Abstract 16745: Usefulness of Analysis of Transthoracic Impedance Signals for Accurate Diagnosis of Sleep Disordered Breathing in Patients with Permanent Pacemaker Implantation
Purpose: There are several reports regarding an excessively high prevalence of undiagnosed sleep disordered breathing (SDB) in patients with permanent pacemaker implantation. Some programs for pacemakers utilize transthoracic impedance changes between the generator and the electrode tip to derive minute ventilation as a sensor for rate adaptation. We investigated whether this system can detect sleep-related breathing disorders.
Methods: We investigated 39 patients (19 male, 20 female, 78±13 (SD) years) who underwent permanent pacemaker implantation for sick sinus syndrome and advanced or complete atrio-ventricular nodal block. Body mass index of these patients was 23±4 kg/m2. Chronic heart failure was observed in 10 (26%) of 39 patients. We measured the number of the transthoracic impedance signals remaining unchanged for more than 10 seconds with use of the pacemaker minute ventilation sensor (SORIN), and compared with the results of polysomnography (Morpheus C, Teijin). By using polysomnography, we calculated the number of apnea/hypopnea episode per hour (apnea/hypopnea index: AHI). We defined the number of respiratory cycles more than 10 seconds of unchanged transthoracic impedance signals as the respiratory disturbance index (RDI). Receiver operating characteristic (ROC) analysis was performed on the RDI for the diagnosis of moderate to severe SDB (AHI >20).
Results: Moderate to severe SDB was diagnosed in 18 (46%) of 39 patients. The area under the ROC curve was 0.87 (95% CI 0.75 to 0.99). Given a cutoff value of 210/hour for the RDI, the RDI can significantly (p<0.05) discriminate between patients with and without moderate to severe SDB, and showed 72.2% sensitivity and 90.5% specificity for the diagnosis. The RDI was well correlated with the AHI in patients with moderate to severe SDB (n=15, r=0.771, p=0.0004).
Conclusions: Detection of apnea/hypopnea episode by pacemaker minute ventilation sensor is feasible and accurate for diagnosing SDB in patients with permanent pacemaker implantation.
- © 2011 by American Heart Association, Inc.