Validation Against Polysomnography of a Transthoracic Impedance Sensor for Screening of Sleep Apnea in Heart Failure Patients: A Pooled Analysis of AIRLESS and UPGRADE.

Cardiac implantable electronic devices and their integrated thoracic impedance sensors have been used to detect sleep apnea for over a decade now. Despite their usage in daily clinical practice, there are only limited data on their diagnostic accuracy. AIRLESS and UPGRADE were prospective investigator-driven trials meant to validate the AP scan (Boston Scientific, Marlborough, MA, USA) in heart failure cohorts. Patients, who either fulfilled the criteria for implantation of an implantable cardioverter-defibrillator (ICD), cardiac resynchronization therapy (CRT), or upgrading to CRT according to most recent guidelines at the time of study conduction, were eligible for enrolment. Sleep apnea and its severity, measured by apnea-hypopnea index (AHI), were assessed by polysomnography. For direct comparison, the apnea sensor-derived AP scan was used from the identical night. Overall, 80 patients were analyzed. Median AHI was 21.6 events/h (7.1-34.7), while median AP scan was 33.0 events/h (26.0-43.0). In the overall cohort, the sensor-derived AP scan correlated significantly with the AHI (r = 0.61, < 0.001) with a mean difference (MD) of -12.6 (95% confidence interval (CI) -38.2 to 13.0). Furthermore, the AP scan was found to correlate well with the AHI in patients with obstructive sleep apnea r = 0.73, = 0.011, MD -5.2, 95% CI -22.7 to 12.3), but not central sleep apnea (r = 0.28, = 0.348, MD -10.4, 95% CI -35.4 to 14.6). In an exclusive heart failure cohort, the AP scan correlated well with the PSG-derived AHI. A similar correlation was found in most subgroups except for patients suffering from central sleep apnea.