Automatic recognition of abnormal respiratory events during sleep by a pacemaker transthoracic impedance sensor
Automatic recognition of abnormal respiratory events during sleep by a pacemaker transthoracic impedance sensor
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DOI：
10.1046/j.1540-8167.2004.04030.x
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发表时间：
2004-09-01
影响因子：
2.7
通讯作者：
Garrigue, S
中科院分区：
文献类型：
--
作者：
Defaye, P;Pépin, JL;Garrigue, S
睡眠中的呼吸异常事件。导言：许多起搏器使用经胸阻抗来获得微小的通气量，作为心率适应的传感器。经胸阻抗还能够跟踪睡眠呼吸暂停/低呼吸综合征(SAS)患者潮气量的波动。我们评估了经胸阻抗衍生起搏器算法用于监测睡眠呼吸紊乱的可行性。方法和结果：42例患者在植入Talent(TM)3起搏器(ELA Medical)后1个月进行了常规多导睡眠监测。将起搏器记忆中存储的呼吸紊乱指数(RDI)与多导睡眠图得出的呼吸暂停/低通气指数(AHI)进行比较。评估起搏器识别重度SAS患者(AHI大于或等于30)的能力。从Bland和Altman图中观察到最小的系统误差(偏差=0.9事件/小时)。起搏器RDI识别重度SAS患者的能力是通过分析接收器操作员的特征来确定的。当RDI值为30.6次/小时时，灵敏度为75%，特异度为94%，阳性预测值为75%，阴性预测值为94%。其性能可与现有的简单筛选技术相媲美。永久监测呼吸的能力与其他诊断功能(如动态心电图功能)相结合，为监测睡眠期间心律失常和呼吸障碍之间的联系提供了一个独特的机会。
Abnormal Respiratory Events During Sleep. Introduction: A number of pacemakers use transthoracic impedance to derive minute ventilation as a sensor for rate adaptation. Transthoracic impedance is also able to track fluctuations in tidal volume occurring in sleep apnea/hypopnea syndromes (SAS). We evaluated the feasibility of a transthoracic impedance-derived pacemaker algorithm for monitoring sleep respiratory disturbances.Methods and Results: Forty-two patients who presented with a conventional indication for DDD pacing or cardiac resynchronization underwent conventional polysomnography 1 month after implantation of a Talent(TM) 3 pacemaker (ELA Medical). The respiratory disturbance index (RDI) stored in the pacemaker memory was compared to the apnea/hypopnea index (AHI) derived from polysomnography. The ability of the pacemaker to identify severe SAS patients (AHI greater than or equal to 30) was assessed. A minimal systematic error was observed from a Bland and Altman plot (bias = 0.9 events/hour). The ability of the pacemaker RDI to identify severe SAS patients was determined by analysis of the receiver operator characteristic. A cutoff RDI value of 30.6/hour of recording was found to yield 75% sensitivity, 94% specificity, 75% positive predictive value, and 94% negative predictive value.Conclusion: The RDI monitoring function appears to be of value in screening pacemaker patients for SAS. Its performance is comparable to existing simple screening techniques. The ability to permanently monitor respiration, in combination with other diagnostic capabilities (such as Holter functions), presents a unique opportunity to monitor the association between arrhythmias and disturbances of breathing during sleep.