UPmémoires

English

Aim: To compare the atrial fibrillation (AF) burden between patients with severe and nonsevere sleep apnea (SA) detected with pacemakers monitoring sleep-disordered breathing (SDB).

Background: New generation pacemaker (MicroPort CRM®, Clamart France) allow the assessment day by day of SDB based on impedance measurement (1). A recent study demonstrated that incidence of AF is higher in case of severe SA monitored by pacemaker (2).

Methods: This retrospective study was carried out at the University Hospital of Poitiers. We included all patients with Microport CRM pacemaker implanted from 2013 to 2016 at Poitiers university hospital. Exclusion criteria were inactivation of sleep apnea monitoring (SAM), history of sleep apnea, missing data or invalid data. AF burden was assessed according to Fallback mode switch (FMS) duration. Respiratory disturbance index (RDI) was calculated as the average number of events (ventilation pause and reductions) per number of hours of monitoring. Data was collected retrospectively. Patients with RDI<20/h were compared with patients with RDI≥20/h (considered as severe).

Results: 404 patients (mean age = 79.7 ± 10 years; 52.0% men) were included and followed for at least one year. The most prevalent indication for cardiac pacing was atrioventricular block in 57%. Mean RDI was 18.89. 234 (58%) of them had a mean RDI < 20 and 170 (42%) had a mean RDI ≥20. Compared to patients with mean RDI<20, those with mean RDI ≥ 20 were youngers (78.6 ± 10 years Vs 81.8 ±8 years; p = 0.02), were more likely to be male (58.2% Vs 47.5%: p = 0.035) and had more heart failure history (28.8% Vs 19.2%: p= 0.03). BMI was not different between groups (26.3 ±5. vs 26.3 ±4; P=0.33). Mean follow-up was 38 weeks. Patients with mean RDI ≥ 20 had a mean FMS duration longer than mean RDI < 20 (37 879 sec Vs 17 466 sec respectively; p=0.014). RDI was correlated with FMS (r=0.26; p=0.0004). The stroke rate tended to be higher in the mean RDI ≥20 group (2.1% vs 5.4%) but it did not reach significativity (p=0.12).

Conclusion: Severe SA detected by pacemaker was associated with longer AF duration. We did not find higher occurrence of stroke in the severe SA group.

Keywords : obstructive sleep apnea, respiratory disturbance index, atrial fibrillation, pacemaker, sleep apnea monitoring.