Multiparameter Physiological Analysis in Obstructive Sleep Apnea Simulated With Mueller Maneuver

Sleep apnea is a common condition that poses serious health risks. Current state-of-the-art technology for diagnosing and assessing sleep apnea is obtrusive, expensive, and lacks integration/analysis of important cardiovascular and respiratory parameters. This paper evaluates a novel unobtrusive multiparameter sleep apnea monitor, namely, the Biopeak chest belt monitor, and describes a collection of associated algorithms for the detection of sleep apnea and assessment of the extent of the resulting physiological disturbance. The system uses dry electrodes to acquire electrocardiogram, respiratory, and stroke volume data and analyzes multiple physiological parameters from it. In a pilot investigation on eight healthy subjects simulating a total of 66 obstructive sleep apnea (OSA) events with Mueller maneuvers, the proposed system achieves an accuracy of 95.6%, a specificity of 97.2%, and a sensitivity of 93.8% for identifying these events. Moreover, the response of the simulated OSA events on the multiple physiological parameters conforms to earlier published work. We thus conclude that the proposed chest belt system has potential to be used for reliable sleep apnea detection and comprehensive evaluation of cardiovascular and respiratory parameters in sleep apnea.

[1]  J. Floras,et al.  Obstructive sleep apnoea and its cardiovascular consequences , 2009, The Lancet.

[2]  J. Ulrich.  [Physiology of the heart]. , 1950, Zeitschrift fur Kreislaufforschung.

[3]  N J Douglas,et al.  Assessment of thoracoabdominal bands to detect respiratory effort-related arousal , 2003, European Respiratory Journal.

[4]  M. Grigg‐Damberger,et al.  Why a Polysomnogram Should Become Part of the Diagnostic Evaluation of Stroke and Transient Ischemic Attack , 2006, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[5]  C. Heneghan,et al.  Automated detection of obstructive sleep apnoea at different time scales using the electrocardiogram , 2004, Physiological measurement.

[6]  C. Zywietz,et al.  ECG Analysis for Sleep Apnea Detection , 2004, Methods of Information in Medicine.

[7]  M. Kryger,et al.  Differences between men and women in the clinical presentation of patients diagnosed with obstructive sleep apnea syndrome. , 2005, Sleep.

[8]  H. Brooks,et al.  Medical physiology , 1961 .

[9]  Voicu Groza,et al.  Measurement of Heart Rate Variability Using an Oscillometric Blood Pressure Monitor , 2010, IEEE Transactions on Instrumentation and Measurement.

[10]  M C Apps,et al.  Sleep-disordered Breathing , 2022 .

[11]  D. Navajas,et al.  Noninvasive monitoring of respiratory mechanics during sleep , 2004, European Respiratory Journal.

[12]  Sara Sulis,et al.  On the Measurement of Power Quality Indexes for Harmonic Distorsion in the Presence of Capacitors”, IEEE Transactions on Instrumentation and Measurement , 2007 .

[13]  J A Parker,et al.  Stroke volume and cardiac output decrease at termination of obstructive apneas. , 1992, Journal of applied physiology.

[14]  Duanping Liao,et al.  Blood Pressure Associated With Sleep-Disordered Breathing in a Population Sample of Children , 2008, Hypertension.

[15]  H Nakano,et al.  Automatic detection of sleep-disordered breathing from a single-channel airflow record , 2007, European Respiratory Journal.

[16]  Susan Redline,et al.  Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study. , 2006, American journal of respiratory and critical care medicine.

[17]  Randy Walld,et al.  What are obstructive sleep apnea patients being treated for prior to this diagnosis? , 2002, Chest.

[18]  Marimuthu Palaniswami,et al.  Automated Scoring of Obstructive Sleep Apnea and Hypopnea Events Using Short-Term Electrocardiogram Recordings , 2009, IEEE Transactions on Information Technology in Biomedicine.

[19]  M. Bilge,et al.  Cardiac autonomic activity in obstructive sleep apnea: time-dependent and spectral analysis of heart rate variability using 24-hour Holter electrocardiograms. , 2004, Texas Heart Institute journal.

[20]  Rafik A. Goubran,et al.  Validation of Unobtrusive Pressure Sensor Array for Central Sleep Apnea Screening , 2012, IEEE Transactions on Instrumentation and Measurement.

[21]  A. Worster,et al.  Understanding receiver operating characteristic (ROC) curves. , 2006, CJEM.

[22]  J.R. Burk,et al.  Time domain analysis of R-wave attenuation envelope for sleep apnea detection , 2004, The 26th Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[23]  J. Weil,et al.  Bradycardia during sleep apnea. Characteristics and mechanism. , 1982, The Journal of clinical investigation.

[24]  Atul Malhotra,et al.  Effect of mild, asymptomatic obstructive sleep apnea on daytime heart rate variability and impedance cardiography measurements. , 2012, The American journal of cardiology.

[25]  C. Heneghan,et al.  Multimodal detection of sleep apnoea using electrocardiogram and oximetry signals , 2009, Philosophical Transactions of the Royal Society A: Mathematical, Physical and Engineering Sciences.

[26]  Shi Yan-fang,et al.  Sleep-disordered breathing: impact on functional outcome of ischemic stroke patients. , 2009, Sleep medicine.

[27]  W. McNicholas,et al.  Portable monitoring in sleep apnoea: the way forward? , 2011, European Respiratory Journal.

[28]  R. Francavilla,et al.  Prevalence of obstructive sleep apnea syndrome in a cohort of 1,207 children of southern Italy. , 2001, Chest.

[29]  Luc G.T. Morris,et al.  Rapid Risk Stratification for Obstructive Sleep Apnea, Based on Snoring Severity and Body Mass Index , 2008, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[30]  Marek Malik.  Time-Domain Measurement of Heart Rate Variability , 1997 .

[31]  P. Kowallik,et al.  Breath-to-breath variability correlates with apnea-hypopnea index in obstructive sleep apnea. , 2001, Chest.

[32]  Zoltán Benyó,et al.  Detection of airway obstructions and sleep apnea by analyzing the phase relation of respiration movement signals , 2003, IEEE Trans. Instrum. Meas..

[33]  H. Dickhaus,et al.  ECG fingerprints of obstructed breathing in sleep apnea patients , 2009, IEEE Engineering in Medicine and Biology Magazine.

[34]  A S Iskandrian,et al.  Use of a tantalum-178 generator and a multiwire gamma camera to study the effect of the Mueller maneuver on left ventricular performance: comparison to hemodynamics and single photon emission computed tomography perfusion patterns. , 1995, American heart journal.

[35]  T. Morgenthaler,et al.  Complex sleep apnea syndrome: is it a unique clinical syndrome? , 2006, Sleep.

[36]  B. Widiger,et al.  A system for comprehensive ECG waveform and trend analysis accompanying polysomnographic sleep apnea detection , 2002, Computers in Cardiology.

[37]  I Viscor,et al.  Stroke volume during mueller maneuver measured by impedance cardiography in patients with mitral regurgitation , 2009, 2009 36th Annual Computers in Cardiology Conference (CinC).

[38]  Charles J Bruce,et al.  Dynamic changes of left ventricular performance and left atrial volume induced by the mueller maneuver in healthy young adults and implications for obstructive sleep apnea, atrial fibrillation, and heart failure. , 2008, The American journal of cardiology.

[39]  R. Leung,et al.  Sleep-disordered breathing: autonomic mechanisms and arrhythmias. , 2009, Progress in cardiovascular diseases.

[40]  J S Floras,et al.  Magnitude and time course of hemodynamic responses to Mueller maneuvers in patients with congestive heart failure. , 1998, Journal of applied physiology.

[41]  William H. Spriggs.  Essentials of Polysomnography: A Training Guide and Reference For Sleep Technicians , 2008 .

[42]  Bradley V Vaughn,et al.  Technical review of polysomnography. , 2008, Chest.

[43]  R. Berry,et al.  Spectral indices of cardiac autonomic function in obstructive sleep apnea. , 1999, Sleep.

[44]  Conor Heneghan,et al.  Automated processing of the single-lead electrocardiogram for the detection of obstructive sleep apnoea , 2003, IEEE Transactions on Biomedical Engineering.

[45]  T. Young,et al.  The occurrence of sleep-disordered breathing among middle-aged adults. , 1993, The New England journal of medicine.