Weather-Associated Variations of Device-Detected Severe Sleep Apnea in Cardiac Pacemaker Patients

Using continuous thoracic impedance measurements, sleep apnea can be long-time monitored via an electronic device sensor. In the ACaSA trial, 233 patients implanted with a cardiac pacemaker (MicroPort CRM, Clamart, France) were prospectively observed between March 2022 and July 2024. For each night of follow-up, the burden of device-detected sleep apnea (DDSA) was measured via transthoracic impedance, defined by a respiratory disturbance index (RDI) ≥ 20 events per sleeping hour. Local meteorological data including maximum ambient diurnal temperature, humidity, precipitation and air pressure change were extracted from the national weather system and linked to the individual patient's place of residence. The association between these weather conditions and RDI in the following night was estimated using a generalised linear mixed effects model. Overall, 74,031 patient-nights of 210 individuals (median age 75.7 years [IQR 69.9-81.3], 77 [36.7%] female) with a median follow up of 593 nights (IQR 348-755) were analysed. In a multivariate regression analysis, ambient maximum diurnal temperature was independently associated with presence of DDSA. Following days with a maximum of 30°C, the odds of experiencing severe DDSA increased by 1.34 (95% CI: 1.17-1.54, p < 0.001) compared to days with only 10°C. Higher relative humidity increased the odds for suffering from severe DDSA as well (OR 1.19 [1.07-1.33] in 90% relative humidity vs. 65% humidity; p = 0.007). These associations of ambient maximum diurnal temperature and relative humidity with severe DDSA the following night need further investigations, in particular in view of upcoming global climate changes.