Severe bradyarrhythmias in patients with sleep apnoea: the effect of continuous positive airway pressure treatment

Aim In this new era of insertable loop recorders, we studied obstructive sleep apnoea-hypopnoea syndrome (OSAHS) patients in order to evaluate their arrhythmias and the beneficial effect of Continuous Positive Airway Pressure treatment (CPAP), over a long-term period. Methods and results We enrolled 23 patients (16 men, 50 +/- 11 years) with moderate and severe OSAHS. In all patients, an insertable loop recorder capable of monitoring the heart rhythm for 16 months was implanted. Cardiac pauses >3 s and bradycardic episodes <40 bpm during a 2-month period before, and for 14 months after, the CPAP application, were noted. In each period, the patients underwent two 24-h Hotter recordings. Before treatment, 11 patients (47%) revealed severe cardiac rhythm disturbances, mostly nocturnal. Hotter recordings showed disturbances in only 3 (13%) patients (P = 0.039), those in whom the insertable loop device had recorded frequent episodes. Eight weeks after the initiation of treatment, the total number of the recorded episodes tended to decrease white, during the last 6 months of the follow-up, no episodes were recorded. Conclusion Approximately half of OSAHS patients evidence severe cardiac rhythm disturbances, which are significantly reduced by CPAP. Hotter recordings seem unable to precisely describe the incidence of severe brady-arrhythmias and the effect of treatment. (C) 2004 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.