SPC365

Usefulness of device-detected respiratory disturbance index to assess CPAP therapy efficacy in patients with sleep apnea syndrome

Session: Posters (Sessão 4 - Écran 1) - Dispositivos em Arritmologia
Speaker: MARIANA GOMES TINOCO

Congress: CPC 2023
Topic: C. Arrhythmias and Device Therapy
Theme: 09. Device Therapy
Subtheme: 09.6 Device Therapy - Other
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Mariana Tinoco; Filipa Cardoso; Tamara Pereira; Margarida Castro; Claudia Mendes; Assunção Alves; Bernardete Rodrigues; Rita Andrade; António Costa; Lucy Calvo; Sérgio Leite; Silvia Ribeiro; Victor Sanfins; António Lourenço

<p style="text-align:justify"><span style="font-family:Comic Sans MS,cursive"><span style="font-size:12px"><strong>Background</strong></span></span></p>

<p style="text-align:justify"><span style="font-family:Comic Sans MS,cursive"><span style="font-size:12px">Sleep apnea syndrome (SAS) is a common sleep-related breathing disorder where precise treatment assessment is of high importance. </span></span></p>

<p style="text-align:justify"><span style="font-family:Comic Sans MS,cursive"><span style="font-size:12px">Some cardiac implantable electronic devices (CIED) are able to monitor intrathoracic impedance for automatic detection of sleep apnea events.</span></span></p>

<p style="text-align:justify"><span style="font-family:Comic Sans MS,cursive"><span style="font-size:12px">We aimed to evaluate the usefulness of CIED-detected respiratory disturbance index (RDI) to assess continuous positive airway pressure (CPAP) therapy efficacy.</span></span></p>

<p style="text-align:justify"><span style="font-family:Comic Sans MS,cursive"><span style="font-size:12px"><strong>Methods</strong></span></span></p>

<p style="text-align:justify"><span style="font-family:Comic Sans MS,cursive"><span style="font-size:12px">We performed a retrospective study that included patients with CIED with sleep apnea algorithm with a previous diagnosis of SAS. </span></span></p>

<p style="text-align:justify"><span style="font-family:Comic Sans MS,cursive"><span style="font-size:12px">We analysed CPAP device data (information about daily use, pattern of use, respiratory events (residual AHI) and mask leaks) and CIED-detected RDI.</span></span></p>

<p style="text-align:justify"><span style="font-family:Comic Sans MS,cursive"><span style="font-size:12px">A cut-off value of 20 and 30 (correlating with apnea hypopnea index (AHI) &gt;30) was used for Microport and Boston Scientific CIEDs, respectively. It was considered the mean RDI of the last week.</span></span></p>

<p style="text-align:justify"><span style="font-family:Comic Sans MS,cursive"><span style="font-size:12px">CPAP therapy efficacy was defined as a reduction AHI episodes to a residual &lt;5 episodes/h.</span></span></p>

<p style="text-align:justify"><span style="font-family:Comic Sans MS,cursive"><span style="font-size:12px"><strong>Results&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </strong></span></span></p>

<p style="text-align:justify"><span style="font-family:Comic Sans MS,cursive"><span style="font-size:12px">Of 45 SAS patients (mean age 72 years; 78% male), 31 (69%) reported using CPAP. The mean polysomnography-measured AHI was 28&plusmn;15 episodes/h. </span></span></p>

<p style="text-align:justify"><span style="font-family:Comic Sans MS,cursive"><span style="font-size:12px">The average percentage of days using CPAP during follow up was 89&plusmn;15% and 7&plusmn;2 hours per night. The median residual AHI was 3 [IQR 1,05-4,75] episodes/h. The median mask leak was 2,5 [IQR 0-19,5] L/min. </span></span></p>

<p style="text-align:justify"><span style="font-family:Comic Sans MS,cursive"><span style="font-size:12px">Considering CPAP users (31), CPAP was effective in 24 (77%) and non-effective in 7 (23% (7). </span></span></p>

<p style="text-align:justify"><span style="font-family:Comic Sans MS,cursive"><span style="font-size:12px">In patients in whom CPAP was effective (n=24), 8 (33%) had a mean RDI&gt;20-30/h and 3 (12,5%) had an RDI&gt;20-30/h in more than 90% of nights. </span></span></p>

<p style="text-align:justify"><span style="font-family:Comic Sans MS,cursive"><span style="font-size:12px">In patients in whom CPAP was not effective (7), 5&nbsp; (71%) had a mean RDI&gt;20-30/h and 3 (43%) &nbsp;had an RDI&gt;20-30/h in more than 90% of nights.</span></span></p>

<p style="text-align:justify"><span style="font-family:Comic Sans MS,cursive"><span style="font-size:12px">Correlation of mean RDI&gt;20-30/h and CPAP efficacy, had a sensitivity of 79,2%, a specificity of 40%, a positive predictive value of 86,4% and a negative predictive value of 28,6%;</span></span></p>

<p style="text-align:justify"><span style="font-family:Comic Sans MS,cursive"><span style="font-size:12px"><strong>Conclusions:</strong></span></span></p>

<p style="text-align:justify"><span style="font-family:Comic Sans MS,cursive"><span style="font-size:12px">Our data suggests a trend to CIED-detected RDI to assess CPAP therapy efficacy. However, the limited number of patients did not allow confirmation that CIED-detected RDI is a good tool for the assessment of CPAP therapy efficacy. </span></span></p>

<p style="text-align:justify"><span style="font-family:Comic Sans MS,cursive"><span style="font-size:12px">Some patients in whom CPAP was effective have high RDI. The reasons for this need to be investigated.</span></span></p>

<p style="text-align:justify"><span style="font-family:Comic Sans MS,cursive"><span style="font-size:12px">We hope that by increasing the sample size, the results will reveal the value of CIED-detected RDI in assessing CPAP efficacy.</span></span></p>