title: Cardiac resynchronization therapy and obstructive sleep-related breathing disorder in patients with congestive heart failure.
abstract: OBJECTIVE
  To assess the impact of cardiac resynchronization therapy (CRT) with or without atrial overdrive pacing, on sleep-related breathing disorder (SRBD).
  
  
  BACKGROUND
  CRT may have a positive influence on SRBD in patients who qualify for the therapy. Data are inconclusive in patients with obstructive SRBD.
  
  
  METHODS
  Consenting patients eligible for CRT underwent a baseline polysomnography (PSG) 2 weeks after implantation during which pacing was withheld. Patients with an apnea hypopnea index (AHI) ≥15 but <50 were enrolled and randomized to atrial overdrive pacing (DDD) versus atrial synchronous pacing (VDD) with biventricular pacing in both arms. Patients underwent two further PSGs 12 weeks apart.
  
  
  RESULTS
  Nineteen men with New York Heart Association class III congestive heart failure participated in the study (age 67.2 ± 7.5, Caucasian 78.9%, ischemic 73.7%). The score on Epworth Sleepiness Score was 7.3 ± 4.0, Pittsburgh Sleep Quality Index 7.4 ± 3.1, and Minnesota Living with Heart Failure Questionnaire 36.9 ± 21.9. There were no differences between the groups. At baseline, patients exhibited poor sleep efficiency (65.3 ± 16.6%) with nadir oxygen saturation of 83.5 ± 5.3% and moderate to severe SRBD (AHI 21.5 ± 15.3) that was mainly obstructive (central apnea index 3.3 ± 6.7/hour). On both follow-up assessments, there was no improvement in indices of SRBD (sleep efficiency [68.3 ± 17.9%], nadir oxygen saturation of 82.8 ± 4.6%, and AHI 24.9 ± 21.9).
  
  
  CONCLUSIONS
  In a cohort of elderly male CHF patients receiving CRT, CRT had no impact on obstructive SRBD burden with or without atrial overdrive pacing.
authors: Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA. Alaa.Shalaby@va.gov
authors: Alaa
authors: A
authors: Shalaby
authors: Charles W
authors: CW
authors: Atwood
authors: Faith
authors: F
authors: Selzer
authors: Matthew
authors: M
authors: Suffoletto
authors: John
authors: J
authors: Gorcsan Iii
authors: Patrick
authors: P
authors: Strollo