Association between implantable defibrillator‐detected sleep apnea and atrial fibrillation: The DASAP‐HF study

Giuseppe Boriani; Igor Diemberger; Ennio Pisanò; Paolo Pieragnoli; Alessandro Locatelli; Alessandro Capucci; A Talarico; Massimo Zecchin; Antonio Rapacciuolo; Marcello Piacenti; Miguel Á. Arias; Catia Checchinato; Maria Teresa La Rovere; Gianfranco Sinagra; Michele Emdin; Renato Pietro Ricci; Antonio D’Onofrio

doi:10.1111/jce.15506

May 2, 2022Journal of Cardiovascular ElectrophysiologyOpen Access

Association between implantable defibrillator‐detected sleep apnea and atrial fibrillation: The DASAP‐HF study

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Why the study?

An ICD-computed Respiratory Disturbance Index (RDI) accurately identifies severe sleep apnea, but whether it could also predict AF burden remained to be tested.

Does ICD-detected severe sleep apnea predict atrial fibrillation burden in patients with heart failure and reduced ejection fraction?

Structured PICO

Does ICD-detected severe sleep apnea predict atrial fibrillation burden in patients with heart failure and reduced ejection fraction?

P

Population

164 patients with ejection fraction ≤35% implanted with an implantable cardioverter defibrillator (ICD)

I

Intervention

Severe sleep apnea detected by continuously measured weekly mean Respiratory Disturbance Index (RDI) ≥ 30 episodes/h computed by an ICD algorithm

C

Comparator

RDI < 30 episodes/h (absence of severe sleep apnea)

O

Outcome

Daily atrial fibrillation (AF) burden of ≥5 min, ≥6 h, and ≥23 h over 24 months follow-up

In heart failure patients with an ICD, device-detected severe sleep apnea is associated with a two- to three-fold higher risk of experiencing significant atrial fibrillation burden.

Implication

May warrant sleep apnea assessment in HF-ICD patients; leaves open whether treatment reduces AF burden.

Abstract

INTRODUCTION: The Respiratory Disturbance Index (RDI) computed by an implantable cardioverter defibrillator (ICD) algorithm accurately identifies severe sleep apnea (SA). In the present analysis, we tested the hypothesis that RDI could also predict atrial fibrillation (AF) burden. METHODS: Patients with ejection fraction ≤35% implanted with an ICD were enrolled and followed up for 24 months. One month after implantation, patients underwent a polysomnographic study. The weekly mean RDI value was considered, as calculated during the entire follow-up period and over a 1-week period preceding the sleep study. The endpoints were as follows: daily AF burden of ≥5 min, ≥6 h, ≥23 h. RESULTS: Here, 164 patients had usable RDI values during the entire follow-up period. Severe SA (RDI ≥ 30 episodes/h) was diagnosed in 92 (56%) patients at the time of the sleep study. During follow-up, AF burden ≥ 5 min/day was documented in 70 (43%), ≥6 h/day in 48 (29%), and ≥23 h/day in 33 (20%) patients. Device-detected RDI ≥ 30 episodes/h at the time of the polygraphy, as well as the polygraphy-measured apnea hypopnea index ≥ 30 episodes/h, were not associated with the occurrence of the endpoints, using a Cox regression model. However, using a time-dependent model, continuously measured weekly mean RDI ≥ 30 episodes/h was independently associated with AF burden ≥ 5 min/day (hazard ratio [HR]: 2.13, 95% confidence interval [CI]: 1.24-3.65, p = .006), ≥6 h/day (HR: 2.75, 95% CI: 1.37-5.49, p = .004), and ≥23 h/day (HR: 2.26, 95% CI: 1.05-4.86, p = .037). CONCLUSIONS: In heart failure patients, ICD-diagnosed severe SA on follow-up data review identifies patients who are from two- to three-fold more likely to experience an AF episode, according to various thresholds of daily AF burden.