Implantable cardiac devices in sleep apnea diagnosis: a systematic review and meta-analysis

Abstract

Aims: A particularly high burden of sleep apnea is reported in patients treated with cardiac implants such as pacemakers and defibrillators. Sleep apnea diagnosis remains a complex procedure mainly based on sleep and respiratory indices captured by polysomnography (PSG) or respiratory polygraphy (PG). We aimed to evaluate whether implantable cardiac devices are reliable for sleep apnea diagnosis compared to reference methods.

Method and results: We performed a systematic literature search (PubMed, Cochrane Library) to identify relevant studies and finally included 13 studies involving 647 patients in the meta-analysis. The majority of patients were men, of mean age of 70.5 ± 4.8 years. Sensitivity of cardiac implants for sleep apnea diagnosis ranged from 60 to 100%, specificity from 50 to 100% with a prevalence of sleep apnea varying from 22 to 91%.

The overall performance of cardiac implants for sleep apnea diagnosis was assessed by a randomized bivariate meta-analysis and completed by pre-specified sensitivity analyses for different implant types and brands. For an apnea-hypopnea index threshold ≥30 events/hour during polysomnography (corresponding to severe sleep apnoea), the optimal respiratory event threshold for cardiac implants was 31.5/hour with a sensitivity of 80% (61-91%) and specificity of 70% (53-83%). Subgroup analyses on implant type and brand provided no additional information owing to the small number of studies.

Conclusions: The respiratory disturbance index provided by cardiac implants is clinically relevant and might improve access to sleep apnea diagnosis in at risk cardiovascular populations.