Long-term effect of cardiac pacing on sleep-disordered breathing in patients with conventional indications for a permanent pacemaker

Abstract

Background: The effect of cardiac pacing on sleep-disordered breathing is controversial. We investigated the long-term effect of cardiac pacing on sleep disordered breathing in patients with conventional indications for permanent pacemakers Methods: Subjects comprised 40 patients (29 men; mean age 69±9 years, mean left ventricle ejection fraction 69±8%, and body mass index 23.6±3.5 kg/m2) who were diagnosed with indications for permanent pacemakers (sick sinus syndrome in 23 patients, atrioventricular block in 15, and brady atrial fibrillation in 2). All patients received polysomnographic evaluations before implantation of permanent pacemakers. After implantation of permanent pacemakers, all patients received polysomnographic evaluations during use of the pacemaker settings (AAI/DDD/VVI at 70 beats per minute). Results: The mean follow-up period was 35±13 months. Before implantation, the distribution of sleep-disordered breathing was as follows: 93% had apnea hypopnea index >5, 58% had apnea hypopnea index >15, and 20% had apnea hypopnea index >30. The mean apnea hypopnea index for all patients was 20±15, for those with obstructive type apnea was 4.9±5.3, and for those with central type apnea was 3.0±4.5. The mean Epworth Sleepiness Score was 5.9±4.0. No patient received continuous positive airway pressure therapy or any other therapy for sleep-disordered breathing during the follow up period. The mean apnea hypopnea index at 1 week after implantation of permanent pacemakers was 21±14 (P=0.8) and the mean apnea hypopnea index at end of follow-up was 11±7 (P<0.0001). Conclusion: Long term cardiac pacing significantly reduces the number of episodes of sleep apnea in patients with conventional permanent pacemaker indications