Incidence of sleep apnea and association with atrial fibrillation in an unselected pacemaker population: Results of the observational RESPIRE study

Abstract

BACKGROUND Patients with atrial fibrillation (AF) often have sleep apnea (SA), but diagnosis of SA with polysomnography is costly. SA monitoring is a pacemaker feature that measures respiratory disturbance index, the sum of abnormal respiratory events divided by sleep duration. OBJECTIVE The purpose of this study was to evaluate the incidence and severity of SA and its association with AF in an unselected population fitted with pacemakers. METHODS RESPIRE (REgistry of Sleep APnea monItoring and Atrial Fibrillation in pacemakeR patients) was a multicenter, international, observational, open-label study following adult subjects for 18 months after implantation with an SA monitoring-enabled dual-chamber pacemaker. Severe SA was defined as average respiratory disturbance index 20 from implantation to follow-up visit. The first co-primary end point was the difference in significant AF (cumulative AF episodes lasting 24 hours over 2 consecutive days) between subjects with severe and those nonsevere SA at 12 months in the full analysis set (N 5 553). The second co-primary end point was the rate of major serious adverse events at 18 months in the modified intention-to-treat set (N 5 1024). RESULTS Severe SA was detected in 31.1% (172 of 553). A higher incidence of significant AF was reported in patients with severe SA than in patients with nonsevere SA (25.0% vs 13.9%; difference 11.1%; 95% confidence interval 3.7%-18.4%; P 5 .002). Significant AF increased with time in both groups, but at a faster rate in the severe SA group. No intergroup difference in the overall rate of major serious adverse events was observed (P 5 .065). CONCLUSION SA screening over 12 months identified severe SA in almost one-third of unselected patients fitted with pacemakers. Severe SA was associated with a higher incidence of significant AF.

Obstructive Sleep Apnea, Hypercoagulability, and the Blood–Brain Barrier

“…OSA has been identified as an independent risk factor for a large number of diseases. Among these, acute coronary syndrome (ACS) [ 111 ], atrial fibrillation (AF) [ 112 , 113 ], stroke [ 114 ], and venous thromboembolism (VTE) [ 115 , 116 ] are prominently represented.…”

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

“…SA has a prevalence of about 60% in patients implanted with pacemakers according to conventional indications 11 . Recently, automated pacemaker algorithms have been developed to calculate a Respiratory Disturbance Index (RDI) that well correlates with the results of standard polysomnography, 12,13 and that showed a good performance in identifying patients at higher risk of new‐onset AF over the mid‐term 14,15 . The availability of these algorithms offers the opportunity to monitor sleep‐disordered breathing in the long run.…”

Sleep-disordered breathing as a risk factor for unnecessary pacemaker implantation

“…Among the study participants, 21.4% had severe SDB with an AHI >30 events/h. In turn, Marti-Almor et al [33], in a REgistry of Sleep APnea monItoring and Atrial Fibrillation in pacemakeR patients (RESPIRE study), found severe OSA, defined as a respiratory disturbance index of ≥20, in 31.1% of patients with PM capable of detecting SDB. The high sensitivity and specificity of PM with transthoracic impedance sensor in the diagnosis of severe SDB were confirmed by Defaye et al [34] and may improve the initial diagnosis of OSA in the group of patients with permanent cardiac pacing.…”

“…The coexistence of sinus bradycardia during sleep and paroxysmal AF (tachycardia-bradycardia syndrome, T-B syndrome) occurred in nine patients (4.3%). It is worth noting that SDB is a significant and reversible risk factor of new-onset AF, T-B syndrome, and AF recurrence despite adequate pharmacological treatment or with the use of ablation techniques [2,20,[31][32][33].…”