Abstract
Pacemaker apnea scan algorithms are able to screen for sleep apnea. We investigated whether these systems were able to accurately detect sleep-disordered breathing (SDB) in two patients from an outpatient clinic. The first patient suffered from ischemic heart failure and severe central sleep apnea (CSA) and underwent adaptive servoventilation therapy (ASV). The second patient suffered from dilated cardiomyopathy and moderate obstructive sleep apnea (OSA). Pacemaker read-outs did not match polysomnography (PSG) recordings well and overestimated the apnea–hypopnea index. However, ASV therapy-induced SDB improvements were adequately recognized by the apnea scan of the Boston Scientific INVIVE® cardiac resynchronization therapy pacemaker. Detection of obstructive respiratory events using impedance-based technology may underestimate the number of events, as frustrane breathing efforts induce impedance changes without significant airflow. By contrast, in the second case, apnea scan overestimated the number of total events and of obstructive events, perhaps owing to a very sensitive but less specific hypopnea definition and detection within the diagnostic algorithm of the device. These two cases show that a pacemaker apnea scan is able to reflect SDB, but PSG precision is not met by far. The device scan revealed the decline of SDB through ASV therapy for CSA in one patient, but not for OSA in the second case. To achieve reliable monitoring of SDB, further technical developments and clinical studies are necessary.
Zusammenfassung
Schrittmacher-Apnoescan-Algorithmen können zum Apnoe-Screening genutzt werden. Wir untersuchten, ob diese Systeme zuverlässig für die Erkennung schlafbezogener Atemstörungen sind bei 2 Patienten unserer Ambulanz. Der erste Patient hatte eine ischämische Kardiomyopathie, schwere zentrale Schlafapnoe (ZSA) und erhielt eine adaptive Servoventilationstherapie (ASV). Der zweite Patient hatte eine dilatative Kardiomyopathie und ein mittelgradiges obstruktives Schlafapnoe-Syndrom (OSAS). Die Schrittmacher-Ausdrucke korrelierten nicht gut mit der Polysomnographie (PSG) und überschätzten den Apnoe-Hypopnoe-Index (AHI). ASV-Therapie-induzierte Verbesserungen der Schlafapnoe wurden jedoch adäquat durch den Apnoe-Scan des CRT-Schrittmachers erkannt. Die Anzahl obstruktiver Atemereignisse kann durch Impedanz-messende Algorithmen unterschätzt werden, da frustrane Atemmanöver Impedanzänderungen verursachen ohne signifikanten Luftstrom. Auf der anderen Seite zeigt der 2. Fall, dass der Apnoe-Scan die Anzahl aller Ereignisse und aller obstruktiven Ereignisse überschätzen kann, am ehesten aufgrund einer zu sensitiven und zu unspezifischen Definition der Hypopnoe und -Detektion in diesem diagnostischen Device-Algorithmus. Diese 2 Fälle zeigen, dass Schrittmacher Apnoe-Scans in der Lage sind, schlafbezogene Atemstörungen zu erkennen, jedoch mit einer Präzision weit unter der Polysomnographie. Der Device-Scan erkannte die Abnahme der Schlafapnoe durch ASV-Therapie bei ZSA bei einem Patienten, jedoch nicht für OSAS im zweiten Fall. Um Schlafapnoe zuverlässig monitoren zu können, sind weitere technische Verbesserungen und klinische Studien notwendig.
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H. Fox, G. Nölker, K-J. Gutleben, T. Bitter, D. Horstkotte, and O. Oldenburg state that there are no conflicts of interest.
This article does not contain any studies with human or animal subjects.
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Fox, H., Nölker, G., Gutleben, KJ. et al. Reliability and accuracy of sleep apnea scans in novel cardiac resynchronization therapy devices: an independent report of two cases. Herzschr Elektrophys 25, 53–55 (2014). https://doi.org/10.1007/s00399-014-0298-6
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DOI: https://doi.org/10.1007/s00399-014-0298-6