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(Circulation. 2004;110:2562-2567.)
© 2004 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Diagnosis of Sleep-Related Breathing Disorders by Visual Analysis of Transthoracic Impedance Signals in Pacemakers

Christoph Scharf, MD; Yong K. Cho, PhD; Konrad E. Bloch, MD; Corinna Brunckhorst, MD; Firat Duru, MD; Kryzstof Balaban, MD; Nancy Foldvary, DO; Lynn Liu, MD; Richard C. Burgess, PhD, MD; Reto Candinas, MD; Bruce L. Wilkoff, MD

From University Hospital of Zurich, Department of Internal Medicine, Division of Cardiology and Pneumology, Zurich, Switzerland (C.S., K.E.B., C.B., F.D., R.C.); the Cleveland Clinic Foundation, Departments of Cardiovascular Medicine and Pulmonary Medicine, Cleveland, Ohio (K.B., N.F., L.L., R.C.B., B.L.W.); and Medtronic Inc, Minneapolis, Minn (Y.K.C.).

Correspondence to Christoph Scharf, MD, Cardiovascular Center, University Hospital Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland. E-mail christoph.scharf{at}usz.ch

Received July 8, 2003; de novo received April 8, 2004; revision received June 16, 2004; accepted June 17, 2004.

Background— Minute ventilation sensors of cardiac pacemakers measure ventilation by means of transthoracic impedance changes between the pacemaker case and the electrode tip. We investigated whether this technique might detect sleep-related breathing disorders.

Methods and Results— In 22 patients, analog waveforms of the transthoracic impedance signal measured by the pacemaker minute ventilation sensor over the course of a night were visualized, scored for apnea/hypopnea events, and compared with simultaneous polysomnography. Analysis of transthoracic impedance signals correctly identified the presence or absence of moderate to severe sleep apnea (apnea/hypopnea index, AHI >20 h^–1) in all patients (receiver operating characteristics, ROC=1.0). The ROC for AHI scores of 5 h^–1 and 10 h^–1 showed an area under the curve of 0.95, P<0.005, and 0.97, P<0.0001, respectively. Accuracy over time assessed by comparing events per 5-minute epochs was high (Cronbach reliability coefficient, 0.85; intraclass correlation, 0.73). Event-by-event comparison within ±15 seconds revealed agreement in 81% (, 0.77; P<0.001).

Conclusions— Detection of apnea/hypopnea events by pacemaker minute ventilation sensors is feasible and accurate compared with laboratory polysomnography. This technique might be useful to screen and monitor sleep-related breathing disorders in pacemaker patients.

Key Words: pacemakers • diagnosis • sleep apnea syndromes

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