Reversal of sinus arrest and atrioventricular conduction block in patients with sleep apnea during nasal continuous positive airway pressure.

Abstract

Sinus arrest and atrioventricular (AV) block have been demonstrated in as much as 30% of patients with sleep apnea (SA). The reversal of heart block after tracheostomy has been shown. Nasal continuous positive airway pressure (nCPAP) now is widely used as the treatment of SA, but little data are available on the effect of nCPAP on heart block in patients with SA. During a 17-mo period 239 patients were found to have SA in an ambulatory study. Heart block was identified in 17 (16 male, one female) of these patients. Standard polysomnography and two-channel long-term ECG before and during nCPAP therapy were performed in order to assess the effect of nCPAP on SA and heart block. Mean age of the 17 patients was 50.7 yr (range, 27 to 78 yr), mean respiratory disturbance index (RDI) was 90/h (SD +/- 36.1) before nCPAP and 6/h (SD +/- 6.2) on the second treatment night. The number of episodes of heart block during sleep decreased significantly (p < 0.001) from 1,575 before therapy to 165 during nCPAP. In 12 patients (70.6%) heart block was totally prevented by nCPAP. In another three patients, there was a 71 to 97% reduction in the number of episodes of heart block on the second treatment night, and in two of them a complete reversal occurred thereafter. Two patients exhibited an increase in block frequency during nCPAP, which was reversed after 4 wk of nCPAP in one but persisted in the other.(ABSTRACT TRUNCATED AT 250 WORDS)

Sleep Apnea and Cardiovascular Disease

“…226,235 Electrophysiological characteristics of the sinus node and atrial conduction system in OSA subjects with nocturnal bradyarrhythmias were normal or nearly normal while awake, and CPAP reversed the bradyarrhythmias, suggesting that OSA may have induced the arrhythmias. 234,236,237 First-line treatment of bradyarrhythmias in the setting of obstructive apneas and normal conduction would consist of treatment of OSA. Data emerging from the European Multi-Center Polysomnographic Study show a remarkably high prevalence (59%) of sleep apnea syndrome in patients with pacemakers.…”

Effects of physiological cardiac pacing on sleep‐disordered breathing in patients with chronic bradydysrhythmias

“…2 A few studies have reported the reversal of heart block after tracheostomy or nasal continuous positive airway pressure. However, these were not bradydysrhythmias induced by apnea but SDB induced by chronic bradydysrhythmia such as third-degree AVB or SND.…”

Sleep-Related Breathing Disorders and Cardiac Arrhythmia

“…This may result in severe nocturnal bradyarrhythmia. In the study of 239 OSA patients by Becker et al (1995), bradyarrhythmia occurred only during apnea and hypopnea. In some studies, these bradyarrhythmias occurred more frequently during REM sleep accompanied by at least a 4% decrease in oxygen saturation (Becker et al, 1995;Koehler et al, 1998;Koehler et al, 2000).…”

“…In the study of 239 OSA patients by Becker et al (1995), bradyarrhythmia occurred only during apnea and hypopnea. In some studies, these bradyarrhythmias occurred more frequently during REM sleep accompanied by at least a 4% decrease in oxygen saturation (Becker et al, 1995;Koehler et al, 1998;Koehler et al, 2000). Conversely, in the study by Guilleminault et al (1983), in 3 patients extreme sinus bradycardia occurred during nonREM sleep, and sinus arrest was associated with apneas during REM sleep.…”

“…Nocturnal bradycardia was present in 17 of 239 (7%) patients with OSA who were diagnosed using a validated ambulatory recording device that measured heart rate, oxygen saturation, snoring, and body position (Becker et al, 1995;Koehler et al, 2000). Patients with bradycardia were then given polysomnograms.…”