We studied the effect of nasal continuous positive airway pressure (nCPAP)on the occurrences of cardiac disturbances in 24 subjects with severe obstructive sleep apnea (OSA). Fifty percent of subjects were hypertensive, but none had symptoms or physical signs suggestive of cardiac disease. Subjects underwent overnight polysomnography with Holter monitoring on 2 consecutive nights (control and nCPAP). nCPAP significantly reduced the apnea/hypopnea index from 66 ± 5 events/h (mean ± SEM) on control nights to 6 ± 1(p < 0.001 ). With nCPAP, only 7 ± 2 % of the night was spent with an arterial oxyhemoglobin saturation <90% as compared with 50 ± 5% on control nights (p < 0.001). No silent myocardial ischemia, severe bradycardia (HR< 30/min for > 1 min) or second degree A-V block were seen during either night. Prolonged sinus pauses (>2 s) were present in 2 subjects on control nights only, and were completely alleviated by nCPAP. Fifteen subjects (63 %)had ventricular premature beats (VPB) on control nights and in 5, these were complex (multiform or repetitive). With nCPAP, 13 subjects had VPB which were complex in 5. The group mean for VPB frequency was not significantly different between study nights. In conclusion, ventricular arrhythmias were common, whereas silent myocardial ischemia was not seen in patients with severe OSA with no evident heart disease. nCPAP relieved all sinus pauses,but had no significant effect on ventricular arrhythmias in this patient population. nCPAP may have a more important effect on cardiac disturbances in patients with OSA and coexistent significant cardiac disease.

Keywords:
Obstructive sleep apnea, Cardiac arrhythmias, Nasal continuous positive airway pressure
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1992
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