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Prognostic value of implantable defibrillator–computed respiratory disturbance index: The DASAP-HF study

Published:October 23, 2020DOI:https://doi.org/10.1016/j.hrthm.2020.10.019

      Background

      Sleep apnea, as measured by polysomnography, is associated with adverse outcomes in heart failure. The DASAP-HF (Diagnosis and Treatment of Sleep Apnea in Patient With Heart Failure) study previously demonstrated that the respiratory disturbance index (RDI) computed by the ApneaScan algorithm (Boston Scientific) accurately identifies severe sleep apnea in implantable cardioverter-defibrillator (ICD) patients.

      Objective

      The purpose of the long-term study phase was to assess the incidence of clinical events after 24 months and investigate the association with RDI values.

      Methods

      Patients with left ventricular ejection fraction ≤35% implanted with an ICD were enrolled and followed-up for 24 months. The RDI calculated at 1 month after implantation was used to stratify patients (below or above 30 episodes/h). The endpoints were all-cause death and a combination of all-cause death or cardiovascular hospitalization.

      Results

      Of the 265 enrolled patients, 224 had usable RDI values. Severe sleep apnea (RDI ≥30 episodes/h) was diagnosed in 115 patients (51%). These patients were more frequently male (84% vs 72%; P = .030) and had higher creatinine levels. During median follow-up of 25 months, 19 patients (8%) died. Cardiovascular hospitalizations were reported in 19 patients (8%). The risk of all-cause death was higher in patients with RDI ≥30 episodes/h (hazard ratio [HR] 3.33; 95% confidence interval [CI] 1.35–8.21; P = .023), as well as the risk of all-cause death or cardiovascular hospitalization (HR 1.94; 95% CI 1.01–3.76; P = .048). At multivariate analysis, independent predictors of death were RDI ≥30 episodes/h (HR 4.02; 95% CI 1.16–13.97; P = .029) and creatinine levels (HR 2.36; 95% CI 1.26–4.42; P = .008).

      Conclusion

      In heart failure patients implanted with an ICD, higher RDI values are associated with death and cardiovascular hospitalizations. Device-detected severe sleep apnea independently predicts death.

      Keywords

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      References

        • Oldenburg O.
        • Lamp B.
        • Faber L.
        • Teschler H.
        • Horstkotte D.
        • Topfer V.
        Sleep disordered breathing in patients with symptomatic heart failure: a contemporary study of prevalence in and characteristics of 700 patients.
        Eur J Heart Fail. 2007; 9: 251-257
        • Emdin M.
        • Giannoni A.
        • Passino C.
        The Breathless Heart—Apneas in Heart Failure.
        Springer, Switzerland2017
        • Peppard P.E.
        • Young T.
        • Palta M.
        • Skatrud J.
        Prospective study of the association between sleep-disordered breathing and hypertension.
        N Engl J Med. 2000; 342: 1378-1384
        • Kanagala R.
        • Murali N.S.
        • Friedman P.A.
        • et al.
        Obstructive sleep apnea and the recurrence of atrial fibrillation.
        Circulation. 2003; 107: 2589-2594
        • Fichter J.
        • Bauer D.
        • Arampatzis S.
        • Fries R.
        • Heisel A.
        • Sybrecht G.W.
        Sleep-related breathing disorders are associated with ventricular arrhythmias in patients with an implantable cardioverter-defibrillator.
        Chest. 2002; 122: 558-561
        • Lanfranchi P.A.
        • Somers V.K.
        • Braghiroli A.
        • Corra U.
        • Eleuteri E.
        • Giannuzzi P.
        Central sleep apnea in left ventricular dysfunction: prevalence and implications for arrhythmic risk.
        Circulation. 2003; 107: 727-732
        • Bitter T.
        • Westerheide N.
        • Prinz C.
        • Hossain M.S.
        • Vogt J.
        • Langer C.
        Cheyne-Stokes respiration and obstructive sleep apnoea are independent risk factors for malignant ventricular arrhythmias requiring appropriate cardioverter-defibrillator therapies in patients with congestive heart failure.
        Eur Heart J. 2011; 32: 61-74
        • Garrigue S.
        • Pépin J.L.
        • Defaye P.
        • et al.
        High prevalence of sleep apnea syndrome in patients with long-term pacing: the European Multicenter Polysomnographic Study.
        Circulation. 2007; 115: 1703-1709
        • Shalaby A.
        • Atwood C.
        • Hansen C.
        • et al.
        Feasibility of automated detection of advanced sleep disordered breathing utilizing an implantable pacemaker ventilation sensor.
        Pacing Clin Electrophysiol. 2006; 29: 1036-1043
        • D'Onofrio A.
        • La Rovere M.T.
        • Emdin M.
        • et al.
        Implantable cardioverter-defibrillator-computed respiratory disturbance index accurately identifies severe sleep apnea: the DASAP-HF study.
        Heart Rhythm. 2018; 15: 211-217
        • Priori S.G.
        • Blomström-Lundqvist C.
        • Mazzanti A.
        • et al.
        2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: the Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC).
        Eur Heart J. 2015; 36: 2793-2867
        • Berry R.B.
        • Budhiraja R.
        • Gottlieb D.J.
        • et al.
        Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine.
        J Clin Sleep Med. 2012; 8: 597-619
      1. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force.
        Sleep. 1999; 22: 667-689
        • Somers V.K.
        • White D.P.
        • Amin R.
        • et al.
        Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council On Cardiovascular Nursing. In collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health).
        Circulation. 2008; 118: 1080-1111
        • La Rovere M.T.
        • Pinna G.D.
        • Maestri R.
        • et al.
        Clinical relevance of short-term day-time breathing disorders in chronic heart failure patients.
        Eur J Heart Fail. 2007; 9: 949954
        • Poletti R.
        • Passino C.
        • Giannoni A.
        • et al.
        Risk factors and prognostic value of daytime Cheyne-Stokes respiration in chronic heart failure patients.
        Int J Cardiol. 2009; 137: 47-53
        • Wang H.
        • Parker J.D.
        • Newton G.E.
        • et al.
        Influence of obstructive sleep apnea on mortality in patients with heart failure.
        J Am Coll Cardiol. 2007; 49: 1625-1631
        • Pépin J.L.
        • Chouri-Pontarollo N.
        • Tamisier R.
        • Lévy P.
        Cheyne-Stokes respiration with central sleep apnoea in chronic heart failure: proposals for a diagnostic and therapeutic strategy.
        Sleep Med Rev. 2006; 10: 33-47
        • Franklin K.A.
        Sleep apnoea screening in heart failure? Not until benefit is proven!.
        Eur Respir J. 2007; 29: 1073-1074
        • Ponikowski P.
        • Voors A.A.
        • Anker S.D.
        • et al.
        2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.
        Eur Heart J. 2016; 37: 2129-2200
        • Flemons W.W.
        • Douglas N.J.
        • Kuna S.T.
        • Rodenstein D.O.
        • Wheatley J.
        Access to diagnosis and treatment of patients with suspected sleep apnea.
        Am J Respir Crit Care Med. 2004; 169: 668-672
        • Kapur V.
        • Strohl K.P.
        • Redline S.
        • Iber C.
        • O'Connor G.
        • Nieto J.
        Underdiagnosis of sleep apnea syndrome in U.S. communities.
        Sleep Breath. 2002; 6: 49-54
        • McKelvie R.S.
        • Moe G.W.
        • Cheung A.
        • et al.
        The 2011 Canadian Cardiovascular Society heart failure management guidelines update: focus on sleep apnea, renal dysfunction, mechanical circulatory support, and palliative care.
        Can J Cardiol. 2011; 27: 319-338
        • Khayat R.
        • Jarjoura D.
        • Porter K.
        • et al.
        Sleep disordered breathing and post-discharge mortality in patients with acute heart failure.
        Eur Heart J. 2015; 36: 1463-1469
        • Arzt M.
        • Young T.
        • Finn L.
        • et al.
        Sleepiness and sleep in patients with both systolic heart failure and obstructive sleep apnea.
        Arch Intern Med. 2006; 166: 1716-1722
        • Linz D.
        • Baumert M.
        • Catcheside P.
        • et al.
        Assessment and interpretation of sleep disordered breathing severity in cardiology: clinical implications and perspectives.
        Int J Cardiol. 2018; 271: 281-288
        • Maestri R.
        • La Rovere M.T.
        • Robbi E.
        • Pinna G.D.
        Night-to-night repeatability of measurements of nocturnal breathing disorders in clinically stable chronic heart failure patients.
        Sleep Breath. 2011; 15: 673-678
        • Prasad B.
        • Usmani S.
        • Steffen A.D.
        • et al.
        Short-term variability in apnea-hypopnea index during extended home portable monitoring.
        J Clin Sleep Med. 2016; 12: 855-863
        • Stöberl A.S.
        • Schwarz E.I.
        • Haile S.R.
        • et al.
        Night-to-night variability of obstructive sleep apnea.
        J Sleep Res. 2017; 26: 782-788
        • Lamba J.
        • Simpson C.S.
        • Redfearn D.P.
        • Michael K.A.
        • Fitzpatrick M.
        • Baranchuk A.
        Cardiac resynchronization therapy for the treatment of sleep apnoea: a meta-analysis.
        Europace. 2011; 13: 1174-1179
        • Augusto J.B.
        • Antunes S.
        • Ferreira J.B.
        • et al.
        Utility of pacemaker with sleep apnea monitor to predict left ventricular overload and acute decompensated heart failure.
        Am J Cardiol. 2019; 124: 1720-1724
        • Khayat R.
        • Abraham W.
        • Patt B.
        • et al.
        Central sleep apnea is a predictor of cardiac readmission in hospitalized patients with systolic heart failure.
        J Card Fail. 2012; 18: 534-540
        • Mazza A.
        • Bendini M.G.
        • De Cristofaro R.
        • et al.
        Pacemaker-detected severe sleep apnea predicts new-onset atrial fibrillation.
        Europace. 2017; 19: 1937-1943