Moubarak Ghassan, Bouzeman Abdeslam, de Geyer d'Orth Thibaut, Bouleti Claire, Beuzelin Christine, Cazeau Serge
Department of Electrophysiology and Pacing, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
Department of Electrophysiology and Pacing, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
Heart Rhythm. 2017 Mar;14(3):359-364. doi: 10.1016/j.hrthm.2016.11.033. Epub 2016 Nov 23.
Obstructive sleep apnea (OSA) is associated with several cardiovascular conditions. Some pacemakers feature specific algorithms detecting respiratory cycles and deriving indices well correlated with the identification of polysomnography-confirmed severe OSA.
The purposes of this study were to analyze respiratory disturbances measured by a validated algorithm in clinical practice and to describe their variability over time and their association with atrial fibrillation.
Fifty-eight patients implanted with dual-chamber LivaNova REPLY 200 DR or KORA 100 DR pacemakers measuring a respiratory disturbance index (RDI) were included. An RDI >20 events per hour of sleep is well correlated with severe OSA as determined by polysomnography. Patients with >10% nights with invalid RDI measurements were excluded.
The RDI could be measured during 98% of nights. During a mean follow-up of 187 ± 123 days, the individual mean RDI was 19.9 ± 12.7 and was superior to 20 in 24 patients (41%). An RDI >20 events/h in at least 1 night was observed in 52 patients (90%). The mean day-to-day RDI variability in individual patients was 19% ± 21%. Patients with the highest burden of severe OSA (as defined by ≥75% of nights with RDI >20 events/h) were older, had a higher prevalence of hypertension, and were more often implanted for atrioventricular block than patients with lower burden of severe OSA. No RDI burden or cutoff was a predictor of atrial fibrillation occurrence.
OSA is frequent in patients with a pacemaker and is reliably detected by pacemakers. OSA is highly variable and could probably be best analyzed in terms of burden.
阻塞性睡眠呼吸暂停（OSA）与多种心血管疾病相关。一些起搏器具有特定算法，可检测呼吸周期并得出与多导睡眠图确诊的重度OSA识别密切相关的指标。
本研究旨在分析临床实践中通过验证算法测量的呼吸紊乱情况，并描述其随时间的变化及其与心房颤动的关联。
纳入58例植入双腔LivaNova REPLY 200 DR或KORA 100 DR起搏器以测量呼吸紊乱指数（RDI）的患者。每小时睡眠中呼吸紊乱事件>20次与多导睡眠图确定的重度OSA密切相关。RDI测量无效的夜晚>10%的患者被排除。
98%的夜晚可测量RDI。在平均187±123天的随访期间，个体平均RDI为19.9±12.7，24例患者（41%）的RDI超过20。52例患者（90%）在至少1个夜晚观察到RDI>20次/小时。个体患者的每日平均RDI变异性为19%±21%。重度OSA负担最高的患者（定义为RDI>20次/小时的夜晚≥75%）比重度OSA负担较低的患者年龄更大，高血压患病率更高，且更常因房室传导阻滞植入起搏器。没有RDI负担或临界值是心房颤动发生的预测因素。
起搏器患者中OSA很常见，且可通过起搏器可靠检测。OSA具有高度变异性，可能最好从负担方面进行分析。
