Polysomnograms are labor-intensive, expensive and impractical to perform repeatedly to assess therapeutic efficacy. Typical measures of sleep disordered breathing (SDB) severity include event counts, such as the apnea-hypopnea index, that utilize physiologically arbitrary scoring criteria. These measures correlate only modestly with neurobehavioral and cardiovascular outcomes in adults and children. Standard sleep stage scoring differentiates REM and NREM sleep types and NREM depth, but provides little information about physiological stability. Thus, there is a need for a simple, inexpensive and easily repeatable measure of the presence and impact of SDB on sleep state physiology and stability. The investigators have developed a fully automated surface electrocardiogram (ECG)-derived sleep physiology estimator, based on the quantitative analysis of cardiopulmonary coupling from a single-lead ECG. This approach combines the use of mechanical and autonomic effects of physiologic vs. periodic breathing on ECG parameters related to heart rate variability and QRS electrical axis. Physiologically unstable sleep associated with SDB manifests the EEG morphology of cyclic alternating pattern (CAP), regardless of conventional stage scoring. In contrast, periods of non-CAP represent physiologically stable sleep behavior. We have found that the coupling estimator shows a strong correlation with CAP and non- CAP states, thus providing a promising new biomarker of sleep physiology and pathology based on the percentage of sleep spent in periods of unstable sleep behavior. The goals of the proposed research are to: 1) Refine the technique using a sleep laboratory database. 2) Test it, using established databases, as a SDE detector in community-dwelling adults (Sleep Heart Health Study, SHHS) and children (Neurobehavioral Assessment and Pediatric Sleep, NAPS). 3) To correlate the biomarker with excessive daytime sleepiness, subjective sleep quality and cardiovascular morbidity (SHHS), and reduced neurocognitive function (NAPS).

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Exploratory/Developmental Grants (R21)
Project #
5R21HL079248-02
Application #
7061681
Study Section
Special Emphasis Panel (ZRG1-BDCN-E (10))
Program Officer
Twery, Michael
Project Start
2005-05-05
Project End
2008-04-30
Budget Start
2006-05-01
Budget End
2008-04-30
Support Year
2
Fiscal Year
2006
Total Cost
$145,794
Indirect Cost
Name
Beth Israel Deaconess Medical Center
Department
Type
DUNS #
071723621
City
Boston
State
MA
Country
United States
Zip Code
02215
Thomas, Robert Joseph (2014) Alternative approaches to treatment of Central Sleep Apnea. Sleep Med Clin 9:87-104
Thomas, Robert Joseph; Mietus, Joseph E; Peng, Chung-Kang et al. (2014) Relationship between delta power and the electrocardiogram-derived cardiopulmonary spectrogram: possible implications for assessing the effectiveness of sleep. Sleep Med 15:125-31
Eiseman, Nathaniel A; Westover, M Brandon; Mietus, Joseph E et al. (2012) Classification algorithms for predicting sleepiness and sleep apnea severity. J Sleep Res 21:101-12
Thomas, Robert Joseph; Mietus, Joseph E (2011) Mapping sleep using coupled biological oscillations. Conf Proc IEEE Eng Med Biol Soc 2011:1479-82
Bianchi, Matt T; Cash, Sydney S; Mietus, Joseph et al. (2010) Obstructive sleep apnea alters sleep stage transition dynamics. PLoS One 5:e11356
Thomas, Robert Joseph; Mietus, Joseph E; Peng, Chung-Kang et al. (2010) Impaired sleep quality in fibromyalgia: Detection and quantification with ECG-based cardiopulmonary coupling spectrograms. Sleep Med 11:497-8
Thomas, Robert Joseph; Weiss, Matthew D; Mietus, Joseph E et al. (2009) Prevalent hypertension and stroke in the Sleep Heart Health Study: association with an ECG-derived spectrographic marker of cardiopulmonary coupling. Sleep 32:897-904
Thomas, Robert J (2009) Strong chemoreflex modulation of sleep-breathing: some answers but even more questions. J Clin Sleep Med 5:212-4
Thomas, Robert Joseph; Mietus, Joseph E; Peng, Chung-Kang et al. (2007) Differentiating obstructive from central and complex sleep apnea using an automated electrocardiogram-based method. Sleep 30:1756-69
Gilmartin, Geoffrey S; Daly, Robert W; Thomas, Robert J (2005) Recognition and management of complex sleep-disordered breathing. Curr Opin Pulm Med 11:485-93