A Meta‐Analysis of the Effects of Atrial Overdrive Pacing on Sleep Apnea Syndrome

Weng, Cui-Lian; Chen, M B Qiang; Ma, Yanliang; He, Quan-ying

doi:10.1111/j.1540-8159.2009.02474.x

Cited by 16 publications

(12 citation statements)

References 31 publications

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“…In the literature, it has been hypothesized that atrial overdrive pacemaker therapy can increase cardiac filling and decrease pulmonary obstruction by increasing the heart rate, thus reduce or prevent CSA formation. In some small sample studies, atrial overdrive pacemaker therapy has been shown to reduce the number of CSA attacks, improve oxygen saturation, and reduce stimulation in HF patients (23,34,35). In another study, it was reported that atrial overdrive pacemaker treatment in CSA did not provide any improvement (36).…”

Section: Discussionmentioning

confidence: 99%

Assessment of the Efficacy of Interventions for the Treatment of Sleep Respiratory Disorder in Chronic Heart Failure Patients: A Systematic Review

Uysal¹,

Oruçoğlu²

2019

Istanbul Med J

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One of the most important problems of heart failure (HF) patients is sleep disturbance. In HF patients with obstructive and central sleep apnea, hypoxia, hypercapnia and overexcitation of the sympathetic system are observed. As a result, negative intrathoracic pressure and left ventricular afterload increase. Treatment of sleep respiratory disorders in chronic HF patients is important for the prognosis of the disease. Therefore, in this systematic review, we aimed to evaluate the efficacy of interventions used for the treatment of sleep respiratory disorder in chronic HF patients. Cochrane Library, Scopus, Springer Link, Science Direct, Clinical Key, PubMed, Turkey Citation Index and EBSCO databases were searched for studies between June 2017-August 2018. When all studies were examined, out of 2.691.006 studies published between 2007-2017, 16 randomized controlled trials that met inclusion criteria were included in the study. In these studies, treatment interventions for treatment groups with sleep respiratory disorder included continuous positive airway pressure (CPAP), bi-level positive airway pressure, adaptive servo-ventilation (ASV), atrial overdrive pacing, home oxygen therapy, slow breathing exercise device and structured physical exercise. When the study results are examined, CPAP treatment improved daytime sleepiness and left ventricular ejection fraction (LVEF) but did not provide significant improvement on quality of life, and that ASV treatment reduced apneahypopnea index, provided improvement in LVEF and cardiac function, and reduced ventricular ejection fraction. However, further research is needed to fully demonstrate the efficacy of interventions for the treatment of sleep respiratory disorder in chronic HF patients.

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Section: Discussionmentioning

confidence: 99%

Assessment of the Efficacy of Interventions for the Treatment of Sleep Respiratory Disorder in Chronic Heart Failure Patients: A Systematic Review

Uysal¹,

Oruçoğlu²

2019

Istanbul Med J

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“…In 2002, Garrigue reported that atrial pacing improves CSR-CSA as well as OSA [14] in patients with pacemaker implantation because of the treatment of bradycardia. Meta-analysis also showed that overdrive atrial pacing reduces AHI in patients with predominantly CSA [15]. However the additional effect of atrial overdrive pacing on CSR-CSA in patients with heart failure was only small [16].…”

Section: Atrial Overdrive Pacingmentioning

confidence: 97%

Treatment of Cheyne–Stokes respiration–central sleep apnea in patients with heart failure

Momomura

2012

Journal of Cardiology

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Sleep disordered breathing including obstructive sleep apnea (OSA) and central sleep apnea (CSA) with Cheyne-Stokes respiration (CSR) is often accompanied by heart failure. Treatment of OSA centered on continuous positive airway pressure (CPAP) is established. However, treatment of CSR-CSA is still controversial. Since CSR-CSA occurs as a consequence of heart failure, optimization of heart failure is essential to treat CSR-CSA. For treatment directed at CSR-CSA itself, a variety of treatment approaches including night oxygen therapy and noninvasive positive pressure ventilation have been applied. Among them, night oxygen therapy improves patients' symptoms, quality of life (QOL), and left ventricular function, but had yet been shown to improve clinical outcome. For CPAP, there are responders and non-responders and for responders CPAP can also improve survival. Adaptive servo-ventilation (ASV), which most effectively treats CSR-CSA, improves exercise capacity, QOL, and cardiac function. Recent reports suggested ASV may also prevent cardiac events in patients with heart failure. However, further studies are needed to conclude that this treatment improves patient survival.

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“…22,23 Furthermore, in patients with HF, CRT might alleviate CSA, while leaving obstructive respiratory events, if present, in the setting of HF. Javaheri et al reported an alleviation of CSA by theophylline in patients with HF, which was attributed to a drug-induced acceleration of the heart rate.…”

Section: Discussionmentioning

confidence: 99%

Overdrive Ventricular Pacing in Pacemaker Recipients with Permanent Atrial Fibrillation and Sleep Apnea

Bordier

Maurice-Tison

Ramana

2012

Journal of Clinical Sleep Medicine

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Study Objectives: Cardiac pacing is ineffective in obstructive sleep apnea (SA), but it can alleviate central SA/CheyneStokes respiration (CSA) in patients with heart failure (HF). We examined whether overnight overdrive ventricular pacing (OVP) has an effect on SA in pacemaker recipients with permanent atrial fi brillation (AF). Methods: An apnea-hypopnea index (AHI) ≥ 15 was confi rmed in 28/38 patients screened by fi nger pulse oximetry during overnight ventricular pacing at a backup rate of 40 bpm (BUV40). These patients (23 men, 77.9 ± 7.6 y, BMI 27.6 ± 5.1 kg/m 2 ) were randomly assigned to 2 consecutive nocturnal ventilation polygraphies with BUV40 versus OVP at 20 bpm above the mean nocturnal heart rate observed during screening. Results: During BUV40 versus OVP, (1) mean heart rate was 49 ± 8 versus 71 ± 8 bpm (p < 0.0001) and percent ventricular pacing 36% ± 38% versus 96% ± 6% (p < 0.0001); (2) AHI was 35.4 ± 11.9 versus 32.5 ± 15.5 (p = ns), central AHI 23.9 ± 11.8 versus 19.1 ± 12.7 (p < 0.001), and obstructive AHI 11.6 ± 13.1 versus 13.5 ± 15.9 (p = ns). In 15/28 patients without HF, mean left ventricular ejection fraction (LVEF) was 51% ± 17%, AHI was 37.6 ± 11.0 during BUV40 and 39.0 ± 11.5 during OVP, versus 32.8 ± 12.9 and 24.9 ± 16.5 in 13/28 patients with HF (p = 0.02) and mean LVEF 35% ± 15% (p = 0.01). Between the 2 subgroups, (1) central AHI was 23.6 ± 12.4 during BUV40 and 21.5 ± 14.0 during OVP versus 24.1 ± 11.6 and 16.2 ± 10.7 (p = 0.05); (2) obstructive AHI was 14.0 ± 13.7 during BUV40 and 17.6 ± 16.5 during OVP versus 8.8 ± 12.3 and 8.7 ± 14.3 (p = ns). Conclusions:The prevalence of SA, predominantly central, was high in our pacemaker recipients with permanent AF. In those with HF, a single overnight OVP resulted in modest improvement in central events. keywords: Heart failure, sleep apnea, atrial fi brillation, cardiac pacing Citation: Bordier P; Maurice-Tison S; Ramana NK. Overdrive ventricular pacing in pacemaker recipients with permanent atrial fi brillation and sleep apnea. S C I E N T I F I C I N V E S T I g A T I O N SA fter a fi rst report suggesting that cardiac pacing might alleviate sleep apnea (SA), subsequent studies have yielded confl icting results.1,2 An increase in pacing rate by overdrive atrial pacing, using a dual chamber pacemaker implanted for the treatment of bradycardia, has no effect on obstructive SA (OSA) in patients without history of heart failure (HF). In contrast, cardiac resynchronization therapy (CRT) does alleviate central SA/Cheyne-Stokes respiration (CSA), a breathing disorder present in > 30% of patients with stable HF and associated with a decreased survival rate. 3-14The aim of this study was to compare the effects of overnight overdrive ventricular pacing (OVP) versus overnight ventricular pacing at a low backup rate on SA in recipients of permanent pacemakers suffering from permanent atrial fi brillation (AF). The comparison was also made in separating the patients depending on whether they suffered from HF or not. Those patients were chosen ...

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A Meta‐Analysis of the Effects of Atrial Overdrive Pacing on Sleep Apnea Syndrome

Abstract: Atrial overdrive pacing appears to be effective in patients with CSAS. The role of atrial overdrive pacing in OSAS remains unclear.

Cited by 16 publications

References 31 publications

Assessment of the Efficacy of Interventions for the Treatment of Sleep Respiratory Disorder in Chronic Heart Failure Patients: A Systematic Review

Assessment of the Efficacy of Interventions for the Treatment of Sleep Respiratory Disorder in Chronic Heart Failure Patients: A Systematic Review

Treatment of Cheyne–Stokes respiration–central sleep apnea in patients with heart failure

Overdrive Ventricular Pacing in Pacemaker Recipients with Permanent Atrial Fibrillation and Sleep Apnea

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