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European Heart Journal Advance Access originally published online on August 26, 2005
European Heart Journal 2005 26(23):2568-2575; doi:10.1093/eurheartj/ehi448
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org

Atrial overdrive pacing compared to CPAP in patients with obstructive sleep apnoea syndrome

Christina Unterberg{dagger}, Lars Lüthje*,{dagger}, Julia Szych, Dirk Vollmann, Gerd Hasenfuß and Stefan Andreas

Department of Cardiology and Pneumology, Georg-August-Universität Göttingen, Robert-Koch-Str. 40, D-37099 Göttingen, Germany

Received 14 December 2004; revised 24 May 2005; accepted 26 May 2005; online publish-ahead-of-print 26 August 2005.

* Corresponding author. Tel: +49 551 3914141; fax: +49 551 3914142. E-mail address: larsluethje{at}med.uni-goettingen.de

Aims Obstructive sleep apnoea (OSA) is associated with oxygen desaturation, blood pressure increase, and neurohumoral activation, resulting in possible detrimental effects on the cardiovascular system. Continuous positive airway pressure (CPAP) is the therapy of choice for OSA. In a recent study, nocturnal atrial overdrive pacing (pacing) reduced the severity of sleep apnoea in pacemaker patients. We compared the effects of CPAP with those of pacing in patients with OSA but without pacemaker indication or clinical signs of heart failure.

Methods and results Ten patients with OSA on CPAP therapy were studied for three nights by polysomnography. During the nights that followed a night without any treatment (baseline), the patients were treated with CPAP or pacing in a random order. Pacing was performed with a temporary pacing lead. The pacing frequency was 15 b.p.m. higher than the baseline heart rate. The apnoea–hypopnoea index was 41.0 h–1 (12.0–66.6) at baseline and was significantly lower during CPAP [2.2 h–1 (0.3–12.4)] compared with pacing [39.1 h–1 (8.2–78.5)]. Furthermore, duration and quality of sleep were significantly improved during CPAP when compared with pacing.

Conclusion Nocturnal atrial overdrive pacing is no alternative therapeutic strategy to CPAP for the treatment of OSA in patients without clinical signs of heart failure and without conventional indication for antibradycardia pacing.

Key Words: Pacing • Continuous positive airway pressure • Sleep apnoea


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