Obstructive sleep apnea in patients with bradyarrhythmias

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Abstract

BACKGROUND: Obstructive sleep apnea (OSA) is associated with various cardiovascular diseases, including arterial hypertension, chronic heart failure, and cardiac rhythm and conduction disorders. In some patients, preexisting bradycardia may not be directly related to OSA. Therefore, it is advisable to rule out OSA in patients referred for pacemaker implantation.

CLINICAL CASES DESCRIPTION: OSA is a common condition frequently associated with bradyarrhythmias. In some cases, treatment for such patients involves the implantation of a permanent endocardial pacemaker. Undiagnosed OSA may lead to an increased number of unnecessary pacemaker implantations, emphasizing the importance of timely diagnosis and treatment of this condition. This article presents clinical observations of seven patients with nocturnal bradyarrhythmias, which resolved following continuous positive airway pressure (CPAP) therapy.

The use of CPAP therapy contributed to the improvement of cardiovascular parameters, including the reduction in the number and duration of heart rhythm pauses. Clinically significant bradyarrhythmias were resolved in patients, allowing them to avoid surgical intervention. In the described cases, patients demonstrated a high apnea–hypopnea index (35.0–79.5 episodes per hour), a significant decrease in blood oxygen saturation (minimum up to 50%), and significant heart rhythm disturbances during the night. The initiation of CPAP therapy led to a reduction in the apnea–hypopnea index (1.9–23.1 episodes per hour), normalization of minimum oxygen saturation (80–93%), and the elimination of prolonged rhythm pauses.

CONCLUSION: The findings highlight the necessity of mandatory screening for OSA in patients with nocturnal bradyarrhythmias before planning pacemaker implantation. CPAP therapy effectively eliminates rhythm disturbances associated with sleep apnea and prevents unnecessary surgical procedures. This confirms the importance of a comprehensive approach to the diagnosis and treatment of this category of patients and the need for further large-scale studies to optimize their management tactics.

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About the authors

Maria V. Yunyaeva

Buyanov City Clinical Hospital

Author for correspondence.
Email: z.maria88@mail.ru
ORCID iD: 0009-0003-3726-734X
Russian Federation, Moscow

Irina A. Bulavina

Buyanov City Clinical Hospital

Email: doctoroirb@yandex.ru
ORCID iD: 0000-0002-6267-3724
SPIN-code: 1275-2773
Russian Federation, Moscow

Azamat M. Baymukanov

Buyanov City Clinical Hospital

Email: baymukanov@gmail.com
ORCID iD: 0000-0003-0438-8981
SPIN-code: 3039-3880

MD, Cand. Sci. (Medicine)

Russian Federation, Moscow

Yulia D. Weissman

Buyanov City Clinical Hospital

Email: judy50@mail.ru
ORCID iD: 0000-0002-5994-4984
SPIN-code: 5883-4809
Russian Federation, Moscow

Artyom A. Evmenenko

Buyanov City Clinical Hospital

Email: rymata1982@mail.ru
ORCID iD: 0009-0000-8682-0680
Russian Federation, Moscow

Ilya L. Ilyich

Buyanov City Clinical Hospital

Email: iilyich@mail.ru
ORCID iD: 0000-0003-4169-1066
Russian Federation, Moscow

Sergey A. Termosesov

Buyanov City Clinical Hospital

Email: stermosesov@list.ru
ORCID iD: 0000-0003-2466-7865
SPIN-code: 5785-5776
Russian Federation, Moscow

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2. Fig. 1. Clinical case No. 1. 24-hour Holter electrocardiogram monitoring: a — before initiating continuous positive airway pressure therapy, prolongation of the R–R interval up to 3.7 s; b — before initiating continuous positive airway pressure therapy, prolongation of the R–R interval up to 15.288 s; c — after initiating continuous positive airway pressure therapy, no pauses exceeding 2 s were recorded. © Eco-Vector, 2025.

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3. Fig. 2. Clinical case No. 1. A fragment of respiratory monitoring: episodes of low pulse and respiratory arrest (apnea) with pronounced desaturation — up to a minimum of 64% — are highlighted in color; Snore (dB); Flow — respiratory flow (s); Thorax — amplitude of chest efforts; SpO2 — blood oxygen saturation (%); Pleth — tissue elasticity; Pulse — heart rate (beats per minute); Activity — patient activity; Pos — patient position (side). © Eco-Vector, 2025.

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4. Fig. 3. Clinical case No. 2. 24-hour Holter electrocardiogram monitoring: a — before initiating continuous positive airway pressure therapy, prolongation of the R–R interval up to 7 s; b — after initiating continuous positive airway pressure therapy, maximum prolongation of the R–R interval reduced to 2.6 s. © Eco-Vector, 2025.

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5. Fig. 4. Clinical case No. 2. A fragment of respiratory monitoring: episodes of low pulse and respiratory arrest (apnea) with pronounced desaturation — up to a minimum of 75% — are highlighted in color; Snore (dB); Flow — respiratory flow (s); Thorax — amplitude of chest efforts; SpO2 — blood oxygen saturation (%); Pleth — tissue elasticity; Pulse — heart rate (beats per minute); Activity — patient activity; Pos — patient position (side). © Eco-Vector, 2025.

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