Feasibility of automated detection of sleep apnea using implantable pacemakers and defibrillators: a comparison with simultaneous polysomnography recording

Abstract

Purpose Sleep-related breathing disorders (SRBD) have been associated with adverse cardiovascular events and prognosis. Some modern pacemakers (PMK) and implantable cardioverter defibrillators (ICD) are equipped with thoracic impedance monitoring systems which allow detecting fluctuations in tidal volume occurring in SRBD. This study aimed at assessing the accuracy of a novel transthoracic impedance-based PMK/ICD sensor for automatic detection of SRBD.Methods We prospectively enrolled 31 consecutive patients scheduled for implantation of a PMK or an ICD with sleep respiratory disturbances monitoring capability. The results of unattended home nocturnal recordings expressed as apnea/hypopnea index (AHI) were compared with the respiratory disturbance index (RDI) stored in the cardiac device memory at the time polygraphy was performed. Results Among the 31 enrolled patients (20 men, mean age 70 ± 8 years), a comparison between the data from polygraphy and cardiac device was feasible in 29 patients. According to the results of home nocturnal recording, a severe SRBD was observed in 7/29 (24.1%) patients. On the basis of receiver-operating characteristic curve analysis of RDI values, the optimal RDI cutoff value to identify severe SRBD was 47 episodes/h (sensitivity 100%, specificity 100%). Bland-Altman agreement analysis of AHI-RDI revealed a bias between measurements of − 11 episodes/h, with limits of agreement − 38 to 15 episodes/h. Conclusions In the present study, the novel transthoracic impedance-based monitoring system ApneaScan TM appeared effective in screening PMK and ICD patients for SRBD.

Home delivery of the communicator for remote monitoring of cardiac implantable devices: A multicenter experience during the covid‐19 lockdown

“…The safety and efficacy of RM was established a decade ago by the landmark TRUST trial, in which RM with automatic daily surveillance of ICD was able to detect actionable events more rapidly than conventional in‐office visits 15 . As also reported in several studies, not only does RM play a central role in preventing hospitalizations and improving survival and quality of life in patients with CIEDs, it is also a cost‐effective alternative to in‐person evaluations 16–25 . Overall, in the context of the COVID‐19 emergency, the improvement of RM coverage has facilitated continuous patient assistance and significantly reduced the risk of virus transmission among both more vulnerable populations and healthcare providers 26–28 …”

Management of cardiac implantable electronic device follow‐up in COVID‐19 pandemic: Lessons learned during Italian lockdown

“…Owing to the wide range of accessible information, RM may contribute to the early detection of a wide range of arrhythmic manifestations, acute decompensation, and device‐related issues 5 . As reported in several studies, 8–13 RM not only plays a central role in preventing hospitalizations, improving survival and quality of life in patients with CIEDs, but is also a cost‐effective alternative to IPEs 14 …”

“…Mounting evidence has confirmed its usefulness for early detection of atrial and ventricular arrhythmias, as well as monitoring of system performance (e.g., lead failure and battery depletion 1–4 ). Additional benefits were also demonstrated among heart failure (HF) patients in terms of preventing unfavorable cardiovascular events and reducing hospital readmissions 5–9 . The outbreak of the novel severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) forced a prompt reorganization of healthcare service delivery, mostly for nonurgent or nonemergent patients, including in‐office follow‐up appointments for patients with a CIED.…”

Remote Monitoring of CIEDs—For Both Safety, Economy and Convenience?

“…Chiu and coworkers recently showed that RM is noninferior to conventional in-hospital follow-up of heart failure patients implanted with a resynchronization device [ 10 ]. Thus, in a number of settings, RM can be beneficial without compromising patient safety, and in several studies, improved safety has actually been demonstrated [ 11 , 12 , 13 , 14 ].…”