PURPOSE: Patients with obstructive sleep apnea (OSA) have a significant increase in the prevalence of cardiac arrhythmias during sleep. Bradyarrhythmia, sinus pause, and atrioventricular block are described which may be reversible with tracheotomy. However, tracheotomy has its own limitation and nasal continuous positive airway pressure (CPAP) therapy has become the initial treatment of choice in clinically important OSA. We describe a series of cases of bradyarrhythmia associated with OSA and their response to long term nasal CPAP therapy.
METHODS: Patients with OSA and documented bradyarrhythmia from our sleep clinic were included from January 2002. Follow-up information was collected until December 2007. Sleep characteristics were obtained with standard EEG based polysomnography. Data from telemetry monitor and 24-holter monitor were used to analyze the cardiac rhythm. A trial of nasal CPAP therapy was given to all these patients and the response was assessed by periodic follow-up using a cardiopulmonary sleep study.
RESULTS: Seven patients with concomitant severe OSA and bradyarrythmia were included (Table-1). Follow-up period ranged from 55–68 months. Six patients had OSA. One patient had a combination of OSA and central sleep apnea. All patients had significant sinus bradycardia and sinus pause ranging from 3.1 to 7.34 seconds. It improved with nasal CPAP therapy in four patients. Three patients underwent permanent pacemaker placement (PPM). One patient required PPM for third degree atrioventricular block. Second patient had poor response to nasal CPAP therapy and underwent PPM for severe bradycardia. Follow-up in the third patient requiring PPM therapy before initiation of nasal CPAP showed that he was no longer dependent on PPM after long term nasal CPAP therapy.
CONCLUSION: The bradyarrythmia associated with OSA was reversible after one night of CPAP. Long term follow up of these patients suggest need for PPM in approx 40% of them.
CLINICAL IMPLICATIONS: Nasal CPAP therapy helps to improve the sinus pause and bradycardia in patients with severe OSA and may alleviate need for PPM.
DISCLOSURE: Shantanu Saraswat, No Financial Disclosure Information; No Product/Research Disclosure Information