Della Rocca Domenico G, Albanese Maria, Placidi Fabio, Forle Giovanni B, Di Biase Luigi, Ribatti Valentina, Santini Luca, Izzi Francesca, Cicchini Lucia, Lovecchio Mariolina, Valsecchi Sergio, Lavalle Carlo, Natale Andrea, Mercuri Nicola B, Romigi Andrea
Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N IH-35, Suite 720, Austin, TX, 78705, USA.
Sleep Disorders Centre, Neurophysiopathology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
J Interv Card Electrophysiol. 2019 Dec;56(3):327-333. doi: 10.1007/s10840-019-00631-x. Epub 2019 Oct 23.
Sleep-related breathing disorders (SRBD) have been associated with adverse cardiovascular events and prognosis. Some modern pacemakers (PMK) and implantable cardioverter defibrillators (ICD) are equipped with thoracic impedance monitoring systems which allow detecting fluctuations in tidal volume occurring in SRBD. This study aimed at assessing the accuracy of a novel transthoracic impedance-based PMK/ICD sensor for automatic detection of SRBD.
We prospectively enrolled 31 consecutive patients scheduled for implantation of a PMK or an ICD with sleep respiratory disturbances monitoring capability. The results of unattended home nocturnal recordings expressed as apnea/hypopnea index (AHI) were compared with the respiratory disturbance index (RDI) stored in the cardiac device memory at the time polygraphy was performed.
Among the 31 enrolled patients (20 men, mean age 70 ± 8 years), a comparison between the data from polygraphy and cardiac device was feasible in 29 patients. According to the results of home nocturnal recording, a severe SRBD was observed in 7/29 (24.1%) patients. On the basis of receiver-operating characteristic curve analysis of RDI values, the optimal RDI cutoff value to identify severe SRBD was 47 episodes/h (sensitivity 100%, specificity 100%). Bland-Altman agreement analysis of AHI-RDI revealed a bias between measurements of - 11 episodes/h, with limits of agreement - 38 to 15 episodes/h.
In the present study, the novel transthoracic impedance-based monitoring system ApneaScan appeared effective in screening PMK and ICD patients for SRBD.
睡眠相关呼吸障碍（SRBD）与不良心血管事件及预后相关。一些现代起搏器（PMK）和植入式心脏复律除颤器（ICD）配备了胸阻抗监测系统，可检测SRBD中出现的潮气量波动。本研究旨在评估一种基于经胸阻抗的新型PMK/ICD传感器自动检测SRBD的准确性。
我们前瞻性纳入了31例计划植入具有睡眠呼吸障碍监测功能的PMK或ICD的连续患者。将无人值守的家庭夜间记录结果以呼吸暂停/低通气指数（AHI）表示，与在进行多导睡眠图检查时存储在心脏设备存储器中的呼吸紊乱指数（RDI）进行比较。
在31例纳入患者（20例男性，平均年龄70±8岁）中，29例患者的多导睡眠图数据与心脏设备数据之间的比较可行。根据家庭夜间记录结果，29例患者中有7例（24.1%）观察到严重SRBD。基于RDI值的受试者工作特征曲线分析，识别严重SRBD的最佳RDI截断值为47次/小时（敏感性100%，特异性100%）。AHI-RDI的Bland-Altman一致性分析显示测量值之间的偏差为-11次/小时，一致性界限为-38至15次/小时。
在本研究中，基于经胸阻抗的新型监测系统ApneaScan似乎可有效筛查PMK和ICD患者的SRBD。
