Sleep-disordered breathing as a risk factor for unnecessary  pacemaker implantation

Szajerska-Kurasiewicz, Anna; Loboda, Danuta; Roleder, Tomasz; Stepanik, Michalina; Durmała, Jacek; Gołba, Krzysztof S.

doi:10.33963/kp.a2022.0011

Cited by 4 publications

(4 citation statements)

References 34 publications

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“…Regardless of the impact of SDB on CRF, OSA diagnosis in patients referred to CR may be relevant due to the increased likelihood of exercise-related complications and adverse events, such as AF, exercise-related ventricular arrhythmias, and nocturnal atrioventricular blocks [ 15 , 21 , 55 , 56 , 59 ]. In the era of home-based hybrid cardiac telerehabilitation [ 46 ], without direct medical supervision during exercise, the diagnosis of OSA as a risk factor for CV complications may change the patient’s qualification to the CR type.…”

Section: Discussionmentioning

confidence: 99%

Effect of Sleep-Disordered Breathing on Exercise Capacity after Myocardial Infarction -- A Cross-Sectional Study

Loboda,

Stepanik,

Durmala

et al. 2023

Rev. Cardiovasc. Med.

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Background: Exercise capacity reflects the cardiovascular risk after myocardial infarction (MI). The study aims to evaluate the impact of sleep-disordered breathing (SDB) on exercise capacity after MI. Methods: Consecutive patients referring to outpatient cardiac rehabilitation up to 28 days after MI and participating in the Polish Managed Care after Acute Myocardial Infarction (MC-AMI) program were included. On admission, we assessed the presence and the severity of SDB using the home sleep apnea test (HSAT), patients’ maximum exercise capacity on a treadmill exercise stress test (EST), and a 6-minute walk test (6MWT), as well as the effect of SDB on the results obtained. In the multivariate analysis, we verified the strength of the observed associations concerning age, anthropometric parameters, and left ventricular ejection fraction (LVEF). Results: A total of 254 patients aged 60.00 (interquartile range 51.00–67.00), including 39 (15.4%) women, with technically adequate HSAT, constituted the study group. Mild SDB was found in 82 (32.3%), moderate in 54 (21.3%), and severe in 51 (20.1%) patients. Among those diagnosed with SDB, obstructive sleep apnea (OSA) was dominant in 167 (89.8%). With the worsening of SDB, the distance in 6MWT and the maximum physical exertion achieved in EST, expressed in metabolic equivalents (METs) and maximal heart rate (MHR), decreased. The linear regression analysis confirmed the following: (1) inversely proportional relationship between the respiratory event index and METs, MHR, and 6MWT distance ( p = 0.005, p = 0.008, and p = 0.004), and the maximum apnea duration and MET and 6MWT distance ( p = 0.042 and p = 0.002); and (2) directly proportional relationship between mean arterial oxygen saturation ( ) during sleep and MET, MHR, and 6MWT distance ( p = 0.019, p = 0.006, and p = 0.013), and minimum and MET and MHR ( p = 0.040 and p 0.001). However, the independent risk factors for impaired exercise capacity, determined using multivariable regression analysis, were age, female sex, higher body mass index (BMI), and decreased LVEF, but not SDB parameters. Conclusions: SDB negatively impacts exercise capacity after MI. However, the strength of this association may be less pronounced due to the interaction of risk factors common for SDB and impaired exercise capacity, e.g., sex, age, BMI, and LVEF.

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Section: Discussionmentioning

confidence: 99%

Effect of Sleep-Disordered Breathing on Exercise Capacity after Myocardial Infarction -- A Cross-Sectional Study

Loboda,

Stepanik,

Durmala

et al. 2023

Rev. Cardiovasc. Med.

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“…Szajerska-Kurasiewicz et al [ 5 ] recently warned that sleep-disordered breathing is a risk factor for unnecessary pacemaker implantation based on a study involving 207 patients hospitalized in a general cardiology ward. Paradoxically, about 5% of patients exhibited so called type II block but none received a pacemaker.…”

Section: How To Avoid the Misdiagnosis Of Mobitz Type II Blockmentioning

confidence: 99%

“…During sleep, second-degree AVB can be manifested by Wenckebach type I AVB block, 2:1 AVB or high grade AVB almost always with a narrow QRS complex. A number of publications have claimed that Mobitz type II AVB may also occur during sleep[ 1 - 5 ]. These reports have been largely discredited because none of the reports defined type II AVB and representative electrocardiograms (ECG) were either misinterpreted or missing[ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Misinterpretation of sleep-induced second-degree atrioventricular block

Barold

2024

World J Cardiol

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A number of publications have claimed that Mobitz type II atrioventricular block (AVB) may occur during sleep. None of the reports defined type II AVB and representative electrocardiograms were either misinterpreted or missing. Relatively benign Wenckebach type I AVB is often misdiagnosed as Mobitz type II which is an indication for a pacemaker. Review of the published reports indicates that Mobitz type II AVB does not occur during sleep when it is absent in the awake state. Conclusion: There is no proof that sleep is associated with Mobitz type II AVB.

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“…The diagnosis and severity of OSA are determined by polysomnography [9] -multiple indicators such as apnoea-hypopnea index (AHI), apnoea index (AI), hypopnea index (HI), oxygen desaturation index (ODI) are assessed during the overnight study. According to the recommendations of the Polish Society of Respiratory Diseases (PTChP) on the diagnosis and treatment of sleep-disordered breathing (SDB) in adults and the American Academy of Sleep Medicine (AASM), OSA is divided into mild (AHI [5][6][7][8][9][10][11][12][13][14][15], moderate (AHI [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] and severe (AHI > 30) [9,10].…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and treatment of obstructive sleep apnoea in patients with pauses in Holter ECG monitoring: case series

Pawłucki,

Domagalski,

Sekuła

et al. 2024

Medical Research Journal

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Obstructive sleep apnoea (OSA) is a common disease in today's society and may affect even more of the population in the near future. Ailments and complications of OSA result from a decrease in the muscle tone of the soft palate, which causes shallow breathing or complete apnoea. The consequences of such episodes may be the development of arterial hypertension, the occurrence of cardiac arrhythmias, and also the deterioration of the quality of life. Diagnosis is based on polysomnography in people with suspected OSA. Continuous Positive Airway Pressure (CPAP) therapy is the most effective treatment for OSA.A case series is presented in which patients with OSA risk factors and nocturnal pauses in Holter ECG monitoring (HEM) were diagnosed due to suspected OSA. In the polysomnographic test, severe OSA was diagnosed and CPAP therapy was introduced. Follow-up HEM performed during treatment showed complete resolution or significant reduction in the number and length of nocturnal pauses. Based on the case series, current medical knowledge and guidelines for pacemaker implantation, it was concluded that in the event of pauses in the HEM, the diagnosis of OSA should be considered in each patient, especially if the pauses occur predominantly at night and the patient is at high risk of OSA. Such a procedure may protect the patient from serious complications related to the pacemaker implantation. It should be emphasized, however, that CPAP therapy requires close cooperation of the patient because it brings effects only when it is used for each sleep.

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Sleep-disordered breathing as a risk factor for unnecessary pacemaker implantation

Cited by 4 publications

References 34 publications

Effect of Sleep-Disordered Breathing on Exercise Capacity after Myocardial Infarction -- A Cross-Sectional Study

Effect of Sleep-Disordered Breathing on Exercise Capacity after Myocardial Infarction -- A Cross-Sectional Study

Misinterpretation of sleep-induced second-degree atrioventricular block

Diagnosis and treatment of obstructive sleep apnoea in patients with pauses in Holter ECG monitoring: case series

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