VirtuOx Cardio-Sleep Solutions facilitates potentially life-saving at-home diagnostics.

By Sree Roy

The connections between heart health and sleep health are becoming increasingly clear. In 2022, the American Heart Association added sleep to its list of modifiable components that are key to cardiovascular health.1

Years ago, respiratory care professional Kyle Miko also saw evidence of the cardio-sleep connection. “In 2018, I put it together,” says Miko, founder of home-based diagnostics company VirtuOx. “During one of our quarterly reviews, I was looking over the sleep studies we’d done—home sleep testing and overnight pulse oximetry summaries—and I noticed a lot of patients with severe tachycardias and bradycardias.

“The arrhythmia findings were so common that I thought we needed to come up with a solution for those internal patients who are flagged as high risk from their sleep testing results.”

Key Takeaway: More and more, experts notice links between cardiac and sleep health.

VirtuOx CardioSleep Solutions

From there, VirtuOx CardioSleep Solutions was born.

VirtuOx now accepts orders for home sleep, cardiac, and overnight oximetry testing from practitioners ranging from primary care to sleep specialists. Cardiac and sleep tests can be ordered together or separately. VirtuOx employs a variety of manufacturers’ devices, for which it handles shipping and returns, payment (it’s in-network with major payors), scoring, and interpretation.

“We have a board-licensed cardiac physician in all 50 states,” Miko says. “So a sleep physician in any state can refer a patient for cardiac monitoring. We can take the patient from A to Z.”

Since then, VirtuOx has also launched VirtuCHECK, an artificial intelligence program that extracts heart rate data from pulse oximetry studies and home sleep tests to identify otherwise asymptomatic patients at risk for severe cardiac arrhythmias. VirtuOx then alerts the ordering physician.

Initial findings resulted in 47% of these patients meeting the threshold of recommending a cardiology consultation. “The abnormal rate seen indicates that we are on track to save many patients from significant cardiac morbidity and likely save lives in the process,” says VirtuOx chief medical officer cardiologist-sleep specialist Lee A. Surkin, MD, in a release.

Key Takeaway: VirtuOx Cardio-Sleep Solutions is one practical way for sleep specialists to be alerted to cardiac red flags in their patients.

Cardio-Sleep Case Report

Miko shares a case report of a cardio-sleep patient for whom VirtuOx Cardio-Sleep Solutions expedited diagnosis and treatment.


A 51-year-old man was referred by his primary care physician for a home sleep test due to complaints of chronic fatigue, snoring, a body mass index of 33.51, and an Epworth Sleepiness Scale of 10.

HST Results

  • AHI of 17
  • Lowest oxygen saturation: 82%; lowest heart rate: 29 bpm; highest heart rate: 129 bpm.
Apnea-hypopnea index of 17


The patient was diagnosed with moderate obstructive sleep apnea by VirtuOx’s panel of board-certified sleep physicians with recommendations to start CPAP therapy and further screen the patient to determine if an ambulatory cardiac monitor was indicated due to the low heart rate.


The patient’s primary care physician assessed the patient and ordered an ambulatory cardiac monitor with VirtuOx. VirtuOx sent the patient a RhythmStar by RhythmMetrics, and its certified cardiac technicians watched the test live remotely.

Cardiac Test Results

The techs witnessed a complete heart block—confirmed by a board-certified cardiologist working with VirtuOx—and immediately called the patient for a wellness check, explaining the nature of his cardiac condition. The patient agreed to a hospital intervention. VirtuOx cardiac tech staff also called the hospital and ordering physician and faxed the follow-up reports.

Complete heart block

Cardiac Therapy

The patient was implanted with a cardiac pacemaker that same day.

Key Takeaway: A low heart rate during a sleep study flagged a patient for further cardiac testing, which led to the discovery of a complete heart block.

Expediting Cardiac Care for Sleep Patients

Unfortunately, some regions have long waits for cardiology appointments, even 90 days or more. That’s where having clear evidence of a likely heart problem can be invaluable.

“What does our system allow the doctor to do? Get the patient diagnosed in a week, two weeks max,” says VirtuOx’s Miko. “If it finds no arrhythmia, OK, that patient can stay within the sleep physicians’ practice. But what if the patient has a complete heart block? That patient needs to be triaged to the front of the line.”

Key Takeaway: Having extra information from a home sleep test or a cardio-sleep test that flags arrhythmias can help patients get timely appointments with cardiologists. 

Landscape Is Changing for the Better

Overall, consumers and clinicians alike are becoming more aware of the signs of heart health, sleep health, and the connections between the two. Consumer wearables, such as the Apple Watch’s heart rate notifications, contribute to increasing awareness. Increasingly, sleep specialists can do their part, quickly and easily, and more programs to facilitate cardiac referrals from sleep specialists are likely to rise. 

“You’ll see more and more people make the connections, which is good,” Miko says. “We need more help to save lives.”

Key Takeaway: Consumers too are becoming more cognizant of the connections between sleep and heart health, spurring more innovative solutions.


1. Lloyd-Jones DM, Allen NB, Anderson CAM, et al; American Heart Association. Life’s Essential 8: Updating and enhancing the American Heart Association’s Construct of Cardiovascular Health: A presidential advisory from the American Heart Association. Circulation. 2022 Aug 2;146(5):e18-43.