Stephane Garrigue, M.D., Philippe Bordier, M.D., Pierre Jaïs, M.D., Dipen C. Shah, M.D., Meleze Hocini, M.D., Chantal Raherison, M.D., Manuel Tunon De Lara, M.D., Michel Haïssaguerre, M.D., and Jacques Clementy, M.D.
Background Many patients with sleep apnea syndrome have nocturnalbradycardia, paroxysmal tachyarrhythmias, or both, which canbe prevented by permanent atrial pacing. We evaluated the effectof using cardiac pacing to increase the heart rate during sleepin patients with sleep apnea syndrome.
Methods We studied 15 patients (11 men and 4 women; mean [±SD]age, 69±9 years) with central or obstructive sleep apneawho had received permanent atrial-synchronous ventricular pacemakersfor symptomatic sinus bradycardia. All patients underwent threepolysomnographic evaluations on consecutive nights, the firstnight for base-line evaluation and then, in random order, onenight in spontaneous rhythm and one in dual-chamber pacing modewith atrial overdrive (basic rate, 15 beats per minute fasterthan the mean nocturnal sinus rate). The total duration andnumber of episodes of central or obstructive sleep apnea orhypopnea were analyzed and compared.
Results The mean 24-hour sinus rate during spontaneous rhythmwas 57±5 beats per minute at base line, as compared with72±3 beats per minute with atrial overdrive pacing (P<0.001).The total duration of sleep was 321±49 minutes in spontaneousrhythm, as compared with 331±46 minutes with atrial overdrivepacing (P=0.48). The hypopnea index (the total number of episodesof hypopnea divided by the number of hours of sleep) was reducedfrom 9±4 in spontaneous rhythm to 3±3 with atrialoverdrive pacing (P<0.001). For both apnea and hypopnea,the value for the index was 28±22 in spontaneous rhythm,as compared with 11±14 with atrial overdrive pacing (P<0.001).
Conclusions In patients with sleep apnea syndrome, atrial overdrivepacing significantly reduces the number of episodes of centralor obstructive sleep apnea without reducing the total sleeptime.
Source Information
From the Hôpital Cardiologique du Haut-Lévêque (S.G., P.B., P.J., D.C.S., M. Hocini, M. Haïssaguerre, J.C.) and the Department of Lungs and Respiratory Disease, Hôpital du Haut-Lévêque (C.R., M.T.D.), University of Bordeaux, Bordeaux, France.
Address reprint requests to Dr. Garrigue at the Cardiac Pacing and Clinical Electrophysiology Department, Hôpital Cardiologique du Haut-Lévêque, 19, ave. de Magellan, Pessac, CEDEX 33604, France, or at stgarrigue{at}aol.com.
Atrial Pacing in Sleep Apnea Syndrome
Wellman A., Malhotra A., White D. P., Schotland H. M., Stein P., Duntley S., Garrigue S., Bordier P., Haïssaguerre M.
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N Engl J Med 2002;
347:445-446, Aug 8, 2002.
Correspondence
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[Abstract][Full Text]
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[Abstract][Full Text]
Tzeng, Y. C., Larsen, P. D., Galletly, D. C.
(2007). Mechanism of cardioventilatory coupling: insights from cardiac pacing, vagotomy, and sinoaortic denervation in the anesthetized rat. Am. J. Physiol. Heart Circ. Physiol.
292: H1967-H1977
[Abstract][Full Text]
Griffioen, K. J. S., Kamendi, H. W., Gorini, C. J., Bouairi, E., Mendelowitz, D.
(2007). Reactive Oxygen Species Mediate Central Cardiorespiratory Network Responses to Acute Intermittent Hypoxia. J. Neurophysiol.
97: 2059-2066
[Abstract][Full Text]
Eckert, D. J., Jordan, A. S., Merchia, P., Malhotra, A.
(2007). Central Sleep Apnea: Pathophysiology and Treatment. Chest
131: 595-607
[Abstract][Full Text]
McNicholas, W. T., Bonsignore, M. R., the Management Committee of EU COST ACTION B26,
(2007). Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities. Eur Respir J
29: 156-178
[Abstract][Full Text]
Simantirakis, E. N., Vardas, P. E.
(2006). Cardiac pacing in sleep apnoea: diagnostic and therapeutic implications.. Europace
8: 984-987
[Abstract][Full Text]
Teramoto, S., Kume, H., Yamaguchi, Y., Yamamoto, H., Ishii, M., Ishii, T., Ouchi, Y.
(2006). Heart rate variation analysis may not effectively detect sleep apnoeas in heart failure.. Eur Respir J
28: 457-458
[Full Text]
Arzt, M., Bradley, T. D.
(2006). Treatment of Sleep Apnea in Heart Failure. Am. J. Respir. Crit. Care Med.
173: 1300-1308
[Abstract][Full Text]
Ferreira, S., Winck, J., Bettencourt, P., Rocha-Goncalves, F.
(2006). Heart failure and sleep apnoea: To sleep perchance to dream. Eur J Heart Fail
8: 227-236
[Abstract][Full Text]
Sinha, A.-M., Skobel, E. C., Breithardt, O.-A., Zheng, H., Zhan, H., Wilcox, I., Booth, V., Lattimore, J., Chhajed, P. N., Tamm, M., Strobel, W., Neuberger, H.-R., Bohm, M., Mewis, C., Bradley, T. D., Floras, J. S., Logan, A. G., Yaggi, H. K., Concato, J., Mohsenin, V.
(2006). Sleep apnea and heart disease.. NEJM
354: 1086-1089
[Full Text]
Krahn, A. D., Yee, R., Erickson, M. K., Markowitz, T., Gula, L. J., Klein, G. J., Skanes, A. C., George, C. F.P., Ferguson, K. A.
(2006). Physiologic Pacing in Patients With Obstructive Sleep Apnea: A Prospective, Randomized Crossover Trial. J Am Coll Cardiol
47: 379-383
[Abstract][Full Text]
Simantirakis, E. N., Schiza, S. E., Chrysostomakis, S. I., Chlouverakis, G. I., Klapsinos, N. C., Siafakas, N. M., Vardas, P. E.
(2005). Atrial Overdrive Pacing for the Obstructive Sleep Apnea-Hypopnea Syndrome. NEJM
353: 2568-2577
[Abstract][Full Text]
Gottlieb, D. J.
(2005). Can Sleep Apnea Be Treated without Modifying Anatomy?. NEJM
353: 2604-2606
[Full Text]
Caples, S. M., Wolk, R., Somers, V. K.
(2005). Influence of cardiac function and failure on sleep-disordered breathing: evidence for a causative role. J. Appl. Physiol.
99: 2433-2439
[Abstract][Full Text]
Unterberg, C., Luthje, L., Szych, J., Vollmann, D., Hasenfuss, G., Andreas, S.
(2005). Atrial overdrive pacing compared to CPAP in patients with obstructive sleep apnoea syndrome. Eur Heart J
26: 2568-2575
[Abstract][Full Text]
Ferrier, K., Campbell, A., Yee, B., Richards, M., O'Meeghan, T., Weatherall, M., Neill, A.
(2005). Sleep-Disordered Breathing Occurs Frequently in Stable Outpatients With Congestive Heart Failure. Chest
128: 2116-2122
[Abstract][Full Text]
Cormican, L J, Williams, A
(2005). Sleep disordered breathing and its treatment in congestive heart failure. Heart
91: 1265-1270
[Abstract][Full Text]
Ryan, C F
(2005). Sleep {middle dot} 9: An approach to treatment of obstructive sleep apnoea/hypopnoea syndrome including upper airway surgery. Thorax
60: 595-604
[Abstract][Full Text]
Luthje, L., Unterberg-Buchwald, C., Dajani, D., Vollmann, D., Hasenfuss, G., Andreas, S.
(2005). Atrial Overdrive Pacing in Patients with Sleep Apnea with Implanted Pacemaker. Am. J. Respir. Crit. Care Med.
172: 118-122
[Abstract][Full Text]
Sinha, A.-M., Stellbrink, C., Skobel, E. C., Scharf, C., Bloch, K. E., Brunckhorst, C., Duru, F., Candinas, R., Cho, Y. K., Balaban, K., Foldvary, N., Liu, L., Burgess, R. C., Wilkoff, B. L.
(2005). Letter Regarding Article by Scharf et al, "Diagnosis of Sleep-Related Breathing Disorders by Visual Analysis of Transthoracic Impedance Signals in Pacemakers" * Response. Circulation
111: e301-e302
[Full Text]
Pepin, J-L., Defaye, P., Garrigue, S., Poezevara, Y., Levy, P.
(2005). Overdrive atrial pacing does not improve obstructive sleep apnoea syndrome. Eur Respir J
25: 343-347
[Abstract][Full Text]
Scharf, C., Cho, Y. K., Bloch, K. E., Brunckhorst, C., Duru, F., Balaban, K., Foldvary, N., Liu, L., Burgess, R. C., Candinas, R., Wilkoff, B. L.
(2004). Diagnosis of Sleep-Related Breathing Disorders by Visual Analysis of Transthoracic Impedance Signals in Pacemakers. Circulation
110: 2562-2567
[Abstract][Full Text]
Gami, A. S., Pressman, G., Caples, S. M., Kanagala, R., Gard, J. J., Davison, D. E., Malouf, J. F., Ammash, N. M., Friedman, P. A., Somers, V. K.
(2004). Association of Atrial Fibrillation and Obstructive Sleep Apnea. Circulation
110: 364-367
[Abstract][Full Text]
Sinha, A.-M., Skobel, E. C., Breithardt, O.-A., Norra, C., Markus, K. U., Breuer, C., Hanrath, P., Stellbrink, C.
(2004). Cardiac resynchronization therapy improves central sleep apnea and Cheyne-Stokes respiration in patients with chronic heart failure. J Am Coll Cardiol
44: 68-71
[Abstract][Full Text]
Porthan, K. M., Melin, J. H., Kupila, J. T., Venho, K. K. K., Partinen, M. M.
(2004). Prevalence of Sleep Apnea Syndrome in Lone Atrial Fibrillation: A Case-Control Study. Chest
125: 879-885
[Abstract][Full Text]
Gula, L J, Krahn, A D, Skanes, A C, Yee, R, Klein, G J
(2004). Clinical relevance of arrhythmias during sleep: guidance for clinicians. Heart
90: 347-352
[Full Text]
Hedner, J., Kraiczi, H., Peker, Y., Murphy, P.
(2003). Reduction of Sleep-disordered Breathing after Physostigmine. Am. J. Respir. Crit. Care Med.
168: 1246-1251
[Abstract][Full Text]
Shamsuzzaman, A. S. M., Gersh, B. J., Somers, V. K.
(2003). Obstructive Sleep Apnea: Implications for Cardiac and Vascular Disease. JAMA
290: 1906-1914
[Abstract][Full Text]
Lattimore, J. o-D. L., Celermajer, D. S., Wilcox, I.
(2003). Obstructive sleep apnea and cardiovascular disease. J Am Coll Cardiol
41: 1429-1437
[Abstract][Full Text]
Arzt, M., Harth, M., Luchner, A., Muders, F., Holmer, S. R., Blumberg, F. C., Riegger, G. A.J., Pfeifer, M.
(2003). Enhanced Ventilatory Response to Exercise in Patients With Chronic Heart Failure and Central Sleep Apnea. Circulation
107: 1998-2003
[Abstract][Full Text]
Harper, R. M., Macey, P. M., Henderson, L. A., Woo, M. A., Macey, K. E., Frysinger, R. C., Alger, J. R., Nguyen, K. P., Yan-Go, F. L.
(2003). fMRI responses to cold pressor challenges in control and obstructive sleep apnea subjects. J. Appl. Physiol.
94: 1583-1595
[Abstract][Full Text]
Resnick, H. E., Redline, S., Shahar, E., Gilpin, A., Newman, A., Walter, R., Ewy, G. A., Howard, B. V., Punjabi, N. M.
(2003). Diabetes and Sleep Disturbances: Findings from the Sleep Heart Health Study. Diabetes Care
26: 702-709
[Abstract][Full Text]
Henderson, L. A., Woo, M. A., Macey, P. M., Macey, K. E., Frysinger, R. C., Alger, J. R., Yan-Go, F., Harper, R. M.
(2003). Neural responses during Valsalva maneuvers in obstructive sleep apnea syndrome. J. Appl. Physiol.
94: 1063-1074
[Abstract][Full Text]
Gozal, D.
(2002). The Brain in Sleep-disordered Breathing: Is It the Chicken or Is It the Egg?. Am. J. Respir. Crit. Care Med.
166: 1305-1306
[Full Text]
Wellman, A., Malhotra, A., White, D. P., Schotland, H. M., Stein, P., Duntley, S., Garrigue, S., Bordier, P., Haissaguerre, M.
(2002). Atrial Pacing in Sleep Apnea Syndrome. NEJM
347: 445-446
[Full Text]
A correction has been published: N Engl J Med 2002;346(11):872.
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