Long-term effects of dynamic atrial overdrive pacing on sleep-related breathing disorders in pacemaker or cardioverter defibrillator recipients.
BACKGROUND
Sleep-related breathing disorders occur in 20-30% of Europeans and North Americans, including 10% of sleep apnea syndrome (SAS). A preliminary study suggested that atrial overdrive pacing with a fixed heart rate might alleviate SAS. However, it is not known whether dynamic atrial overdrive pacing alleviates SAS.


METHODS
Patients with indications for a dual chamber pacemaker or implantable cardioverter-defibrillator (ICD) were screened for SAS using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. If PSQI was >5, cardio-respiratory polygraphy was performed before and 4 and 7 months after device implantation. Patients were randomized to algorithm ON-OFF (group A) or OFF-ON (group B) and the apnea-hypopnea index (AHI) was measured.


RESULTS
Out of 105 consecutive patients, 46 (44%) had a positive PSQI. This analysis included 12 patients (mean age = 61 +/- 10 years, body mass index 28.9 +/- 6.5 kg/m(2), left ventricular ejection fraction = 38.3 +/- 13.6%; 10 men). All patients suffered from obstructive or mixed SAS. There were no significant differences in PSQI or AHI between baseline and follow-up or between the two study groups. Therefore, the study was terminated ahead of schedule.


CONCLUSIONS
The prevalence of obstructive or mixed SAS was high in pacemaker or ICD recipients and reduced left ventricular ejection fraction. In these patients, long-term dynamic atrial overdrive pacing using did not improve PSQI or SAS. Therefore, patients with relevant obstructive or mixed SAS should not be offered atrial pacing therapy.
Sinha
Anil-Martin
AM
II. Medizinische Klinik, Klinikum Coburg, Germany. anilmartin.sinha@klinikum-coburg.de
Bauer
Alexander
A
Skobel
Eric C
EC
Markus
Kai-U
KU
Ritscher
Guido
G
Noelker
Georg
G
Breithardt
Ole-Alexander
OA
Brachmann
Johannes
J
Stellbrink
Christoph
C
D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000453:epidemiology*; D013813:Therapy, Computer-Assisted / Q000706:statistics & numerical data*