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Title: | Pacemaker guided screening for severe sleep apnea, a possible option for patients with atrial fibrillation: A systematic review and meta-analysis | Authors: | Wyckmans, Martin Tukanov, Eldar Winters, Robbe Stinissen, Robin VERMEULEN, Helene DENDALE, Paul DESTEGHE, Lien |
Issue Date: | 2021 | Publisher: | WILEY | Source: | Pacing and Clinical Electrophysiology, 44 (8) , p. 1421-1431 | Abstract: | Introduction Obstructive sleep apnea is often underdiagnosed in atrial fibrillation (AF) patients although it is an important risk factor. A systematic review and meta-analysis was performed to assess which techniques cardiac implantable electronic devices (CIED) and Holter monitors use to screen for sleep apnea (SA), and to evaluate if these are suitable for AF patients from a diagnostic accuracy perspective.Methods The search was conducted in accordance with the PRISMA-guidelines. PICO was defined as (P) patients with AF, (I) Holter monitors or CIED suitable for screening for SA, (C) overnight polysomnography (PSG), (O) positive screening with subsequent positive polysomnographic diagnosis of SA. Optimal index test cut-off points corresponding to reference test cut-off for severe SA (PSG-AHI >= 30) were compared. Meta-analysis was conducted for the diagnostic odds ratio (DOR), with forest plot and ROC-curve for summary DOR.Results A total of five prospective cohort studies (n = 192) were included in the systematic review of which four studies (n = 132) were included in the meta-analysis. All included studies use transthoracic impedance measurement as a screening parameter. No studies evaluating Holter monitors were included. The population consisted of patients indicated for pacemaker implantation. The summary DOR was 27.14 (8.83; 83.37), AUC was 0.8689 (0.6872; 0.9456) and Q* was 0.8390 (0.7482; 0.9013).Conclusion At optimal pacemaker-cut-off, pacemaker-guided screening for severe SA in patients with AF can be an effective triage tool for clinical practice. Further studies with larger sample sizes are needed to strengthen the evidence for this conclusion. | Keywords: | ambulatory electrocardiography;artificial pacemaker;atrial fibrillation;implantable defibrillator;obstructive sleep apnea;polysomnography | Document URI: | http://hdl.handle.net/1942/34417 | ISSN: | 0147-8389 | e-ISSN: | 1540-8159 | DOI: | 10.1111/pace.14256 | ISI #: | 000652797000001 | Rights: | 2021 Wiley Periodicals LLC | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2022 |
Appears in Collections: | Research publications |
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File | Description | Size | Format | |
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CIED-screening-OSA-AF_Pacing Clin Electrophysiol_manuscript_R1_18_03_2021.pdf | Peer-reviewed author version | 256.9 kB | Adobe PDF | View/Open |
Pacemaker guided screening for severe sleep apnea, a possible option for patients with atrial fibrillation_ A systematic review and meta‐analysis.pdf Restricted Access | Published version | 2.25 MB | Adobe PDF | View/Open Request a copy |
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