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.
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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
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A correction has been published: N Engl J Med 2002;346(11):872.
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