Cardiac Resynchronization Therapy and Obstructive Sleep-Related Breathing Disorder in Patients with Congestive Heart Failure

Introduction: CRT may have a positive influence on SRBD in patients who qualify for the therapy. Data are inconclusive in patients with obstructive SRBD. Methods: Consenting patients eligible for CRT underwent a baseline polysomnography (PSG) 2 weeks after implantation during which pacing was withheld. Patients with an apnea hypopnea index (AHI) >= 15 but < 50 were enrolled and randomized to atrial overdrive pacing (DDD) versus atrial synchronous pacing (VDD) with biventricular pacing in both arms. Patients underwent two further PSGs 12 weeks apart. Results: Nineteen men with New York Heart Association class III congestive heart failure participated in the study (age 67.2 +/- 7.5, Caucasian 78.9%, ischemic 73.7%). The score on Epworth Sleepiness Score was 7.3 +/- 4.0, Pittsburgh Sleep Quality Index 7.4 +/- 3.1, and Minnesota Living with Heart Failure Questionnaire 36.9 +/- 21.9. There were no differences between the groups. At baseline, patients exhibited poor sleep efficiency (65.3 +/- 16.6%) with nadir oxygen saturation of 83.5 +/- 5.3% and moderate to severe SRBD (AHI 21.5 +/- 15.3) that was mainly obstructive (central apnea index 3.3 +/- 6.7/hour). On both follow-up assessments, there was no improvement in indices of SRBD (sleep efficiency [68.3 +/- 17.9%], nadir oxygen saturation of 82.8 +/- 4.6%, and AHI 24.9 +/- 21.9). Conclusion: In a cohort of elderly male CHF patients receiving CRT, CRT had no impact on obstructive SRBD burden with or without atrial overdrive pacing. (PACE 2011; 34:593-603).