ICD sleep apnea algorithm may also detect AF burden
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Patients with HF who received an implantable cardioverter defibrillator that detected severe sleep apnea may be two- to threefold more likely to experience an atrial fibrillation episode, according to a new analysis of DASAP-HF data.
“Diagnosing and treating apnea is a relevant issue in the management of HF patients,” Giuseppe Boriani, MD, PhD, FEHRA, FESC, full professor of cardiology and director of the postgraduate school in cardiology at the University of Modena and Reggio Emilia in Modena, Italy, and colleagues wrote in the Journal of Cardiovascular Electrophysiology. “Indeed, a large body of clinical data indicates that HF patients with sleep apnea, as detected by conventional polysomnography, have an increased risk of mortality independent of traditional risk factors. However, the standard diagnosis of sleep apnea by means of the overnight polysomnography requires special institutions and trained technicians. The limited access to polysomnography is known to result in undiagnosed patients with clinically significant and treatable obstructive sleep apnea and undertreated sleep apnea, as well as excessively long waiting lists. Therefore, the availability of accurate algorithms for the automatic detection of advanced sleep apnea in pacemakers and ICDs represents an opportunity for screening patients at risk of sleep apnea.”
Boriani and colleagues analyzed data from 164 patients enrolled in DASAP-HF, a nonrandomized multicenter study of patients who received an ICD or cardiac resynchronization therapy ICD with the ApneaScan (Boston Scientific) diagnostic feature. Patients had an ejection fraction of 35% or lower and usable respiratory disturbance index (RDI) data, computed by the ICD algorithm to identify severe sleep apnea. At 1 month after ICD implantation, patients underwent polysomnography. Researchers assessed weekly mean RDI value during the entire follow-up period and during the 1-week period preceding the sleep study. Study endpoints were daily AF burden of at least 5 minutes, at least 6 hours and at least 23 hours.
During follow-up, 10% of patients died.
Researchers found that 56% of patients were diagnosed with severe sleep apnea at the time of the sleep study. Within the cohort, 43% of patients had a documented AF burden of at least 5 minutes per day, 29% experienced AF at least 6 hours per day and 20% of patients experienced AF at least 23 hours per day.
Device-detected RDI of at least 30 episodes per hour at the time of polygraphy and polygraphy-measured apnea-hypopnea index of at least 30 episodes per hour were not associated with AF occurrence using a Cox regression model. However, using a time-dependent model, continuously measured weekly mean RDI of at least 30 episodes per hour was independently associated with AF burden of at least 5 minutes per day (HR = 2.13; 95% CI, 1.24-3.65; P = .006), at least 6 hours per day (HR = 2.75; 95% CI, 1.37-5.49; P = .004), and at least 23 hours per day (HR = 2.26; 95% CI, 1.05-4.86; P = .037).
“In HF patients implanted with an ICD, device-diagnosed severe sleep apnea is associated with a higher risk of AF,” the researchers wrote. “In particular, severe sleep apnea during follow-up identifies patients who are from two- to threefold more likely to experience an AF episode, according to various thresholds of daily AF burden.”
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