Cardiopulmonary Coupling Published Papers
- Electrocardiogram-Based Sleep Spectrogram Measures of Sleep Stability and Glucose Disposal in Sleep Disordered Breathing
- Heritability of Abnormalities in Cardiopulmonary Coupling in Sleep Apnea: Use of an Electrocardiogram-based Technique
- ECG-derived Cardiopulmonary Analysis of Pediatric Sleep-Disordered Breathing
- The Sleep Quality Recovery of a Snorer's Bed Partner
- An Early Indicator of Complex Sleep Apnea
- Impaired Sleep Quality in Fibromyalgia: Detection and Quantification with ECG-based Cardiopulmonary Coupling Spectrograms
- Prevalent hypertension and stroke in the sleep heart health study: association with an ECG-derived spectrographic marker of cardiopulmonary coupling
- Differentiating obstructive from central and complex sleep apnea using an automated electrocardiogram-based method
- An electrocardiogram-based technique to assess cardiopulmonary coupling (CPC) during sleep
- Sleep State Instabilities in Major Depressive Disorder: Detection and Quantification with Electrocardiogram-based Analysis
- Mapping Sleep Using Coupled Biological Oscillations
Electrocardiogram-Based Sleep Spectrogram Measures of Sleep Stability and Glucose Disposal in Sleep Disordered Breathing
Pogach, MD; Naresh M. Punjabi, MD, PhD; Neil Thomas; Robert J. Thomas, MD
SLEEP 2012 35(1):139-148
O: This analysis explored associations between glucose metabolism and an EEG-independent measure of sleep quality, the sleep spectrogram, which maps coupled oscillations of heart-rate variability and electrocardiogram (ECG)-derived respiration.
C: The ECG-spectrogram analysis of sleep quality may provide information beyond that obtained by conventional polysomnography in relationship to glucose metabolism
Practical Significance: Experimental sleep fragmentation can impair insulin sensitivity. ECG-derived sleep-spectrogram measures of sleep quality are associated with alterations in glucose-insulin homeostasis.This could improve our understanding of sleep and sleep-breathing effects on glucose metabolism.
Heritability of Abnormalities in Cardiopulmonary Coupling in Sleep Apnea: Use of an Electrocardiogram-based Technique
Ibrahim LH, Jacono FJ, Patel SR, Thomas RJ, Larkin EK, Mietus JE, Peng CK, Goldberg AL, Redline S
O: To evaluate the familial aggregation of distinctive spectrographic biomarkers of unstable sleep, related to elevated-low frequency cardiopulmonary coupling (e-LFC), and to assess their utility in genetic studies.
C: Approximately 30% of the variability of e-LFC, measured from continuous ECG during sleep, is explained by familial factors other than BMI. ECG-based spectrographic measures of cardiopulmonary coupling may provide novel phenotypes for characterizing subgroups of individuals with different propensities and genetic etiologies for sleep apnea or for other conditions associated with sleep fragmentation.
Practical Significance: This study suggests that CPC can enhance our understanding of the genetics of OSA by identifying intermediate traits with high heritability.
O: An ECG-derived sleep spectrogram (CPC) analysis previously described in adults can provide information about the severity of SDB and coupled interactions of sleep modulated autonomic drive and respiration. We hypothesized that CPC algorithm-derived metrics will correlate with nasal pressure-based apnea–hypopnea scoring in pediatric population.
C: ECG-derived sleep spectrogram metrics are correlated with nasal flow-derived respiratory abnormality in pediatric SDB. In suitable clinical contexts, this method may have screening utility and possibly allow tracking of treatment effects, specifically in children with severe SDB
Practical Significance: The high correlation between CPC metrics and nasal flow derived metrics in pediatric SDB patients demonstrates an opportunity to screen for SDB and track treatment effects.
Schramm PJ, Neville AN, Baker D,
Respiratory Therapy Magazine
Volume 5, No
O: To demonstrate through the negative impact of snoring and OSA and objectively demonstrate benefit of PAP therapy as well as the impact on the bed partner’s sleep quality.
C: Both the snorer and his bed partner’s sleep quality improved significantly with the application of PAP therapy.
Practical Significance: Proof to a reticent CPAP user of the benefit of CPAP compliance to their bed partner as well as themselves
Advance for Managers in Respiratory Care and Sleep
O: Demonstration of the impact on a Complex Sleep Apnea patient’s sleep quality with CPAP versus ASV using CPC to detect stable and unstable sleep.
C: CPC variables indicated that the patient’s sleep quality had improved objectively. Subjectively, the patient reported his sleep more restful when using the combination of ASV at 9 cm H2O and added dead space compared to CPAP.
Practical Significance: This study highlights the fact that the presence of eLFCnb is capable of identifying complex sleep apnea both before and after initiation of PAP therapy. A follow up CPC study after the application of ASV with dead space showed improved quality of sleep in the form of increased HFC and this agreed with the patients' subjective findings as well.
Impaired Sleep Quality in Fibromyalgia: Detection and Quantification with ECG-based Cardiopulmonary Coupling Spectrograms
Thomas RJ, Mietus JE, Peng CK, Goldberger AL. Crofford LJ and Chervin RD
Sleep Med. 2010 May;
11(5):497-8. Epub 2009 Dec 16
O: To retrospectively analyze the PSG ECG with CPC from patients with fibromyalgia and compare to matched controls.
C: Both ECG and EEG approaches yield consistent findings in this syndrome further solidifying the hypothesis of altered sleep stability in fibromyalgia.
Practical Significance: This study shows the favorable comparison of CPC findings over time with traditional PSG findings and the pain diaries of patients suffering from Fibromyalgia.
Prevalent hypertension and stroke in the sleep heart health study: association with an ECG-derived spectrographic marker of cardiopulmonary coupling
Thomas RJ, Weiss MD, Mietus JE, Peng CK, Goldberger AL.
O: The ECG-based sleep spectrogram generates a map of CPC based on heart rate variability and respiration derived from QRS amplitude variations. A distinct spectrographic phenotype, designated as e-LFCnb, has been associated with central apneas and periodic breathing and predicts sleep laboratory failure of continuous positive airway pressure therapy. This study assesses, at a population level, the associations of this spectrographic biomarker with prevalent cardiovascular disease using the Sleep Heart Health Study (SHHS)-I dataset.
C: An ECG derived spectrographic marker related to low frequency cardiopulmonary coupling is associated with greater sleep apnea severity. Whether this biomarker is solely a sign of more severe disease or whether it reflects primary alterations in sleep apnea pathophysiology, which may either cause or result from sleep apnea, is unknown. This ECG-based spectral marker is associated with a higher prevalence of hypertension and stroke.
Practical Significance: The presence of e-LFCnb represents for the first time a biomarker for sleep disordered breathing independent of whether age, sex and body mass has been described.
Differentiating obstructive from central and complex sleep apnea using an automated electrocardiogram-based method
Thomas RJ, Mietus JE, Peng CK, Gilmartin G, Daly RW, Goldberger AL, Gottlie DJ.
O: Complex sleep apnea is defined as sleep disordered breathing secondary to simultaneous upper airway obstruction and respiratory control dysfunction. The objective of this study was to assess the utility of an electrocardiogram (ECG) based CPC technique to distinguish obstructive from central or complex sleep apnea.
C: ECG based spectral analysis allows automated, operator-independent characterization of probable interactions between respiratory dyscontrol and upper airway anatomical obstruction. The clinical utility of spectrographic phenotyping, especially in predicting failure of positive airway pressure therapy, remains to be more thoroughly tested.
Practical Significance: Using the Sleep Heart Health Study population of 3,989 subjects, this study shows that CPC not only differentiated obstructive vs central vs complex sleep apnea, it positively correlated with periodic breathing episodes in PSG and was the strongest predictor of success or failure with PAP titration.
Thomas RJ, Mietus JE, Peng CK, Goldberger AL
O: Evaluate a new automated measure of cardiopulmonary coupling during sleep using a single-lead electrocardiographic (EKG) signal.
C: A sleep spectrogram derived from a single lead electrocardiogram can be used to dynamically track cardiopulmonary interactions. The 2 distinct (bimodal) regimes demonstrate a closer relationship with visual cyclic alternating pattern and non-cyclic alternating pattern states than with standard sleep stages. This technique may provide a complementary approach to the conventional characterization of graded non-rapid eye movement sleep stages.
Practical Significance: This seminal work establishes the link between high frequency coupling being representative of good sleep quality, and low frequency coupling being representative of poor sleep quality.
Sleep State Instabilities in Major Depressive Disorder: Detection and Quantification with Electrocardiogram-based Analysis
Yang AC, Yang CH, Hong CJ, Tsai SJ, Kuo CH, Peng CK, Mietus JE, Goldberger AL, Thomas RJ.
Psychophysiology, 2010;48: 285–291
O: To evaluate the utility of electrocardiogram (ECG)-based analysis to quantify physiologic sleep stability in patients with major depression
C: Relative to controls, non-medicated depressed patients had a reduction in high-frequency coupling (index of stable sleep), an increase in low-frequency coupling ( index of unstable sleep), and an increase in very-low-frequency coupling (index of wakefulness/REM sleep).
Practical Significance: ECG-based analysis can offer a simple, cost-efficient point-of-care method to quantify sleep quality/stability and to objectively evaluate the severity of insomnia in patients with major depression.
Thomas RJ, Mietus JE.
O: To examine the utility of an electrocardiogram-derived sleep spectrogram to provide adifferent view of sleep
C: Non-electroencephalogram (EEG) recordings can provide an alternative approach to viewing sleep.
Practical Significance: Novel insights into physiology and pathology of sleep can be obtained through the coupling of ECG and respiratory signal.