Abstract 19496: Sleep Quality Change After Catheter Ablation in Paroxysmal Atrial Fibrillation and R

Authors:
Woohyeun Kim, Jin Oh Na

Reference:
American Heart Assn. Circulation. 2017;136:A19496

Objectives:
Sleep instability is highly prevalent in patients with cardiovascular disease (CVD) and evidence supports a causal association of sleep instability with CVD. We investigate the impact of radio-frequency catheter ablation (RFCA) on sleep instability in patients with paroxysmal atrial fibrillation (pAF) and the effect of sleep stability on recurrence of AF.

Conclusions:
Sleep quality was improved after RFCA in patients with pAF. Furthermore, the recurrence rate was significantly lower after RFCA in patient who had pre-RFCA sleep instability(LFC≥50.3%). These results suggest that RFCA can influence sleep quality and sleep quality assessment by analyzing routine 24-hr Holter study can be a predictable marker of recurrence after RFCA in patients with pAF.

Practical Significance:
This retrospective observational study was performed in pAF patients who underwent RFCA between October 2007 and January 2017. Of the total 445 patients, 24-hr Holter study was performed in 218 patients before and 6 months after RFCA. Sleep stability was assessed by 24-hr Holter study using cardiopulmonary coupling (CPC) analysis. We compared CPC parameter (high-frequency coupling[HFC], low-frequency coupling[LFC], very low-frequency coupling[VLFC], narrow-band, broad-band) before and after RFCA.

Sleep stability was significantly improved six-month after RFCA. HFC (marker of stable sleep) and VLFC (REM/wakefulness marker) was increased (29.84% to 36.15%, p<0.001, 26.20% to 28.76%, p=0.002, respectively) while LFC, unstable sleep marker, was decreased (41.25% to 32.13%, p<0.001) after RFCA. In the patients with pre-RFCA LFC<50.3%, the recurrence rate was higher than patients with pre-RFCA LFC≥50.3%. After adjusting for baseline characteristics (including age, CHA2DS2-VASC score, LAVI, creatinine, etc.), pre-RFCA LFC<50.3% remained a significant predictor of recurrence of AF (HR 8.24 (1.88-36.06), p=0.005) during 46.4 months of median follow-up.

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ECG-based cardiopulmonary coupling for sleep stability assessment in patients with amyotrophic lateral sclerosis [abstract]

Authors:
8. S. Mariani, P. Congiu, G. Milioli, G. Gioi, G. Borghero, F. Marrosu, R.J. Thomas, A.L. Goldberger, M. Puligheddu

Reference:
Mov Disord. 2016; 31 (suppl 2)

Objectives:
The goal of this preliminary study is to introduce the technique of CardioPulmonary Coupling (CPC) to visualize and quantify the sleep spectrograms of Amyotrophic Lateral Sclerosis (ALS) patients with different ages and pathology severity and estimate the percentage of stable sleep and unstable sleep during the night.

Conclusions:
Further studies are warranted to see if CPC provides a useful way to analyze sleep stability in ALS and if this method provides insights into autonomic dysfunction and overall prognosis. References: [1] Thomas, R. J., …, & Goldberger, A. L., (2005). An electrocardiogram-based technique to assess cardiopulmonary coupling during sleep. Sleep, 28(9), 1151-1161. [2] Thomas, R. J., …, & Goldberger, A. L. (2014). Relationship between delta power and the electrocardiogram-derived cardiopulmonary spectrogram: possible implications for assessing the effectiveness of sleep.

Practical Significance:
ALS is a progressive neurodegenerative disease. Sleep quality and fragmentation in ALS patients have not yet been extensively studied. Electrocardiogram (ECG)-based (CPC) provides a graphical and computational method to represent the behavior of dynamical interactions between the cardio-autonomics and respiration during sleep. Introduced by Thomas, Goldberger and colleagues [1], CPC combines spectral information derived from inter-beat interval (RR) time series and an ECG-derived respiratory signal (EDR). The method reveals two distinct modes of cardiopulmonary interaction during non-REM sleep: one in the low frequency band [0.01 Hz-0.1 Hz] and the other in the high frequency band [0.1 Hz-0.4 Hz]. Prior studies have shown that former reflects unstable (more arousable) sleep, while the latter reflects stable (deeper) sleep.

We applied this method to ECG data from a cohort of 13 ALS patients (4 F, 9 M, age 46-79, mean 62.3 yrs) recorded at the Sleep Disorders Center of Cagliari. The patients underwent a full PSG exam, including a continuous ECG. The patient’s level of self-sufficiency was measured by means of the ALS functional rating scale (ALS-FRS), where 0=worst and 48=best.

Subjects with the most advanced pathology had the most unstable sleep patterns, with %HFC<4%. Mean reported values for healthy controls of similar age range are 56% [2], 50% and 48%.

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Enhancement of sleep stability with Tai Chi exercise in chronic heart failure: preliminary findings using an ECG-based spectrogram method.

Authors:
Yeh GY, Mietus JE, Peng CK, Phillips RS, Davis RB, Wayne PM, Goldberger AL, Thomas RJ.

Reference:
Sleep Med. 2008 Jul;9(5):527-36. Epub 2007 Aug 3.

Objectives:
To assess the effects of a 12-week Tai Chi exercise program on sleep using the sleep spectrogram, a method based on a single channel electrocardiogram (ECG)-derived estimation of cardiopulmonary coupling, previously shown to identify stable and unstable sleep states.

Conclusions:
At 12 weeks, those who participated in Tai Chi showed a significant increase in HFC and significant reduction in LFC, compared to patients in the control group. Correlations were seen between improved sleep stability and better disease-specific quality of life.

Practical Significance:
Tai Chi exercise may enhance sleep stability in patients with chronic heart failure. This sleep effect may have a beneficial impact on blood pressure, arrhythmogenesis and quality of life.

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On-Call Duty Effects on Sleep-State Physiological Stability in Male Medical Interns

Authors:
Yu-Hsuan Lin, Yen-Cheng Ho, Sheng-Hsuan Lin, Yao-Hsien Yeh, Chia-Yih Liu, Terry B. J. Kuo, Cheryl C. H. Yang, Albert C. Yang

Reference:
PLoS One. 2013 Jun 4;8(6):e65072.

Objectives:
To investigate sleep stability decreased in medical interns during on-call duty.

Conclusions:
The medical interns had significantly reduced stable sleep, and displayed increased latency to the first epoch of stable sleep during the on-call night shift, compared to the pre-call and on-call duty-free nights.

Practical Significance:
The medical interns had significantly reduced stable sleep, and displayed increased latency to the first epoch of stable sleep during the on-call night shift, compared to the pre-call and on-call duty-free nights.

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Sleep Quality among Female Hospital Staff Nurses

Authors:
Chien PL, Su HF, Hsieh PC, Siao RY, Ling PY, Jou HJ.

Reference:
Sleep Disord. 2013; 2013: 283490.

Objectives:
To investigate sleep quality of hospital staff nurses, both by subjective questionnaire and objective measures.

Conclusions:
Among the staff nurses, 75.8% (117) had a PSQI score of ≥5 and 39.8% had an inadequate stable sleep ratio.

Practical Significance:
Both subjective and objective measures demonstrated that poor sleep quality is a common health problem among hospital staff nurses.

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The Sleep Quality Recovery of a Snorer's Bed Partner

Authors:
Schramm PJ, Neville AN, Baker D

Reference:
Respiratory Therapy Vol. 5 No. 3 June-July 2010 pg. 39

Objectives:
To demonstrate, through the use of CPC technology, the negative impact of snoring and Obstructive Sleep Apnea (OSA) and the response to PAP initiation the bed partner’s sleep quality.

Conclusions:
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

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Assessment of sleep quality using cardiopulmonary coupling analysis in patients with Parkinson’s dis

Authors:
Chen L, Liu C, Ye Z, Wang B, He S.

Reference:
Brain Behav.2018;8:e00970.

Objectives:
To assess the sleep quality of patients with Parkinson's disease (PD) and evaluate the effect of cardiopulmonary coupling (CPC) analysis on sleep quality and its correlation with subjective complaints in patients with PD.

Conclusions:
The sleep quality of patients with PD was generally decreased. CPC analysis can reflect the subjective sleep quality of patients with PD and serve as an effective sleep monitoring tool.

Practical Significance:
High‐frequency coupling (HFC) and sleep efficiency were significantly lower in the PD than in the control group, whereas very low‐frequency coupling (VLFC) and sleep latency were significantly higher in the PD than in the control group. PSQI scores were significantly higher in the PD than in the control group (all p < .05). The PSQI score showed a negative correlation with the HFC ratio in the PD group (r = −.478, p = .001). Factors related to the occurrence of PD with poor sleep quality were the unified Parkinson's disease rating scale (UPDRS) score and nocturia.

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