Reversal of sinus arrest and atrioventricular conduction block in patients with sleep apnea during nasal continuous positive airway pressure

Sinus arrest and atrioventricular (AV) block have been demonstrated in as much as 30% of patients with sleep apnea (SA). The reversal of heart block after tracheostomy has been shown. Nasal continuous positive airway pressure (nCPAP) now is widely used as the treatment of SA, but little data are available on the effect of nCPAP on heart block in patients with SA. During a 17-mo period 239 patients were found to have SA in an ambulatory study. Heart block was identified in 17 (16 male, one female) of these patients. Standard polysomnography and two-channel long-term ECG before and during nCPAP therapy were performed in order to assess the effect of nCPAP on SA and heart block. Mean age of the 17 patients was 50.7 yr (range, 27 to 78 yr), mean respiratory disturbance index (RDI) was 90/h (SD +/- 36.1) before nCPAP and 6/h (SD +/- 6.2) on the second treatment night. The number of episodes of heart block during sleep decreased significantly (p < 0.001) from 1,575 before therapy to 165 during nCPAP. In 12 patients (70.6%) heart block was totally prevented by nCPAP. In another three patients, there was a 71 to 97% reduction in the number of episodes of heart block on the second treatment night, and in two of them a complete reversal occurred thereafter. Two patients exhibited an increase in block frequency during nCPAP, which was reversed after 4 wk of nCPAP in one but persisted in the other.(ABSTRACT TRUNCATED AT 250 WORDS)