Continuous monitoring of sleep‐disordered breathing with pacemakers: Indexes for risk stratification of atrial fibrillation and risk of stroke

Abstract

Background: Sleep apnea (SA) is a risk factor for atrial fibrillation (AF). Advanced pacemakers are now able to calculate indexes of SA severity. Hypothesis: We investigated the changes in pacemaker-measured indexes of SA, we assessed their predictive value for AF occurrence and the associated risk of stroke and death at long-term. Methods: We enrolled 439 recipients of a pacemaker endowed with an algorithm for the calculation of a Respiratory Disturbance Index (RDI). The RDI variability was measured over the first 12 months after implantation, as well as its potential association with the occurrence of AF, defined as device-detected cumulative AF burden ≥6 hoursours in a day. Results: The individual RDI mean was 30 ± 18 episodes/h, and the RDI maximum was 59 ± 21 episodes/h. RDI ≥30 episodes/h was detected in 351 (80%) patients during at least one night. The proportion of nights with RDI ≥30 episodes/h was 14% (2%-36%). AF ≥6 hours was detected in 129 (29%) patients during the first 12 months. The risk of AF was higher in patients with RDI maximum ≥63 episodes/h

Combination of an implantable defibrillator multi-sensor heart failure index and an apnea index for the prediction of atrial high-rate events

“… 13 Our results extend previous findings by demonstrating that the continuously measured weekly RDI values allow dynamic stratification for AHRE risk during follow-up, unlike the maximum RDI value calculated during the entire follow-up period. In agreement with pervious results obtained in pacemaker patients, 14 we observed a considerable variability in ICD-detected SA. This suggests the superiority of the continuous monitoring vs. a single overnight sleep study that may result in the misclassification of severe SA and is also hypothesized by other authors.…”

Association between implantable defibrillator‐detected sleep apnea and atrial fibrillation: The DASAP‐HF study

“…34 According to the authors, their findings explain the poorer efficacy of rhythm control strategies among AF cohorts with increasingly severe SA 35 and highlight paroxysmal AF cohorts with severe SA as a group well poised to derive maximal antiarrhythmic benefit from obstructive SA treatment, in agreement with previous evidence. 36 The availability of a reliable tool which allows automated detection of advanced SA together with continuous monitoring of the burden of AF may facilitate the management of cardiovascular risk factors and concomitant diseases advocated by current guidelines, 22 in addition to appropriately approach risk stratification for ischemic stroke 37 with institution of an adequate antithrombotic treatment. 38,39 Moreover, observational studies suggested that SA is associated with a reduced efficacy of catheter-and pharmacological-based rhythm control strategies, and that treatment with continuous positive airway pressure has a positive impact on AF recurrences after electrical cardioversion and improves catheter ablation outcomes.…”