Feasibility of automated detection of sleep apnea using implantable pacemakers and defibrillators: a comparison with simultaneous polysomnography recording

Domenico G. Della Rocca, Maria Albanese, Fabio Placidi, Giovanni B. Forle, Luigi Di Biase, Valentina Ribatti, Luca Santini, Francesca Izzi, Lucia Cicchini, Mariolina Lovecchio, Sergio Valsecchi, Carlo Lavalle, Andrea Natale, Nicola B. Mercuri, Andrea Romigi

Research output: Contribution to journalArticle

Abstract

Purpose: 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. Methods: 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. Results: 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. Conclusions: In the present study, the novel transthoracic impedance-based monitoring system ApneaScanTM appeared effective in screening PMK and ICD patients for SRBD.

Original languageEnglish (US)
JournalJournal of Interventional Cardiac Electrophysiology
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Implantable Defibrillators
Polysomnography
Sleep Apnea Syndromes
Sleep
Respiration
Impedance Cardiography
Apnea
Equipment and Supplies
Tidal Volume
Electric Impedance
ROC Curve
Thorax
Sensitivity and Specificity

Keywords

  • Implantable defibrillator
  • Pacemaker
  • Sleep apnea
  • Sleep apnea screening
  • Transthoracic impedance

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Feasibility of automated detection of sleep apnea using implantable pacemakers and defibrillators : a comparison with simultaneous polysomnography recording. / 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.

In: Journal of Interventional Cardiac Electrophysiology, 01.01.2019.

Research output: Contribution to journalArticle

Della Rocca, DG, Albanese, M, Placidi, F, Forle, GB, Di Biase, L, Ribatti, V, Santini, L, Izzi, F, Cicchini, L, Lovecchio, M, Valsecchi, S, Lavalle, C, Natale, A, Mercuri, NB & Romigi, A 2019, 'Feasibility of automated detection of sleep apnea using implantable pacemakers and defibrillators: a comparison with simultaneous polysomnography recording', Journal of Interventional Cardiac Electrophysiology. https://doi.org/10.1007/s10840-019-00631-x
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. / Feasibility of automated detection of sleep apnea using implantable pacemakers and defibrillators : a comparison with simultaneous polysomnography recording. In: Journal of Interventional Cardiac Electrophysiology. 2019.
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abstract = "Purpose: 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. Methods: 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. Results: 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. Conclusions: In the present study, the novel transthoracic impedance-based monitoring system ApneaScanTM appeared effective in screening PMK and ICD patients for SRBD.",
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author = "{Della Rocca}, {Domenico G.} and Maria Albanese and Fabio Placidi and Forle, {Giovanni B.} and {Di Biase}, Luigi and Valentina Ribatti and Luca Santini and Francesca Izzi and Lucia Cicchini and Mariolina Lovecchio and Sergio Valsecchi and Carlo Lavalle and Andrea Natale and Mercuri, {Nicola B.} and Andrea Romigi",
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T1 - Feasibility of automated detection of sleep apnea using implantable pacemakers and defibrillators

T2 - a comparison with simultaneous polysomnography recording

AU - Della Rocca, Domenico G.

AU - Albanese, Maria

AU - Placidi, Fabio

AU - Forle, Giovanni B.

AU - Di Biase, Luigi

AU - Ribatti, Valentina

AU - Santini, Luca

AU - Izzi, Francesca

AU - Cicchini, Lucia

AU - Lovecchio, Mariolina

AU - Valsecchi, Sergio

AU - Lavalle, Carlo

AU - Natale, Andrea

AU - Mercuri, Nicola B.

AU - Romigi, Andrea

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: 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. Methods: 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. Results: 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. Conclusions: In the present study, the novel transthoracic impedance-based monitoring system ApneaScanTM appeared effective in screening PMK and ICD patients for SRBD.

AB - Purpose: 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. Methods: 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. Results: 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. Conclusions: In the present study, the novel transthoracic impedance-based monitoring system ApneaScanTM appeared effective in screening PMK and ICD patients for SRBD.

KW - Implantable defibrillator

KW - Pacemaker

KW - Sleep apnea

KW - Sleep apnea screening

KW - Transthoracic impedance

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