Volume 11, Issue 5, Pages (May 2014)

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Volume 11, Issue 5, Pages 842-848 (May 2014) A pacemaker transthoracic impedance sensor with an advanced algorithm to identify severe sleep apnea: The DREAM European study Pascal Defaye, MD, Ines de la Cruz, MD, Julio Martí-Almor, MD, PhD, Roger Villuendas, MD, Paul Bru, MD, Jérémie Sénéchal, MSc, Renaud Tamisier, MD, PhD, Jean-Louis Pépin, MD, PhD Heart Rhythm Volume 11, Issue 5, Pages 842-848 (May 2014) DOI: 10.1016/j.hrthm.2014.02.011 Copyright © 2014 Heart Rhythm Society Terms and Conditions

Figure 1 Nasal pressure measurements during polysomnography (PSG) and corresponding sleep apnea monitoring (SAM) recordings of transthoracic impedance from the minute ventilation sensor. A: Two typical apneas are framed. Apneas are identified clearly on the nasal pressure signal during PSG as a drop in the peak signal excursion by ≥90% of pre-event baseline. Note the concurrent reduction of the amplitude of the thoracic impedance signal from the pacemaker. B: Hypopnea events are framed. Hypopneas in adults are scored when the peak signal excursions drop by ≥30% of pre-event baseline using nasal pressure. Note the simultaneous reduction of the amplitude of the thoracic impedance signal from the pacemaker. Heart Rhythm 2014 11, 842-848DOI: (10.1016/j.hrthm.2014.02.011) Copyright © 2014 Heart Rhythm Society Terms and Conditions

Figure 2 Receiver operator characteristic curve for the detection of severe sleep apnea (defined as PSG-AHI > 30 events/h). The sensitivity is plotted against (1 − specificity) at different SAM-RDI cutoffs (in red). The smoothed curve is shown in black. Statistics are provided with the optimal SAM-RDI cutoff of 20 events/h found to provide the best trade-off between sensitivity and specificity. AUC = area under the curve; PSG-AHI = apnea-hypopnea index evaluated by polysomnography; SAM-RDI = respiratory disturbance index evaluated by the sleep apnea monitoring algorithm. Heart Rhythm 2014 11, 842-848DOI: (10.1016/j.hrthm.2014.02.011) Copyright © 2014 Heart Rhythm Society Terms and Conditions

Figure 3 Scatter plot between the respiratory disturbance index evaluated by the SAM algorithm (SAM-RDI, in events/h) and the apnea-hypopnea index evaluated by polysomnography (PSG-AHI, in events/h). PSG-AHI = apnea-hypopnea index evaluated by polysomnography; SAM = sleep apnea monitoring; SAM-RDI = respiratory disturbance index evaluated by the sleep apnea monitoring algorithm. Heart Rhythm 2014 11, 842-848DOI: (10.1016/j.hrthm.2014.02.011) Copyright © 2014 Heart Rhythm Society Terms and Conditions

Figure 4 Bland-Altman plot (y axis: difference between the PSG-AHI and the SAM-RDI; x axis: mean of the SAM-RDI and PSG-AHI), showing mean of the differences (bias) presented with the 2SD interval. Mean = 9.2 ± 11.6; limits of agreement (2SD) = [−14 to 32.4]. SA = sleep apnea; PSG-AHI = apnea-hypopnea index evaluated by polysomnography; SAM-RDI = respiratory disturbance index evaluated by the sleep apnea monitoring algorithm. Heart Rhythm 2014 11, 842-848DOI: (10.1016/j.hrthm.2014.02.011) Copyright © 2014 Heart Rhythm Society Terms and Conditions