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Introduction Sleep apnea (SA) is probably the most common breathing disorder occurring during sleep; it is characterized by recurrent episodes of cessation of breathing (apnea) and decrease in breathing (hipopnea). This affection can be associated with oxyhaemoglobin desaturation in the arterial blood and sympathetic activation. These and other physiopathologic mechanisms can contribute to the morbidity and mortality of patients with heart failure, in which set SA frequently occurs; other reported consequences are represented by arrhythmias, social and family disruption and increased incidence of traffic accidents. SA associated with daytime hypersomnolence is estimated to affect 2 to 4% of the middle aged population of the United States. The aim of our study is to evaluate the possible correlation between SA and ventricular arrhythmias (pvcs) in patients (pts) implanted with a DDDR pace maker (pm). Methods 20 pts were enrolled, including 10 women and 10 men with mean age of 70±6.8 years; left ventricular ejection fraction (EF) ranged from 30 to 60%; underlying heart disease was ischemic (30%), hypertensive(20%), valvular (30%), cardiomyopathy (20%); all patients have been recently implanted with a Ela-Medical Talent™ 3 DR p.m. Because of various rhythm disturbances. Ela Medical Talent 3 DR p.m., utilizing a peculiar algorithm, is able to measure minute-ventilation, recording the apnea/hypopnea (a/h) episodes, the a/h histograms of last 24 hours, total number of episodes in the follow-up phase and a/h indexes related to hours of sleep; a complete absence of respiratory activity for at least 10 seconds is interpreted as apnea, whereas a decrease of at least 50% in breathing depth is classified as hypopnea. Pts. Were asked to carry out a 24 hours Holter, in order to establish a possible correlation between pvcs and SA; at the moment of removal of Holter recorder, a complete interrogation of p.m. Was effected. Besides the automatic analysis carried out by the device, a correlation between a/h periods and sleep was realized by a manual search (utilizing p.m. Algorithm) of a/h phases occurring during the effective hours of sleep, as deducted by Holter diary. Results The apnea index ranged between 3.83 and 34.8 (normal ≤10), with an average of 6.65 hours of sleep. 12 pts (60%) had no spontaneous sinus activity during the 24 hours holter, with a steady atrial overdrive pacing. A higher apnea index didn't significantly correlate with a larger presence of pvcs at Holter nor with a lower EF; otherwise, a low EF and the ischemic origin of heart disease seemed to be connected, in this group of pts., with a higher number of pvcs on the Holter ECG. Conclusions Bearing in mind the limitation of the sample, it doesn't seem to exist a correlation, in pts. Implanted with a DDDR p.m., between pvcs and SA, unless it was associated with a low EF and an ischemic origin of heart disease. |
