Benefit of Atrial Pacing in Sleep Apnea Syndrome

Garrigue, Stéphane; Bordier, P; Jaı̈s, Pierre; Shah, Dipen; Hocini, M.; Rahérison, Chantal; Lara, Manuel Tuñón de; Haı̈ssaguerre, Michel; Clémenty, Jacques

doi:10.1056/nejmoa011919

Cited by 303 publications

(120 citation statements)

References 39 publications

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“…Carvedilol, a β-blocker commonly used for the treatment of CHF, has been demonstrated to reduce CSR in patients with CHF [63]. Atrial overdrive pacing was reported to reduce CSR in patients with heart failure, but these results could not be reproduced by several consecutive studies [64,65,66,67]. Cardiac resynchronization with biventricular pacemakers has repeatedly been reported to more than halve CSR in patients with severe heart failure and ventricular asynchrony.…”

Section: Treatment Of Csrmentioning

confidence: 99%

Cheyne-Stokes Respiration in Patients with Heart Failure: Prevalence, Causes, Consequences and Treatments

Brack¹,

Randerath

Bloch

2011

Respiration

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Cheyne-Stokes respiration (CSR) is characterized by a pattern of cyclic oscillations of tidal volume and respiratory rate with periods of hyperpnea alternating with hypopnea or apnea in patients with heart failure. CSR harms the failing heart through intermittent hypoxia brought about by apnea and hypopnea and recurrent sympathetic surges. CSR impairs the quality of life and increases cardiac mortality in patients with heart failure. Thus, CSR should actively be pursued in patients with severe heart failure. When CSR persists despite optimal therapy of heart failure, noninvasive adaptive servoventilation is currently the most promising treatment.

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Section: Treatment Of Csrmentioning

confidence: 99%

Cheyne-Stokes Respiration in Patients with Heart Failure: Prevalence, Causes, Consequences and Treatments

Brack¹,

Randerath

Bloch

2011

Respiration

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“…Since bradyarrhythmias are noted with apneic episodes, especially in those patients with obstructive sleep apnea, it was proposed that increasing the heart rate with atrial pacing would improve sleep disordered breathing [72]. In a preliminary study of 15 patients who had an existing pacemaker, and polysomnogram evidence of sleep apnea, Garrigue et al [72] noted that pacing at a rate 15 beats/min faster than the control night decreased the AHI.…”

Section: Cardiac Pacingmentioning

confidence: 99%

Treatment of sleep disordered breathing in congestive heart failure

et al. 2008

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In patients with congestive heart failure, sleep disordered breathing occurs commonly and is associated with an increased mortality. In addition to central sleep apnea (Cheyne-Stokes respiration), obstructive sleep apnea is more prevalent in patients with congestive heart failure than in the general population. As a result, a number of treatments have been investigated, with varying results. While many therapies may improve the severity of sleep disordered breathing, only positive pressure ventilation has been shown to improve cardiac function. Newer forms of positive pressure ventilation, such as adaptive servo-ventilation, appear to be even more effective at correcting central sleep apnea. Whether any of these treatments have an effect on transplant-free survival is presently unknown and awaits further study.

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“…Reversion of OSA with CPAP or tracheostomy has been shown to abolish arrhythmia in most patients [66, 69]. Atrial overdrive pacing during sleep has been shown to reduce the number of episodes of OSA or central sleep apnea (CSA) without reducing the total sleep time [70]. Arrhythmias, especially tachyarrhythmias, may have a role in the pathogenesis of stroke by thrombus formation and embolism.…”

Section: Arrhythmiamentioning

confidence: 99%

Deleterious Effects of Sleep-Disordered Breathing on the Heart and Vascular System

Dincer

O’Neill

2006

Respiration

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Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing, affecting 5–15% of the population. It is characterized by intermittent episodes of partial or complete obstruction of the upper airway during sleep that disrupts normal ventilation and sleep architecture, and is typically associated with excessive daytime sleepiness, snoring, and witnessed apneas. Patients with obstructive sleep apnea present risk to the general public safety by causing 8-fold increase in vehicle accidents, and they may themselves also suffer from the physiologic consequences of OSA; these include hypertension, coronary artery disease, stroke, congestive heart failure, pulmonary hypertension, and cardiac arrhythmias. Of these possible cardiovascular consequences, the association between OSA and hypertension has been found to be the most convincing. Although the exact mechanism has not been understood, there is some evidence that OSA is associated with frequent apneas causing mechanical effects on intrathoracic pressure, cardiac function, and intermittent hypoxemia, which may in turn cause endothelial dysfunction and increase in sympathetic drive. Therapy with continuous positive airway pressure has been demonstrated to improve cardiopulmonary hemodynamics in patients with OSA and may reverse the endothelial cell dysfunction. Despite the availability of diagnostic measures and effective treatment, many patients with sleep-disordered breathing remain undiagnosed. Therefore, OSA continues to be a significant health risk both for affected individuals and for thegeneral public. Awareness and timely initiation of an effective treatment may prevent potential deleterious cardiovascular effects of OSA.

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Benefit of Atrial Pacing in Sleep Apnea Syndrome

Abstract: In patients with sleep apnea syndrome, atrial overdrive pacing significantly reduces the number of episodes of central or obstructive sleep apnea without reducing the total sleep time.

Cited by 303 publications

References 39 publications

Cheyne-Stokes Respiration in Patients with Heart Failure: Prevalence, Causes, Consequences and Treatments

Cheyne-Stokes Respiration in Patients with Heart Failure: Prevalence, Causes, Consequences and Treatments

Treatment of sleep disordered breathing in congestive heart failure

Deleterious Effects of Sleep-Disordered Breathing on the Heart and Vascular System

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