Pacemakers with sleep apnea monitor (SAM) provide an easy tool to assess obstructive
sleep apnea over long periods of time. The link between respiratory disturbances at
night and the incidence of acute decompensated heart failure (ADHF) is not well established.
We aimed at (1) determining the ability of SAM pacemakers to evaluate the extent of
left ventricular overload and (2) assess the impact of respiratory disturbances at
night on the occurrence of ADHF over 1-year of follow-up. We conducted a single-center
prospective study. Consecutive patients with SAM pacemakers were comprehensively assessed.
SAM automatically computes a respiratory disturbance index (RDI, apneas/hypopneas
per hour - AH/h) in the previous night and the percentage of nights with RDI >20 AH/h
in the previous 6 months. Thirty-seven patients were included (79.3 ± 11.2 years,
46% males). A high RDI in the previous night and a higher %nights with increased RDI
were associated with increased NT-proBNP values (p = 0.008 and p = 0.013, respectively)
and were the sole predictors of increased noninvasive pulmonary capillary wedge pressures
(PCWP) in the morning of assessment (p = 0.031 and p = 0.044, respectively). Receiver
operating characteristic curve analysis revealed an area under the curve of 0.804
(95% confidence interval 0.656 to 0.953, p = 0.002) for %nights with RDI >20 AH/h
in the prediction of high PCWP. Patients with >12.5% of nights with RDI >20AH/h tended
to have more ADHF during follow-up (log-rank p = 0.067). In conclusion, a high burden
of apneas/hypopneas at night is associated with elevated NT-proBNP and PCWP values
and an increased risk of ADHF over 1 year. These patients might benefit from early
tailored clinical management.
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Article info
Publication history
Published online: September 10, 2019
Received in revised form:
August 18,
2019
Received:
July 19,
2019
Footnotes
Funding: This study is funded by an investigator-led research grant from LivaNova. LivaNova had no role in the study beyond funding.
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© 2019 Elsevier Inc. All rights reserved.
