Byrne Richard E, Miyaki Candace
Department of Sleep Medicine, Geisinger, Wilkes-Barre, PA, USA.
Internal Medicine Residency Program, Geisinger, Danville, PA, USA.
Am J Case Rep. 2025 Jun 18;26:e947160. doi: 10.12659/AJCR.947160.
BACKGROUND Obstructive sleep apnea (OSA) is a highly prevalent condition associated with several cardiovascular diseases, and positive airway pressure (PAP) therapy is considered the standard treatment. In patients with OSA and nocturnal bradyarrhythmias, treatment with PAP therapy improves nocturnal bradyarrhythmias and is the basis for recommending OSA screening in patients with asymptomatic nocturnal bradyarrhythmia. As many patients do not tolerate PAP therapy, alternative treatment options like hypoglossal nerve stimulation (HNS) have been developed. Less is known regarding whether HNS therapy improves nocturnal bradyarrhythmia to a similar extent as PAP therapy. Our case highlights the unexpected return of nocturnal asystole in a patient who switched from PAP therapy to HNS therapy. CASE REPORT We report a case of a 77-year-old man with severe obstructive sleep apnea and nocturnal asystole treated with PAP therapy. Due to dissatisfaction with PAP therapy, he switched to HNS therapy. Upon discontinuing PAP therapy and during the self-titration phase of HNS therapy, the nocturnal asystole events returned unexpectedly despite symptomatic benefit from HNS therapy. Given the patient's concerns regarding the return of nocturnal asystole, he resumed PAP therapy and discontinued HNS therapy, which resolved the bradyarrhythmia. CONCLUSIONS The self-titration phase of HNS therapy can precipitate the return of comorbid conditions, like bradyarrhythmias, which can lead to patients abandoning therapy. Patients considering switching from PAP therapy to HNS therapy should be counseled that this can occur. Research evaluating the effects of HNS therapy on outcomes like nocturnal bradyarrhythmias using implanted loop recorders is warranted.
阻塞性睡眠呼吸暂停（OSA）是一种与多种心血管疾病相关的高度流行疾病，气道正压（PAP）治疗被认为是标准治疗方法。在患有OSA和夜间缓慢性心律失常的患者中，PAP治疗可改善夜间缓慢性心律失常，这也是推荐对无症状夜间缓慢性心律失常患者进行OSA筛查的依据。由于许多患者不耐受PAP治疗，因此已开发出舌下神经刺激（HNS）等替代治疗方案。关于HNS治疗是否能像PAP治疗一样在同等程度上改善夜间缓慢性心律失常，人们了解较少。我们的病例突出了一名从PAP治疗转为HNS治疗的患者夜间心脏停搏意外复发的情况。病例报告：我们报告一例77岁男性患者，患有严重阻塞性睡眠呼吸暂停和夜间心脏停搏，接受PAP治疗。由于对PAP治疗不满意，他转而接受HNS治疗。在停止PAP治疗并处于HNS治疗的自我滴定阶段时，尽管HNS治疗有症状改善，但夜间心脏停搏事件意外复发。鉴于患者对夜间心脏停搏复发的担忧，他恢复了PAP治疗并停止了HNS治疗，这解决了缓慢性心律失常问题。结论：HNS治疗的自我滴定阶段可能会促使合并症（如缓慢性心律失常）复发，这可能导致患者放弃治疗。应告知考虑从PAP治疗转为HNS治疗的患者可能会出现这种情况。有必要开展研究，使用植入式环路记录仪评估HNS治疗对夜间缓慢性心律失常等结局的影响。
