P3796Prediction of severe sleep apnea in patients with nocturnal bradycardia or conduction disorders

Abstract

Abstract Background According to the 2018 ACC/AHA/HRS Bradycardia Clinical Practice Guidelines an effective treatment of obstructive sleep apnea (OSA) can prevent the need to implant a pacemaker. The aim of the study was to create a prediction model of high risk of OSA in patients with bradycardia or conduction disorders during sleep and referred for pacemaker implantation. Methods and results The polysomnography was performed in 118 (20 female) high-cardiovascular risk patients; aged 60.1±11.7 years; body mass index (BMI) 32.65±7.1. Sleep-disordered breathing (SDB) as an apnea/hypopnea index (AHI) ≥5 per hour was observed in 101 (85.6%) subjects including moderate SDB (AHI≥15) in 28 (27.7%) and severe SDB (AHI≥30) in 43 (42.6%) subjects. The risk of severe SDB increased with increasing BMI; if ≥30kg/m2 (AUC=0.725, sensitivity 81.4%, specificity 55.4%, p<0.0001), the neck size; if ≥43cm (AUC=0.74, sensitivity 60.0%, specificity 75.7%, p<0.0001). The ECG Holter was performed in 93 patients and revealed in 27 of them bradycardia and/or conduction disorders during sleep: episodes of bradycardia <40 beats per minute in 19 (20.4%), sinus arrest in 7 (7.5%) and an atrioventricular block in 8 (8.6%). The neck size, BMI and AHI in these patients were larger: 45.8±4.0 vs. 42.6±3.0 cm (p=0.081), 37.5±8.4 vs. 30.4±5.5kg/m2 (p=0.0003) and 38.0±22.5 vs. 21.7±21.4 (p=0.0016) respectively. When age, sex, BMI and neck size were taken into consideration using multivariate modeling the BMI and sex if male were revealed as independent predictors of clinically significant SDB (AHI ≥15); (p=0.0001, AUC for model 0.820) (figure 1). Figure 1. Receiver-operating characteristic curve showed the best cut-off value of BMI >34,9 kg/m2 (sensitivity 72,73, specificity 78,12) to predict nocturnal bradycardia or conduction disorders in patients with sleep apnea and AHI index ≥15. Conclusions In patients who are being considered for a pacemaker implantation for bradycardia or conduction disorders during sleep, with BMI >30kg/m2 or the neck size over 43cm screening for sleep apnea syndrome is reasonable.