CPAP telemonitoring can track Cheyne-Stokes respiration and detect serious cardiac events: The AlertApnée Study

Arnaud Prigent, Claude Pellen, Joëlle Texereau, Sébastien Bailly, Nicolas Coquerel, Renaud Gervais, Jean-Marc Liegaux, Régis Luraine, Jean-Christophe Renaud, Anne-Laure Serandour, Jean Louis Pépin, Arnaud Prigent, Claude Pellen, Joëlle Texereau, Sébastien Bailly, Nicolas Coquerel, Renaud Gervais, Jean-Marc Liegaux, Régis Luraine, Jean-Christophe Renaud, Anne-Laure Serandour, Jean Louis Pépin

Abstract

Background and objective: Case reports have suggested that continuous positive airway pressure (CPAP) telemonitoring can detect the onset of acute cardiac events such as decompensated heart failure (HF) or atrial fibrillation through an increase in the apnoea-hypopnoea index (AHI) and onset of Cheyne-Stokes Respiration (CSR). This study addressed whether long-term remote CPAP treatment telemonitoring revealing CSR can help detect serious cardiac events (SCEs) in obstructive sleep apnoea (OSA) patients.

Methods: This monocentric prospective cohort study included adults receiving CPAP therapy for OSA with daily telemonitoring. Any sudden increase in AHI generated an alert for the home healthcare provider to download CPAP data to identify CSR. A medical consultation was scheduled if CSR was detected.

Results: We included 555 adults (412 men; 57% with known cardiovascular comorbidities). During the 1-year follow-up, 78 CSR episodes were detected in 74 patients (CSR+). The main conditions associated with incident CSR were HF (24 patients [30.8%]), ventilatory instability (21, 26.9%), leaks (13, 16.7%), medications inducing central apnoeas (baclofen, ticagrelor, opioids) (7, 9.0%), arrhythmias (6, 7.7%) and renal failure (2, 2.6%). Fifteen (20.3%) CSR+ patients had a confirmed SCE. In univariable analysis, a CSR episode increased the risk of an SCE by 13.8-fold (5.7-35.6) (p < 0.0001), with an adjusted OR of 5.7 (2.0-16.8) in multivariable analysis.

Conclusion: Long-term telemonitoring of patients on CPAP treatment can alert CSR episodes and allows early detection of SCEs in patients with or without known cardiac comorbidities.

Trial registration: ClinicalTrials.gov NCT03592108.

Keywords: CPAP; Cheyne-Stokes respiration; cardiac event; central sleep apnoea; chronic heart failure; continuous positive airway pressure; telemonitoring; the AlertApnée study.

© 2021 Asian Pacific Society of Respirology.

References

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Source: PubMed

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