Pacemaker guided screening for severe sleep apnea, a possible option for patients with atrial fibrillation: A systematic review and meta-analysis.

Autor: Wyckmans M; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium., Tukanov E; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium., Winters R; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium., Stinissen R; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium., Vermeulen H; Interuniversity Institute for Biostatistics and statistical Bioinformatics, Data Science Institute, Hasselt University, Hasselt, Belgium., Dendale P; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.; Heart Center Hasselt, Jessa Hospital, Hasselt, Belgium., Desteghe L; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.; Heart Center Hasselt, Jessa Hospital, Hasselt, Belgium.; Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium.; Cardiology Department, Antwerp University Hospital, Edegem, Belgium.
Jazyk: angličtina
Zdroj: Pacing and clinical electrophysiology : PACE [Pacing Clin Electrophysiol] 2021 Aug; Vol. 44 (8), pp. 1421-1431. Date of Electronic Publication: 2021 May 22.
DOI: 10.1111/pace.14256
Abstrakt: Introduction: Obstructive sleep apnea is often underdiagnosed in atrial fibrillation (AF) patients although it is an important risk factor. A systematic review and meta-analysis was performed to assess which techniques cardiac implantable electronic devices (CIED) and Holter monitors use to screen for sleep apnea (SA), and to evaluate if these are suitable for AF patients from a diagnostic accuracy perspective.
Methods: The search was conducted in accordance with the PRISMA-guidelines. PICO was defined as (P) patients with AF, (I) Holter monitors or CIED suitable for screening for SA, (C) overnight polysomnography (PSG), (O) positive screening with subsequent positive polysomnographic diagnosis of SA. Optimal index test cut-off points corresponding to reference test cut-off for severe SA (PSG-AHI ≥ 30) were compared. Meta-analysis was conducted for the diagnostic odds ratio (DOR), with forest plot and ROC-curve for summary DOR.
Results: A total of five prospective cohort studies (n = 192) were included in the systematic review of which four studies (n = 132) were included in the meta-analysis. All included studies use transthoracic impedance measurement as a screening parameter. No studies evaluating Holter monitors were included. The population consisted of patients indicated for pacemaker implantation. The summary DOR was 27.14 (8.83; 83.37), AUC was 0.8689 (0.6872; 0.9456) and Q* was 0.8390 (0.7482; 0.9013).
Conclusion: At optimal pacemaker-cut-off, pacemaker-guided screening for severe SA in patients with AF can be an effective triage tool for clinical practice. Further studies with larger sample sizes are needed to strengthen the evidence for this conclusion.
(© 2021 Wiley Periodicals LLC.)
Databáze: MEDLINE
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