Feasibility of Transcatheter Caval Valve Implantation to Improve -Disordered Breathing in Patients With Severe Tricuspid Regurgitation-A Pilot Study

Transcatheter caval valve implantation (CAVI) has been evaluated as a treatment option for inoperable patients with severe symptomatic tricuspid regurgitation (TR). We studied the effect of CAVI on sleep disorder breathing (SDB) in patients with right heart failure and TR. Twenty right heart failure patients with severe symptomatic TR who underwent portable monitoring of SDB (ApneaLink), echocardiography, cardiopulmonary exercise (CPET), and laboratory testing were enrolled. This was a single-center, nonblinded study. There were no significant changes in sleep variables, echocardiographic parameters, laboratory results, lung function, and CPET after CAVI. In conclusion, these data suggest that CAVI may not have an effect on SDB; however, additional follow-up fully powered studies with appropriate statistical analyses are needed.

Clinical screening tools for obstructive sleep apnea in a population with atrial fibrillation: a diagnostic accuracy trial

STUDY OBJECTIVES

Although obstructive sleep apnea (OSA) is a known risk factor for atrial fibrillation (AF), there is a paucity of data around its diagnosis and management in patients with AF. The objectives of this study were to compare the diagnostic accuracy of commonly used OSA screening tools in an AF population, including a level 3 portable sleep study device, and to examine the epidemiology of OSA in a hospital cohort with AF.

METHODS

One hundred seven patients with AF recruited from 2 tertiary centers underwent a panel of OSA screening tools and in-laboratory polysomnography in randomized order.

RESULTS

Oxygen desaturation index derived from a level 3 portable sleep study device performed best for moderate to severe and severe OSA, with excellent diagnostic accuracy (area under the curve, 0.899; 95% confidence interval, 0.838-0.960 and area under the curve, 0.925; 95% confidence interval, 0.859-0.991, respectively). Sixty-seven patients (62.6%) were newly diagnosed with OSA (31.8% mild, 18.7% moderate, 12.1% severe).

CONCLUSIONS

Undiagnosed OSA is highly prevalent in a hospital AF cohort. However, it is characterized by a relative paucity of symptoms, markedly limiting the usefulness of history or screening questionnaires. This is the first study to find that a level 3 home sleep study device shows excellent diagnostic accuracy in patients with AF. This finding may inform AF management guidelines.

CLINICAL TRIAL REGISTRATION

Registry: Australian New Zealand Clinical Trials Registry; Name: The validity and reliability of a portable device for the diagnosis of Obstructive Sleep Apnoea in patients with Atrial Fibrillation; URL:https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371024; Identifier: ACTRN12616001016426.

Obstructive sleep apnoea and open heart surgery: a review of its incidence and impact to patients

Background

Obstructive sleep apnea (OSA) is a serious health disorder which contributes to cardiovascular complications, decreased work productivity, automobile accidents, and death. This condition is characterized by a temporary cessation of breathing resulting due to upper airway closure during a person's sleep. Strain to the heart caused by this repetitive hypoxic insult can lead to postoperative complications for patients undergoing heart surgery. Recognizing cardiac surgical patients with OSA is important. Early recognition and intervention such as use of BiPAP device can reduce the postoperative complications due to OSA.

Methods

The aim of this study is to identify the incidence of unrecognized OSA in cardiac surgical patients. This is a retrospective analysis of a prospective data of the study which was done between July 2012 and July 2013 in University Malaya Medical Center. All patients undergoing elective cardiac surgery were recruited and the demographic data, questionnaire and the portable sleep study results were obtained. Patients were followed up till 30 days to record any complications. Data were entered in SPSS version 17 and analysis was done.

Results

The incidence of OSA was 61.4% and 43.5% were moderate to severe OSA. There was male predominance of OSA (79%) with a mean age of 60 years. OSA subjects had shorter inter-incisor distance (4.18±0.6 cm) and larger waistline (94.1±12.1 cm). The STOP-Bang questionnaire has a sensitivity of 75.8% in predicting apnoa-hypopnea index (AHI) ≥5/hour.

Conclusions

OSA can be diagnosed with a simple screening questionnaire and a bedside portable sleep study. Cardiac patients diagnosed with OSA can be pre-emptively given extra attention in managing their postoperative care.

Diagnosis of sleep apnea in patients with stable chronic heart failure using a portable sleep test diagnostic device

PURPOSE

ApneaLink is a portable device for the screening of sleep apnea, a prevalent and underdiagnosed comorbidity in heart failure patients. A prospective cross-sectional study in patients with chronic heart failure was carried out to assess the sensitivity and specificity of apnea-hypopnea index (AHI) measurements using ApneaLink against the standard polysomnography test.

METHODS

Adult patients with a prior hospitalization in an acute heart failure hospital unit were recruited for the study. All participants were tested for sleep apnea using ApneaLink and polysomnography simultaneously during an overnight stay at a sleep laboratory. Global sleep apnea was evaluated according to the AHI, which was analyzed and compared. Subpopulation comparison based on ejection fraction was not realized due to population size.

RESULTS

Thirty-five patients with stable chronic heart failure completed the study (mean age 70.9 ± 10.5 years and body mass index 30.0 ± 4.7 kg/m²). Two patients were excluded due to insufficient study duration. ApneaLink had a sensitivity greater than 80% for all AHI measurements, and a specificity greater than 80% for all AHI measurements, except for AHI ≥ 5 events/h (61.5%). The results showed higher sensitivities and specificities at AHI values of ≥ 10 events/h (sensitivity 81.3% and specificity 84.2%) and ≥ 15 events/h (sensitivity 83.3% and specificity 91.3%). Correlation analysis showed that AHI measurements using ApneaLink and polysomnography had a strong and significant correlation (r = 0.794; P < 0.001).

CONCLUSIONS

Our results suggest that ApneaLink could be used in clinical practice to identify heart failure patients with high (AHI ≥ 15 events/h) and low (AHI < 5 events/h) probability of having sleep apnea, sparing the need for a diagnostic polysomnography and thus potentially impacting prognosis by providing a more cost-effective and timely diagnosis of this non-cardiac comorbidity.

Ambulatory screening for obstructive sleep apnea in patients with resistant arterial hypertension

OBJECTIVE

Obstructive sleep apnea (OSA) is one of the most common causes of secondary arterial hypertension. It is important to rule out OSA as a cause of resistant hypertension. The ApneaLink device is a simple and cost-efficient outpatient examination, but its usefulness in screening OSA in resistant hypertension has not yet been evaluated.

METHODS

A total of 69 patients with resistant arterial hypertension were enrolled. Patients underwent a physical examination, including the use of ApneaLink, followed by respiratory polygraphy. The presence of OSA was assessed by the apnea-hypopnea index (AHI), oxygen desaturation index (ODI), mean nocturnal desaturation (SpO₂), and percentage of sleep time with SpO₂ less than 90%.

RESULTS

There was no significant difference between the values of AHI found during the use of ApneaLink and respiratory polygraphy (mean 30.4 ± 21.7 vs. 37.2 ± 20.9, P = 0.07). ApneaLink had 77.3% sensitivity and 100% specificity to diagnose OSA with the area under the ROC curve 0.866 (P < 0.001). We also found no significant difference in mean SpO₂ (91.3 ± 2.5 vs. 90.9 ± 3.3%, P = 0.22). The ODI evaluated via ApneaLink was significantly lower than by the polygraphy (31.1 ± 18.3 vs. 43.9 ± 24.8, P < 0.001), while the measured percentage of sleep time with SpO₂ less than 90% was higher (31.8 ± 23.7 vs. 23.3 ± 24.4, P = 0.001). The severity of OSA was correctly determined by ApneaLink in 50.7% of patients, underestimated in 23.2% and overestimated in 26.1%.

CONCLUSIONS

The use of ApneaLink is a suitable method for screening the presence of OSA in patients with resistant hypertension, but to accurately assess the severity of OSA, respiratory polygraphy or polysomnography is required.

Validation of the screening tool ApneaLink® in comparison to polysomnography for the diagnosis of sleep-disordered breathing in children and adolescents

OBJECTIVE

While out-of-center testing was introduced as an alternative for the diagnosis of obstructive sleep apnea in adults, polysomnography (PSG) is still considered mandatory in the diagnosis of sleep-disordered breathing (SDB) in children. The purpose of this study was to validate the outpatient screening device ApneaLink^® in comparison to PSG in children and adolescents for the diagnosis of SDB.

METHODS

Sixty consecutive children and adolescents (10.4 ± 6.2, 0-22 years) with suspected SDB admitted to the sleep laboratory underwent simultaneous recording with full PSG and the screening device ApneaLink^® based on flow measurement and oxygen saturation.

RESULTS

The mean apnea-hypopnea index (AHI) was 11.8 ± 19.7 in PSG and 10.3 ± 12.0 in ApneaLink^®. When the AHI threshold was set to 5/h to diagnose SDB, the overall sensitivity for ApneaLink^® was 79% and the specificity was 63%. After reducing the AHI threshold to 1/h, the sensitivity and specificity were 94% and 29%. In children older than 10 years, the performance of ApneaLink^® improved (AHI 5/h: sensitivity 80%, specificity 64%; AHI 1/h: sensitivity 100%, specificity 50%).

CONCLUSION

These results show that the outpatient screening device ApneaLink^® reliably identifies SDB in preselected children older than 10 years. In contrast, it may not be used for the exclusion of SDB.

Targeted case finding for OSA within the primary care setting

STUDY OBJECTIVES

The aim was to determine the feasibility of using an unattended 2-channel device to screen for obstructive sleep apnea in a population of high-risk patients using a targeted, case-finding strategy. The case finding was based on the presence of risk factors not symptoms in the studied population.

METHODS

The study took place from June 2007 to May 2008 in rural and metropolitan Queensland and New South Wales. Family doctors were asked to identify patients with any of the following: BMI > 30, type 2 diabetes, treated hypertension, ischemic heart disease. Participants applied the ApneaLink+O2 at home for a single night. The device recorded nasal flow and pulse oximetry. Data were analyzed by proprietary software, then checked and reported by either of two sleep physicians.

RESULTS

1,157 patients were recruited; mean age 53 ± 14.6, M/F% = 62/38, mean BMI = 31.8, obesity = 35%, diabetes = 16%, hypertension = 39%, IHD = 5%, Mean Epworth Sleepiness Scale score (ESS) = 8.3. The prevalence of unrecognized OSA was very high: 71% had an AHI > 5/h, 33% had an AHI > 15/h, and 16% had an AHI > 30/h. The ApneaLink+O2 device yielded technically adequate studies in 93% of cases.

CONCLUSION

The study shows that a "real world" simple low cost case finding and management program, based on unattended home monitoring for OSA, can work well in a population with risk factors and comorbidities associated with OSA, independent of the presence of symptoms. The prevalence of unrecognized OSA was very high.

Associations of moderate to severe asthma with obstructive sleep apnea

PURPOSE

This study aimed to evaluate the correlation between associating factors of moderate to severe asthma with obstructive sleep apnea (OSA).

MATERIALS AND METHODS

One hundred and sixty-seven patients who visited the pulmonary and sleep clinic in Severance Hospital presenting with symptoms of sleep-disordered breathing were evaluated. All subjects were screened with ApneaLink. Thirty-two subjects with a high likelihood of having OSA were assessed with full polysomnography (PSG).

RESULTS

The mean age was 58.8±12.0 years and 58.7% of subjects were male. The mean ApneaLink apnea-hypopnea index (AHI) was 12.7±13.0/hr. The mean ApneaLink AHI for the 32 selected high risk patients of OSA was 22.3±13.2/hr, which was lower than the sleep laboratory-based PSG AHI of 39.1±20.5/hr. When OSA was defined at an ApneaLink AHI≥5/hr, the positive correlating factors for OSA were age, male gender, and moderate to severe asthma.

CONCLUSION

Moderate to severe asthma showed strong correlation with OSA when defined at an ApneaLink AHI≥5/hr.

The utility of a portable recording device for screening of obstructive sleep apnea in obese adolescents

STUDY OBJECTIVES

The ApneaLink Plus is a portable recording device that measures air flow, respiratory effort, heart rate, and pulse oximetry. In the current study, we asked whether this device could be used to screen for obstructive sleep apnea in the pediatric population.

METHODS

Sleep-laboratory polysomnography (PSG) was performed simultaneously with measurements using the portable device on obese pediatric patients referred for snoring. The obstructive apnea hypopnea index (OAHI) was calculated automatically by the device (autoscore) and manually by the investigators. Sensitivity, specificity, correlation, and receiver operating curves (ROC) were used to compare the portable device to PSG.

RESULTS

Twenty-five subjects (60% male, mean age 13.6 ± 3.0 years, OAHI on PSG 11.8 ± 27.1) were studied. We identified a significant correlation between the OAHI of the ApneaLink autoscore and PSG (Spearman Rho = 0.886 [p < 0.001]). Using the PSG results as standard, ROC curves comparing the ApneaLink OAHI with the PSG OAHI demonstrated high congruence. The autoscore agreement was very good at PSG OAHI > 1.5 (area under the receiver operating curve [AUC] 0.965, OAHI > 5 [AUC 0.937], and OAHI > 10 [AUC 1.00]). The agreement of the manual score and autoscore were essentially equivalent. The device's autoscore demonstrated high sensitivity at all cutoffs examined (100% at OAHI > 1.5, 85.7% at OAHI > 5, and 100% at OAHI > 10). The specificity increased with increasing cutoffs (46.2% at OAHI > 1.5, 83.3% at OAHI > 5, and 90.0% at OAHI > 10).

CONCLUSION

he ApneaLink Plus is a sensitive screening tool for evaluation of suspected OSAS in obese pediatric patients aged 9-18 years. The specificity improves with increasing OAHI cutoffs. The device detects OSAS when tested in a sleep laboratory on obese adolescents referred for symptoms of sleep related breathing disorder.