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Europace Advance Access originally published online on June 23, 2009
Europace 2009 11(8):1037-1040; doi:10.1093/europace/eup165
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Pacing and CRT

Atrial overdrive pacing in sleep apnoea: a meta-analysis

Adrian Baranchuk1,*, Jeff S. Healey2, Christopher S. Simpson1, Damian P. Redfearn1, Carlos A. Morillo2, Stuart J. Connolly2 and Michael Fitzpatrick1

1 Cardiac Electrophysiology and Pacing, Kingston General Hospital, Queen's University, FAPC 3, 76 Stuart Street, Kingston, ON, Canada K7L 2V7; 2 Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada

Aims: Sleep apnoea (SA) is a common breathing disorder that affects 5% of the North American adult population. It has been suggested that suppressing periods of bradycardia associated with apnoea may reduce the autonomic imbalance associated with SA, thereby improving the respiratory condition. The goals of this study were to conduct a systematic review to identify all randomized clinical trial data evaluating atrial overdrive pacing (AOP) for the treatment of SA and to perform a meta-analysis to estimate the true effect of AOP on SA.

Methods and results: A systematic review of the literature was performed to identify all reports of the effect of AOP for the treatment of SA. To be eligible for analysis, studies had to be randomized and controlled, and use the apnoea–hypopnoea index (AHI) to determine the severity of SA. A total of 10 studies were identified, which included 175 patients with intermediate to severe SA. Overall, AOP reduced the AHI by –4.65 episodes/h [95% confidence interval (CI) –8.27 to –1.03, P = 0.01]. In comparison, studies that included a continuous positive airway pressure (CPAP) arm found a greater reduction in AHI with CPAP: –46.3 episodes/h (CI –56.2 to –36.5, P < 0.001).

Conclusion: Although it appears that AOP is associated with a statistically significant reduction in AHI, the magnitude of this benefit is small and likely not of clinical significance. Atrial overdrive pacing should not be universally indicated in patients with SA, unless they have a conventional indication for cardiac pacing.

Key Words: Atrial overdrive pacing, Sleep apnoea

* Corresponding author. Tel: +1 613 549 6666 ext 3801, Fax: +1 613 548 1387, Email: barancha{at}kgh.kari.net

Manuscript submitted 26 January 2009. Accepted after revision 1 June 2009.


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