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Sleep Apnea Common in Pacemaker Users

Sleep Disorder Often Undiagnosed; Treatment May Help Heart
By
WebMD Health News
Reviewed by Louise Chang, MD

March 12, 2007 -- Heart patients with pacemakers have a high prevalence of undiagnosed sleep apnea, findings from a small European study suggest.

Researchers evaluated 98 pacemaker patients for sleep apnea. Fifty-nine percent of the patients had undiagnosed sleep apnea.

The findings are reported in the April issue of the American Heart Association publication Circulation.

Although it is not clear from the study if sleep apnea contributed to the need for the pacemakers, the findings highlight the need for a greater awareness of the potential association between the two conditions, study co-author Patrick Levy MD, PhD, tells WebMD.

“We know that there is a relationship between sleep apnea and heart arrhythmias (abnormal heart rhythm),” Levy says. “The question is, ‘If we treat the sleep apnea will we reduce the need for pacemakers?’ We don’t know, but we need to find out.”

Obesity, Age Didn’t Explain Link

Sleep apnea is characterized by repeated interruptions of breathing during sleep, which leads to excessive daytime sleepiness and other health problems.

Obesity and age are both major risk factors for heart disease and sleep apnea, but they did not explain the excess of sleep breathing problems among the pacemaker recipients in the study, Levy says.

The patients in the study who were found to have sleep apnea also had less daytime sleepiness than is generally reported for the condition.

“There was no relationship with [sleep apnea] symptoms in this population, which may explain why the disorder remains undiagnosed in so many heart patients,” Levy says.

He recommends that all heart patients who are candidates for pacemakers be evaluated for sleep apnea before they have the devices implanted, and that patients who have sleep apnea receive treatment for the condition.

In the absence of lifestyle changes, such as weight loss, continuous positive airway pressure (CPAP) remains the most effective treatment for sleep apnea. Patients wear a mask during sleep, which delivers pressurized air to the lungs.

More Study Needed

Levy says successful sleep apnea treatment may help heart patients avoid pacemakers.

Cardiologist Kenneth Ellenbogen, MD, tells WebMD that more study is needed to back up this claim. But he agrees that heart patients who are candidates for pacemakers should be evaluated for sleep apnea.

Ellenbogen is a professor of medicine at Virginia Commonwealth University.

“Patients who need pacemakers usually have a variety of other problems,” he says. “A physician who puts a pacemaker in and tells the patient to come back in six months is doing the patient a disservice.”

Ellenbogen says identifying and treating sleep apnea may prove to be as important in heart patients as identifying and treating high blood pressure and diabetes.

“It is another co-morbid condition that we can actually treat, and treat well,” he says.

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