Ospedale Monaldi, Naples, Italy.
Fondazione 'Salvatore Maugeri', IRCCS, Istituto Scientifico di Montescano, Montescano (PV), Italy.
Heart Rhythm. 2018 Feb;15(2):211-217. doi: 10.1016/j.hrthm.2017.09.038. Epub 2017 Oct 7.
Sleep apnea (SA) is a relevant issue in the management of patients with heart failure for risk stratification and for implementing treatment strategies.
The purpose of this study was to evaluate in patients with implantable cardioverter-defibrillators (ICDs) the performance of the respiratory disturbance index (RDI) computed by the ApneaScan algorithm (Boston Scientific Inc., Natick, MA) as a discriminator of severe SA.
ICD-indicated patients with left ventricular ejection fraction ≤35% were enrolled. One month after implantation, patients underwent a polysomnographic study. We evaluated the accuracy of the RDI for the prediction of severe SA (apnea-hypopnea index [AHI] ≥30 episodes/h) and the agreement between RDI and AHI during the sleep study night.
Two hundred sixty-five patients were enrolled to obtain the required sample of 173 patients with AHI and RDI data for analysis. The mean AHI was 21 ± 15 episodes/h and severe SA was diagnosed in 38 patients (22%), while the mean RDI was 33 ± 13 episodes/h. On the basis of the receiver operating characteristic curve analysis of RDI values, the area under the curve was 0.77 (95% confidence interval [CI] 0.70-0.83; P < .001). At an RDI value of 31 episodes/h, severe SA was detected with 87% (95% CI 72%-96%) sensitivity and 56% (95% CI 48%-66%) specificity. RDI closely correlated with AHI recorded during the same night (r = 0.74; 95% CI 0.57-0.84; P < .001), and the Bland-Altman agreement analysis revealed a bias of 11 episodes/h, with limits of agreement being -10 to 32 episodes/h.
The RDI accurately identified severe SA and demonstrated good agreement with AHI. Therefore, it may serve as an efficient tool for screening patients at risk of SA.
睡眠呼吸暂停（SA）是心力衰竭患者进行风险分层和实施治疗策略的一个重要问题。
本研究旨在评估植入式心脏复律除颤器（ICD）患者中，由 ApneaScan 算法（波士顿科学公司，马萨诸塞州纳提克）计算得出的呼吸紊乱指数（RDI）作为严重 SA 鉴别器的性能。
入选左心室射血分数≤35%的 ICD 指征患者。植入后 1 个月，患者接受多导睡眠图检查。我们评估了 RDI 预测严重 SA（呼吸暂停低通气指数[AHI]≥30 次/小时）的准确性，以及 RDI 与睡眠研究夜间 AHI 的一致性。
共纳入 265 例患者，以获得 173 例具有 AHI 和 RDI 数据的患者的样本量。平均 AHI 为 21±15 次/小时，38 例（22%）诊断为严重 SA，平均 RDI 为 33±13 次/小时。基于 RDI 值的受试者工作特征曲线分析，曲线下面积为 0.77（95%置信区间[CI]0.70-0.83；P<.001）。在 RDI 值为 31 次/小时时，严重 SA 的检测敏感性为 87%（95% CI 72%-96%），特异性为 56%（95% CI 48%-66%）。RDI 与同一夜间记录的 AHI 密切相关（r=0.74；95% CI 0.57-0.84；P<.001），Bland-Altman 一致性分析显示存在 11 次/小时的偏差，一致性界限为-10 至 32 次/小时。
RDI 准确识别了严重 SA，与 AHI 具有良好的一致性。因此，它可能成为筛查 SA 风险患者的有效工具。
