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Atrial Overdrive Pacing Not Effective for Sleep Apnea

Comparison to continuous positive airway pressure shows little effect on sleep quality

WEDNESDAY, Dec. 14 (HealthDay News) -- Atrial overdrive pacing (AOP) does not appear to be effective for treatment of obstructive sleep apnea-hypopnea syndrome, at least in a group of middle-aged, obese patients, according to a report in the Dec. 15 issue of the New England Journal of Medicine.

Panos E. Vardas, M.D., Ph.D., and colleagues from Heraklion University Hospital in Greece, randomly divided 16 patients with obstructive sleep apnea and a pacemaker to either nasal continuous positive airway pressure (n-CPAP) therapy or to AOP. For AOP, their pacemaker was reprogrammed to 15 bpm above average nocturnal heart rates. Each patient was treated for one month and then switched to the alternate therapy for another month.

The researchers found no difference in apnea-hypopnea index or sleep quality during polysomnography in patients undergoing AOP. In contrast, all respiratory variables significantly improved with n-CPAP therapy. Since the cohort was limited to middle-aged obese patients, the authors suggest these results may not apply in general to all patients with obstructive sleep apnea.

"The failure of overdrive pacing to improve sleep apnea in patients with more typical obstructive sleep apnea, in whom adverse anatomical features were probably the predominant mechanism of obstruction...suggests that overdrive pacing is likely to have at most a very limited role in this setting," according to an editorial. "In the meantime, treatments that primarily modify airway anatomy during sleep (e.g., CPAP, surgery and oral appliances) will probably remain the most important tools in the treatment of sleep apnea."

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