title: Variability in obstructive sleep apnea: Analysis of pacemaker-detected respiratory disturbances.
abstract: Obstructive sleep apnea (OSA) is associated with several cardiovascular conditions. Some pacemakers feature specific algorithms detecting respiratory cycles and deriving indices well correlated with the identification of polysomnography-confirmed severe OSA.
  
  
  
  The purposes of this study were to analyze respiratory disturbances measured by a validated algorithm in clinical practice and to describe their variability over time and their association with atrial fibrillation.
  
  
  
  Fifty-eight patients implanted with dual-chamber LivaNova REPLY 200 DR or KORA 100 DR pacemakers measuring a respiratory disturbance index (RDI) were included. An RDI >20 events per hour of sleep is well correlated with severe OSA as determined by polysomnography. Patients with >10% nights with invalid RDI measurements were excluded.
  
  
  
  The RDI could be measured during 98% of nights. During a mean follow-up of 187 ± 123 days, the individual mean RDI was 19.9 ± 12.7 and was superior to 20 in 24 patients (41%). An RDI >20 events/h in at least 1 night was observed in 52 patients (90%). The mean day-to-day RDI variability in individual patients was 19% ± 21%. Patients with the highest burden of severe OSA (as defined by ≥75% of nights with RDI >20 events/h) were older, had a higher prevalence of hypertension, and were more often implanted for atrioventricular block than patients with lower burden of severe OSA. No RDI burden or cutoff was a predictor of atrial fibrillation occurrence.
  
  
  
  OSA is frequent in patients with a pacemaker and is reliably detected by pacemakers. OSA is highly variable and could probably be best analyzed in terms of burden.
authors.affiliation: Department of Electrophysiology and Pacing, Groupe Hospitalier Paris Saint-Joseph, Paris, France. Electronic address: gmoubarak@rythmologie.paris.
authors.forename: Ghassan
authors.initials: G
authors.lastname: Moubarak
authors.affiliation: Department of Electrophysiology and Pacing, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
authors.forename: Abdeslam
authors.initials: A
authors.lastname: Bouzeman
authors.affiliation: LivaNova CRM SAS, Clamart, France.
authors.forename: Thibaut
authors.initials: T
authors.lastname: de Geyer d'Orth
authors.affiliation: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Bouleti
authors.affiliation: Department of Pulmonary Medicine, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Beuzelin
authors.affiliation: Department of Electrophysiology and Pacing, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Cazeau
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000628:therapy; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D015897:Comorbidity; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D017286:Polysomnography / Q000379:methods; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000209:etiology; D012307:Risk Factors; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology
keywords: Atrial fibrillation; Obstructive sleep apnea; Pacemaker; Sleep apnea burden; Sleep apnea monitoring