Atrial overdrive pacing in sleep apnoea: a meta-analysis

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.

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).

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.