Implantable cardiac devices in sleep apnoea diagnosis: A systematic review and meta-analysis. (1st February 2022)

• Record Type: Journal Article
• Authors: Ben Messaoud, Raoua; Khouri, Charles; Pépin, Jean Louis; Cracowski, Jean Luc; Tamisier, Renaud; Barbieri, Fabian; Heidbreder, Anna; Joyeux-Faure, Marie; Defaye, Pascal
• Is Part Of: International journal of cardiology. Volume 348(2022)
• Page Start: 76
• Page End: 82
• Publication Date: 2022-02-01
• Subjects: Sleep apnoea syndrome -- Diagnosis -- Pacemaker -- Implantable cardiac defibrillator -- Polysomnography; AF Atrial Fibrillation -- AHI Apnoea-Hypopnoea Index -- AIC Akaike Information Criterion -- AUC Area Under the ROC Curve -- AVB Atrioventricular Block -- BMI Body Mass Index -- CAI Central Apneoa Index -- CI Confidence Interval -- CPAP Continuous Positive Airway Pressure -- CRT-D Cardiac Resynchronization Therapy Defibrillator -- CRT-P Cardiac Resynchronization Therapy Pacemaker -- CSA Central Sleep Apnoea -- HF Heart Failure -- ICD Implantable Cardioverter Defibrillator -- OSA Obstructive Sleep Apnoea -- PG Polygraphy -- PM Pacemaker -- PSG Polysomnography -- RDI Respiratory Disturbance Index -- ROC Receiver Operating Characteristic -- SAS Sleep Apnoea Syndrome -- SND Sinus Node Dysfunction; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2021.12.014
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: A particularly high burden of sleep apnoea is reported in patients treated with cardiac implants such as pacemakers and defibrillators. Sleep apnoea diagnosis remains a complex procedure mainly based on sleep and respiratory indices captured by polysomnography (PSG) or respiratory polygraphy (PG). Aim: We aimed to evaluate the performance of implantable cardiac devices for sleep apnoea diagnosis compared to reference methods. Method: Systematic structured literature searches were performed in PubMed, Embase and. Cochrane Library was performed to identify relevant studies. Quantitative characteristics of the studies were summarized and a qualitative synthesis was performed by a randomized bivariate meta-analysis and completed by pre-specified sensitivity analyses for different implant types and brands. Results: 16 studies involving 999 patients met inclusion criteria and were included in the meta-analysis. The majority of patients were men, of mean age of 64 ± 4.6 years. Sensitivity of cardiac implants for sleep apnoea diagnosis ranged from 60 to 100%, specificity from 50 to 100% with a prevalence of sleep apnoea varying from 22 to 91%. For an apnoea-hypopnoea index threshold ≥30 events/h during polysomnography (corresponding to severe sleep apnoea), the overall performance of the implants was relevant with a sensitivity of 78% and a specificity of 79%. Subgroup analyses on implant type and brand provided no additional information owing to the small number of studies. Conclusion: The respiratory disturbance index provided by cardiac implants is clinically relevant and might improve access to sleep apnoea diagnosis in at-risk cardiovascular populations. PROSPERO Registration number: CRD42020181656. Graphical abstract: An overview on sleep apnoea diagnosis with cardiac devices versus the reference test (Polysomnography or Polygraphy) and the principal meta-analysis results. Unlabelled Image Highlights: Implantable Cardiac Devices perform well for sleep apnoea diagnosis. It is mportant to implement an apnoea diagnosis strategy in Cardiology clinics. Data provided by cardiac implants are a step towards the daily comprehensive health monitoring of cardiology patients.