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Utility of new-generation pacemakers in sleep apnea screening
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Orientador(es)
Resumo(s)
Objective: Patients with cardiac pacemakers present a high prevalence of undiagnosed sleep apnea
syndrome (SAS). New-generation pacemakers have algorithms that identify sleep respiratory events. Our
aim was to evaluate their accuracy in the diagnosis of SAS.
Methods: We performed a prospective study that included patients with new-generation pacemakers
(Reply 200 pacemakers). All patients underwent a polysomnography (PSG). On the same night, the
respiratory disturbance index of the PSG (RDI-PSG) and of the pacemaker (RDI-PM) were recorded. The
agreement between methods was assessed using the kappa coefficient, Bland and Altman statistics and
receiver operating characteristic (ROC) curves.
Results: Sixty patients were recruited but the RDI-PM for the PSG night was not available in six patients.
PSG diagnosed SAS in 74% of patients (20% severe, 19% moderate, 35% mild). Besides snoring (63%), most
patients had no SAS symptoms.
There was a strong positive correlation between RDI-PSG and RDI-PM (r ¼ 0.522, p < 0.001), but the level
of agreement between methods regarding SA diagnosis/severity was poor (k ¼ 0.167). ROC curves
identified a RDI-PM of 10 events/h as the optimal cut-off point for diagnosing SAS (area under the curve
(AUC): 0.81, sensitivity: 80%, specificity: 79%, positive predictive value: 91%, negative predictive value:
58%). The best cut-off for identifying moderate/severe SAS was at 13 events/h (AUC: 0.86, sensitivity:
100%, specificity: 70%, positive predictive value: 68%, negative predictive value: 100%).
Conclusions: SAS prevalence in patients with pacemakers is high (74%). Most are asymptomatic, which
could delay the diagnosis. Patients with clinical indication for a pacemaker may benefit from a device
with sleep apnea monitoring.
Descrição
© 2017 Elsevier B.V. All rights reserved.
Palavras-chave
Sleep apnea syndrome Cardiac pacemaker Polysomnography
Contexto Educativo
Citação
Sleep Medicine 37 (2017) 27-31
Editora
Elsevier