Dominik Linz1, Kadhim Kadhim2, Anthony G Brooks3, Adrian D Elliott2, Jeroen M L Hendriks2, Dennis H Lau2, Rajiv Mahajan2, Aashray K Gupta2, Melissa E Middeldorp2, Mathias Hohl4, Chrishan J Nalliah5, Jonathan M Kalman5, R Doug McEvoy6, Mathias Baumert7, Prashanthan Sanders2. 1. Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia. Electronic address: Dominik.Linz@adelaide.edu.au. 2. Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia. 3. CRM MicroPort, Australia. 4. Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homburg, Saar, Germany. 5. Department of Cardiology, Royal Melbourne Hospital and Department of Medicine, University of Melbourne, Melbourne, Australia. 6. Adelaide Institute for Sleep Health (AISH) and the School of Medicine, College of Medicine & Public Health, Flinders University, Adelaide, Australia; Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, Australia. 7. University of Adelaide, School of Electrical and Electronic Engineering, Adelaide, Australia.
Abstract
BACKGROUND: Sleep-disordered breathing (SDB) is highly prevalent in patients with atrial fibrillation (AF) and its treatment can improve rhythm control. Polysomnography (PSG) is the gold standard for the diagnosis of SDB but its high cost and limited availability constrain its role as a standard SDB screening tool. We sought to assess the diagnostic utility of overnight oximetry in predicting SDB in AF patients. METHODS: We analyzed prospectively collected data on 439 patients with documented AF (62% paroxysmal AF) who underwent PSG. Overnight oximetry was used to determine the oxygen desaturation index (ODI, number of desaturation/h) by a novel automated computer algorithm. ODI was validated against PSG derived apnea-hypopnea index (AHI). RESULTS: The sample consisted of 69% men with a mean age of 59.9 ± 11.3 years and body mass index of 30 ± 5 kg/m2. The median AHI was 9.5 [3.6-21.0]/h and the prevalence of moderate (AHI 15-29/h) and severe SDB (AHI ≥ 30/h) was 17.3% and 16.6% respectively. The ODI was able to detect moderate-to-severe SDB (AHI ≥ 15/h; area under the receiver-operating-characteristic curve (AUC): 0.951, 95% CI: 0.929-0.972) and severe SDB (AHI ≥ 30/h; 0.932, 95% CI: 0.895-0.968) with high diagnostic accuracy. An ODI cut-off of 4.1/h resulted in a 91% sensitivity and 83% specificity in discriminating between patients with and without AHI ≥ 15/h. An ODI of 7.6/h yielded a sensitivity and specificity for AHI ≥ 30/h of 89% and 83%, respectively. CONCLUSIONS: ODI derived from a simple and low-cost overnight oximetry can be used as an accessible and reliable screening tool, particularly to rule out SDB.
BACKGROUND:Sleep-disordered breathing (SDB) is highly prevalent in patients with atrial fibrillation (AF) and its treatment can improve rhythm control. Polysomnography (PSG) is the gold standard for the diagnosis of SDB but its high cost and limited availability constrain its role as a standard SDB screening tool. We sought to assess the diagnostic utility of overnight oximetry in predicting SDB in AFpatients. METHODS: We analyzed prospectively collected data on 439 patients with documented AF (62% paroxysmal AF) who underwent PSG. Overnight oximetry was used to determine the oxygen desaturation index (ODI, number of desaturation/h) by a novel automated computer algorithm. ODI was validated against PSG derived apnea-hypopnea index (AHI). RESULTS: The sample consisted of 69% men with a mean age of 59.9 ± 11.3 years and body mass index of 30 ± 5 kg/m2. The median AHI was 9.5 [3.6-21.0]/h and the prevalence of moderate (AHI 15-29/h) and severe SDB (AHI ≥ 30/h) was 17.3% and 16.6% respectively. The ODI was able to detect moderate-to-severe SDB (AHI ≥ 15/h; area under the receiver-operating-characteristic curve (AUC): 0.951, 95% CI: 0.929-0.972) and severe SDB (AHI ≥ 30/h; 0.932, 95% CI: 0.895-0.968) with high diagnostic accuracy. An ODI cut-off of 4.1/h resulted in a 91% sensitivity and 83% specificity in discriminating between patients with and without AHI ≥ 15/h. An ODI of 7.6/h yielded a sensitivity and specificity for AHI ≥ 30/h of 89% and 83%, respectively. CONCLUSIONS: ODI derived from a simple and low-cost overnight oximetry can be used as an accessible and reliable screening tool, particularly to rule out SDB.
Authors: Dominik Linz; Kelly A Loffler; Prashanthan Sanders; Peter Catcheside; Craig S Anderson; Danni Zheng; WeiWei Quan; Mary Barnes; Susan Redline; R Doug McEvoy; Mathias Baumert Journal: Chest Date: 2020-07-14 Impact factor: 9.410
Authors: Anna M Mohammadieh; Kate Sutherland; Logan B Kanagaratnam; David W Whalley; Mark J Gillett; Peter A Cistulli Journal: J Clin Sleep Med Date: 2021-05-01 Impact factor: 4.062
Authors: Dominik Linz; Mathias Baumert; Lien Desteghe; Kadhim Kadhim; Kevin Vernooy; Jonathan M Kalman; Dobromir Dobrev; Michael Arzt; Manu Sastry; Harry J G M Crijns; Ulrich Schotten; Martin R Cowie; R Doug McEvoy; Hein Heidbuchel; Jeroen Hendriks; Prashanthan Sanders; Dennis H Lau Journal: Int J Cardiol Heart Vasc Date: 2019-10-18
Authors: Astrid N L Hermans; Rachel M J van der Velden; Monika Gawalko; Dominique V M Verhaert; Lien Desteghe; David Duncker; Martin Manninger; Hein Heidbuchel; Ron Pisters; Martin Hemels; Laurent Pison; Afzal Sohaib; Arian Sultan; Daniel Steven; Petra Wijtvliet; Robert Tieleman; Dhiraj Gupta; Dobromir Dobrev; Emma Svennberg; Harry J G M Crijns; Nikki A H A Pluymaekers; Jeroen M Hendriks; Dominik Linz Journal: Clin Cardiol Date: 2020-10-08 Impact factor: 2.882
Authors: Samantha Y Starkey; Daniel R Jonasson; Stephanie Alexis; Susan Su; Ravinder Johal; Paul Sweeney; Penelope M A Brasher; John Fleetham; Najib Ayas; Teddi Orenstein; Iqbal H Ahmed Journal: CJC Open Date: 2020-12-03