopnea index (PDAHI). Results: Thirty patients underwent simultaneous Holter monitoring and overnight diagnostic PSG. An ROC curve for peak HDRDI was 0.79 (95% CI 0.61, 0.97) for OSA, with sensitivity of 94.4% and specificity of 54.5%. A cutoff value of HDRDI < 10 appeared to identify those individuals without clinically significant sleep-disordered breathing. Conclusion: Holter-derived respiration detected OSA comparable to PSG. Further study is warranted to determine its utility for screening and diagnosing OSA in appropriately selected patients.

Original languageEnglish
Pages (from-to)1021-1028
Number of pages8
JournalSleep and Breathing
Issue number4
StatePublished - 1 Dec 2018
Externally publishedYes


  • Holter monitor
  • Home sleep test
  • Obstructive sleep apnea
  • Portable monitor
  • Sleep apnea


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