Benefit of atrial pacing in sleep apnea syndrome

Garrigue, Stéphane; Bordier, P; Jaïs, Philippe

doi:10.1016/s1062-1458(02)00628-1

Cited by 47 publications

(73 citation statements)

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“…Considering the high likelihood that the severity of sleep apnoea changes in association with changes of cardiac function, present data support the re-evaluation of sleep apnoea after improvement of cardiac function in order to prevent unjustified long-term treatment of patients without sleep apnoea or mild sleep apnoea without sleep apnoea-related symptoms. This finding is in line with previous studies that demonstrated that improvement of cardiac function by various therapies, such as implantation of a biventricular cardiac device [13,14] and cardiac transplantation [15], correlates with an attenuation of the severity of sleep apnoea [11][12][13][14][15]35]. In contrast to most studies [11][12][13][14][15], which observed patients with CSA and found an improvement in CSA, we demonstrated that, in our sample of AMI patients, the reduction of sleep apnoea in the group with an improvement of left ventricular EF is mainly caused by the reduction of OSA.…”

Section: Sleep-related Disorders S Buchner Et Alsupporting

confidence: 92%

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Natural course of sleep-disordered breathing after acute myocardial infarction

et al. 2012

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The aim of this study was to test whether an improvement of left ventricular ejection fraction (EF) in the early phase after acute myocardial infarction is associated with a reduction of the severity of central and obstructive sleep apnoea.40 consecutive patients with acute myocardial infarction underwent polysomnography and cardiovascular magnetic resonance imaging within 5 days and 12 weeks after the event to assess sleep apnoea and cardiac function. We stratified the sample in patients who improved their left ventricular EF within 12 weeks by o5% (improved EF group, DEF 9¡1%, n516) and in those who did not (unchanged EF group, DEF -1¡1%, n524).Prevalence of sleep apnoea (o15 apnoea and hypopnoea events?h -1 ) within f5 days after myocardial infarction was 55%. Apnoea and hypopnoea events?h -1 were significantly more reduced in the improved EF group compared with the unchanged EF group (-10¡3 versus 1¡3 events?h -1 ; p50.036). This reduction was based on a significant alleviation of obstructive events (-7¡2 versus 4¡3 events?h -1 ; p50.009), while the reduction of central events was similar between groups (p50.906).An improvement of cardiac function early after myocardial infarction is associated with an alleviation of sleep apnoea. This finding suggests that re-evaluation of treatment indication for sleep apnoea is needed when a change in cardiac function occurs.

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Section: Sleep-related Disorders S Buchner Et Alsupporting

confidence: 92%

“…GARRIGUE et al [35] observed a reduction in obstructive respiratory events as a consequence of increasing cardiac output by atrial overdrive pacing in patients with bradyarrythmias. However, this was not confirmed in a similar randomised controlled trial [37].…”

Section: Sleep-related Disorders S Buchner Et Almentioning

confidence: 99%

Natural course of sleep-disordered breathing after acute myocardial infarction

et al. 2012

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“…A study in patients with pacemakers and sleep apnea syndrome showed that the stabilization of heart rate and in turn blunting baroreceptormediated oscillations of cardiac output by atrial overdrive pacing reduces the severity of the breathing disorder. [37] Conversely, central and peripheral chemoreceptors do not seem to be involved in the underlying sympathetic dysregulation, as CO 2 -breathing and hyperoxic deactivation of peripheral chemoreceptors led to similar respiration responses in our patients with and without PB. Baroreceptor gain in the low frequency range however, was twice as pronounced in patients with PB compared to the control group, indicating that arterial baroreceptors are much more sensitive to slow changes of blood pressure in patients with PB.…”

Section: Discussionmentioning

confidence: 47%

Spontanous periodic breathing is associated with sympathetic hyperreactivity and baroreceptor dysfunction in hypertension

Binggeli

Sudano²,

Corti³

et al. 2010

Journal of Hypertension

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OBJECTIVES: Intermittent periods of hypoxemia such as during periodic breathing are associated with hypertension and increased sympathetic activity. In patients with sleep apnea syndrome, hypertension is common. Treating apnea improves hypertension and reduces sympathetic outflow. The aim of the present study was to investigate the phenomenon and mechanisms of spontaneous periodic breathing in patients with hypertension. METHOD: We examined 43 hypertensive patients with untreated hypertension without left-ventricular dysfunction, heart failure or sleep apnea syndrome. Muscle sympathetic nerve activity (MSA), heart rate (HR), blood pressure (BP) and respiration were continuously recorded at rest and during cold-pressor testing. Oxygen and a CO2-enriched gas were used to test central and peripheral chemoreceptors, respectively. Baroreceptor gain was measured using the alpha method. RESULTS: Seven out of 43 patients showed spontaneous periodic breathing while awake. No difference in MSA, HR and BP was seen between patients with and without periodic breathing at rest except the breathing pattern. However, the cold-pressor test caused a larger increase of MSA in patients with periodic breathing (203 +/-62 vs. 62 +/-8%, P < 0.0001 by ANOVA), as well as systolic (46 +/-6 vs. 25 +/-3 mmHg, P = 0.002) and diastolic BP (26 +/-5 vs. 12 +/-1 mmHg, P = 0.004, ANOVA). Baroreceptor gain was markedly higher in patients with periodic breathing. Chemoreceptor sensitivity was comparable. CONCLUSION: Spontaneous periodic breathing is relatively common in patients with hypertension and is associated with greatly enhanced responses to cold-pressor testing. We suggest increased baroreceptor gain and sympathetic outflow as a cause for the oscillatory respiration pattern via barorespiratory coupling.

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“…An initial report of atrial overdrive pacing in patients with pacemaker implantation 253 for bradyarrhythmia demonstrated a 50% reduction in obstructive apneas (from 6 to 3 per hour) and generated considerable interest in the concept of overdrive pacing for the treatment of OSA. However, this finding has not been replicated in subsequent investigations involving somewhat different patient populations.…”

Section: Treatment Of Arrhythmias: Effects On Sleep Apneamentioning

confidence: 99%