Association Between Device-Detected Sleep-Disordered Breathing and Implantable Defibrillator Therapy in Patients With...

Area of Science:

• Cardiology
• Sleep Medicine
• Medical Devices

Background:

• Sleep-disordered breathing (SDB) is common in heart failure (HF).
• SDB is a potential risk factor for malignant ventricular arrhythmias.
• Implantable cardioverter-defibrillator (ICD) algorithms can calculate the Respiratory Disturbance Index (RDI) to detect severe sleep apnea.

Purpose of the Study:

• To evaluate the association between ICD-detected sleep apnea and appropriate ICD therapies in HF patients.
• To determine if RDI predicts adverse cardiac events in HF patients.

Main Methods:

• 411 HF patients with ICDs capable of RDI calculation were enrolled.
• Weekly mean RDI values were analyzed over a median follow-up of 26 months.
• Time-dependent Cox regression was used to assess the association between RDI and appropriate ICD shocks.

Main Results:

• 58 patients (14%) received at least one appropriate ICD shock.
• A continuously measured weekly mean RDI ≥45 episodes/h was independently associated with shock occurrence (HR: 4.63; P < 0.001).
• Patients with shocks were younger and more likely to have received ICDs for secondary prevention.

Conclusions:

• In HF patients, appropriate ICD shocks are more likely during periods of increased sleep-disordered breathing.
• ICD-detected RDI can identify HF patients at higher risk for ventricular arrhythmias.
• Monitoring RDI in HF patients may aid in risk stratification and management.