Yokohama City University Graduate School of Medicine, Department of Medical Science and Cardio-renal Medicine, Yokohama, Japan.
Yokohama City University Graduate School of Medicine, Department of Medical Science and Cardio-renal Medicine, Yokohama, Japan.
J Cardiol. 2019 May;73(5):394-400. doi: 10.1016/j.jjcc.2018.10.007. Epub 2019 Jan 7.
Recent pacemakers with transthoracic impedance sensors have a specific algorithm identifying sleep apnea (SA). Our aim was to evaluate the algorithm in Japanese patients.
Consecutive patients implanted with a pacemaker with sleep apnea monitoring algorithm at our hospital were enrolled prospectively. After implantation, patients underwent polysomnography (PSG). The respiratory disturbance index measured by pacemaker (RDI-PM) was extracted in the morning after PSG.
Forty-five patients were recruited; 78% of patients underwent overnight PSG completely, and among them RDI-PM was invalid for one patient. Then the analysis was performed in 34 patients. Moderate/severe SA (apnea hypopnea index, AHI≥15events/h) and severe SA (AHI≥30events/h) by PSG were diagnosed in 65% and 41% of patients. The mean AHI-PSG and RDI-PM were 30.4±22.6 and 21.7±14.2events/h, respectively. There was a significant positive correlation between AHI-PSG and RDI-PM (r=0.543; p=0.001). The correlation was stronger in the severe SA group (r=0.664; p=0.010), in a group whose apnea index was higher than hypopnea index (r=0.822; p=0.002), and in a group whose central sleep apnea (CSA) index was higher than obstructive sleep apnea index (r=0.977; p<0.001). RDI-PM cut-off value for identifying severe SA was 22 (area under the curve, 0.682; sensitivity, 64%; specificity, 75%).
The pacemaker-based algorithm is a useful screening tool for SA in Japanese individuals, especially in the severe SA group, apnea-dominant group, and CSA-dominant group.
最近具有经胸阻抗传感器的起搏器具有识别睡眠呼吸暂停（SA）的特定算法。我们的目的是评估该算法在日本患者中的应用。
前瞻性地招募在我院植入带有睡眠呼吸暂停监测算法的起搏器的连续患者。植入后，患者接受多导睡眠图（PSG）检查。从 PSG 后早上提取起搏器测量的呼吸窘迫指数（RDI-PM）。
共纳入 45 例患者；78%的患者完全进行了夜间 PSG，其中 1 例患者的 RDI-PM 无效。然后对 34 例患者进行了分析。根据 PSG 诊断，65%和 41%的患者患有中度/重度 SA（呼吸暂停低通气指数，AHI≥15 次/小时）和重度 SA（AHI≥30 次/小时）。PSG 平均 AHI 和 RDI-PM 分别为 30.4±22.6 和 21.7±14.2 次/小时。AHI-PSG 和 RDI-PM 之间存在显著的正相关（r=0.543；p=0.001）。在重度 SA 组（r=0.664；p=0.010）、呼吸暂停指数高于低通气指数的组（r=0.822；p=0.002）和中枢性睡眠呼吸暂停（CSA）指数高于阻塞性睡眠呼吸暂停指数的组（r=0.977；p<0.001）中，相关性更强。用于识别重度 SA 的 RDI-PM 截断值为 22（曲线下面积，0.682；敏感性，64%；特异性，75%）。
起搏器算法是识别日本个体 SA 的有用筛查工具，尤其是在重度 SA 组、呼吸暂停主导组和 CSA 主导组中。
