Simantirakis Emmanuel N, Schiza Sophia E, Chrysostomakis Stavros I, Chlouverakis Gregory I, Klapsinos Nikolaos C, Siafakas Nikolaos M, Vardas Panos E
Department of Cardiology, Heraklion University Hospital, Heraklion, Crete, Greece.
N Engl J Med. 2005 Dec 15;353(24):2568-77. doi: 10.1056/NEJMoa050610.
The role of atrial overdrive pacing (AOP) in sleep apnea remains uncertain. We prospectively evaluated the effect of AOP after 24 hours and after one month in patients with the obstructive sleep apnea-hypopnea syndrome and compared it with the use of nasal continuous positive airway pressure (n-CPAP).
We studied 16 patients with a moderate or severe case of the obstructive sleep apnea-hypopnea syndrome (baseline mean apnea-hypopnea index, 49) and normal left ventricular systolic function in whom a dual-chamber pacemaker had been implanted. After 48 hours, the patients were randomly assigned to AOP (pacing at 15 bpm above the spontaneous mean nocturnal heart rate) or backup atrial pacing (pacing at a heart rate below 40 bpm); the latter group began n-CPAP therapy one day later. After one month, the two groups switched therapies and were followed for an additional month. Polysomnographic studies were performed at baseline, on the first night after randomization, at crossover, and at the end of the study.
During AOP, no significant changes were observed in any of the respiratory variables measured. The change in the apnea-hypopnea index at one month with AOP was +0.2 (95 percent confidence interval, -2.7 to +2.3; P=0.87). In contrast, all variables improved significantly after one month of n-CPAP (change in the apnea-hypopnea index, -46.3; 95 percent confidence interval, -56.2 to -36.5; P<0.001).
Nasal continuous positive airway pressure therapy is highly effective for the treatment of the obstructive sleep apnea-hypopnea syndrome, whereas AOP has no significant effect.
心房超速起搏（AOP）在睡眠呼吸暂停中的作用仍不确定。我们前瞻性评估了阻塞性睡眠呼吸暂停低通气综合征患者在24小时及1个月后AOP的效果，并将其与使用鼻持续气道正压通气（n-CPAP）进行比较。
我们研究了16例患有中度或重度阻塞性睡眠呼吸暂停低通气综合征（基线平均呼吸暂停低通气指数为49）且左心室收缩功能正常的患者，这些患者均已植入双腔起搏器。48小时后，患者被随机分配至AOP组（起搏频率比夜间自发平均心率高15次/分钟）或备用心房起搏组（起搏频率低于40次/分钟）；后一组在一天后开始n-CPAP治疗。1个月后，两组交换治疗方法，并再随访1个月。在基线、随机分组后的第一个晚上、交叉时以及研究结束时进行多导睡眠图研究。
在AOP期间，所测量的任何呼吸变量均未观察到显著变化。AOP治疗1个月时呼吸暂停低通气指数的变化为+0.2（95%置信区间为-2.7至+2.3；P=0.87）。相比之下，n-CPAP治疗1个月后所有变量均显著改善（呼吸暂停低通气指数变化为-46.3；95%置信区间为-56.2至-36.5；P<0.001）。
鼻持续气道正压通气治疗对阻塞性睡眠呼吸暂停低通气综合征非常有效，而AOP没有显著效果。
