Tokavanich Nithi, Leelapatana Pattranee, Prechawat Somchai, Rungpradubvong Voravut, Mongkonsritrakoon Wimwipa, Vallabhajosyula Saraschandra, Prasitlumkum Narut, Thongprayoon Charat, Cheungpasitporn Wisit, Chokesuwattanaskul Ronpichai
Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand.
Department of Pediatric, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand.
J Clin Med. 2021 Sep 9;10(18):4065. doi: 10.3390/jcm10184065.
Sleep apnea is one of the most common conditions around the world. This disorder can significantly impact cardiovascular morbidity and mortality. Atrial overdrive pacing (AOP) is a treatment modality that can potentially decrease respiratory events. There is currently a lack of evidence to confirm the benefits of AOP. We aimed to assess the impact of AOP in patients with obstructive sleep apnea (OSA), central sleep apnea (CSA), and mixed type.
A literature search for studies that reported the impact on apnea-hypopnea index (AHI) by cardiac implantable electronic devices with different pacing modes was conducted using MEDLINE, Embase, and Cochrane Database from inception through July 2020. Pooled standard mean difference with 95%CI was calculated using a random-effects model.
Fifteen studies, including thirteen randomized studies and two observational studies containing 440 patients, were identified. The standard mean difference in apnea-hypopnea index of atrial overdrive pacing demonstrated less duration of apnea/hypopnea in patients with atrial overdrive pacing (AOP) (SMD -0.29, 95%CI: -0.48, -0.10, I = 57%). Additional analysis was performed to assess the effect of atrial overdrive pacing in patients with or without severe sleep apnea syndrome (mean AHI < 30 defined as non-severe). There was no statistically significant difference in standardized mean in AHI in both subgroups between AOP and control groups (SMD -0.25, severe sleep apnea syndrome SMD -0.03, I = 0.00%).
AOP was associated with a statistically significant reduction in AHI, but the magnitude of reduction was small. AOP may potentially be used as an adjunctive treatment with other modalities in treating patients with sleep apnea.
睡眠呼吸暂停是全球最常见的病症之一。这种疾病会显著影响心血管疾病的发病率和死亡率。心房超速起搏（AOP）是一种可能会减少呼吸事件的治疗方式。目前缺乏证据来证实AOP的益处。我们旨在评估AOP对阻塞性睡眠呼吸暂停（OSA）、中枢性睡眠呼吸暂停（CSA）和混合型患者的影响。
使用MEDLINE、Embase和Cochrane数据库，对从创刊至2020年7月报道不同起搏模式的心脏植入式电子设备对呼吸暂停低通气指数（AHI）影响的研究进行文献检索。采用随机效应模型计算合并标准平均差及95%置信区间。
共纳入15项研究，其中包括13项随机研究和2项观察性研究，涉及440例患者。心房超速起搏组的呼吸暂停低通气指数标准平均差显示，心房超速起搏（AOP）患者的呼吸暂停/低通气持续时间更短（SMD -0.29，95%CI：-0.48，-0.10，I² = 57%）。进行了额外分析以评估心房超速起搏对有或无严重睡眠呼吸暂停综合征（平均AHI < 30定义为非严重）患者的影响。AOP组和对照组在两个亚组的AHI标准化均值上均无统计学显著差异（SMD -0.25，严重睡眠呼吸暂停综合征SMD -0.03，I² = 0.00%）。
AOP与AHI的统计学显著降低相关，但降低幅度较小。AOP可能潜在地用作治疗睡眠呼吸暂停患者的其他方式的辅助治疗。
