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Sleep apnea detection by a cardiac resynchronization device integrated thoracic impedance sensor: A validation study against the gold standard polysomnography.

Sleep apnea detection by a cardiac resynchronization device integrated thoracic impedance sensor: A validation study against the gold standard polysomnography.
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Barbieri F, Dichtl W, Heidbreder A, Brandauer E, Stefani A, Adukauskaite A, Senoner T, Schgör W, Hintringer F, Högl B,


Barbieri F, Dichtl W, Heidbreder A, Brandauer E, Stefani A, Adukauskaite A, Senoner T, Schgör W, Hintringer F, Högl B, (click to view)

Barbieri F, Dichtl W, Heidbreder A, Brandauer E, Stefani A, Adukauskaite A, Senoner T, Schgör W, Hintringer F, Högl B,

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PloS one 2018 04 0613(4) e0195573 doi 10.1371/journal.pone.0195573
Abstract
BACKGROUND
Sleep disordered breathing is a common but often undiagnosed comorbidity in heart failure patients. Cardiac implantable electronic devices used for cardiac resynchronization therapy (CRT) may detect sleep apnea by use of a transthoracic impedance sensor. Validation of the AP scan® algorithm (Boston Scientific®) was performed by using the diagnostic gold standard polysomnography (PSG).

METHODS
Forty-one patients with impaired left ventricular ejection fraction, frequent right ventricular pacing due to atrioventricular block and heart failure symptoms despite optimal medical therapy underwent upgrading to biventricular pacing. Within one month after left ventricular lead implantation, sleep apnea was assessed by single-night PSG and AP scan® measurements.

RESULTS
AP scan® measurements were valid in only 21 of 41 (51.2%) patients in the index night of the PSG. The PSG determined apnea-hypopnea index did not correlate statistically significant with the AP scan® measurements (r = 0.41, 95% confidence interval -0.05-0.72, p = 0.07). The degree of overestimation is displayed by using the Bland-Altman method: mean difference -12.4, standard deviation ± 15.8, 95% confidence interval -43.3-18.6.

CONCLUSIONS
In heart failure patients receiving CRT upgrading, the AP scan® algorithm may need further improvement before it can be recommended for sleep apnea detection.

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