Continuous positive airway pressure treatment reduces ventricular arrhythmias in obstructive sleep apnea patients with nocturnal dominance of arrhythmias and severe desaturations.

Introduction: Continuous positive airway pressure (CPAP) treatment is considered effective in reducing ventricular arrhythmias (VAs) in patients with obstructive sleep apnea (OSA).

Objectives: We aimed to assess the influence of this treatment and to identify determinants of antiarrhythmic response.

Patients And Methods: We included patients with OSA and VAs (corresponding to grades 2-5 in the Lown classification), who underwent CPAP treatment and controls, who refused CPAP therapy. Holter electrocardiographic monitoring was performed at baseline and after 3 months of follow‑up.

Results: The study consisted of 46 patients in the CPAP group and 30 controls. We observed a significant reduction in premature ventricular contractions (PVCs) and nonsustained ventricular tachycardia events (P = 0.007 and P = 0.03, respectively) in the CPAP group after 3 months, and no difference in controls. The effect of PVC reduction was significant in the patients with nocturnal dominance of PVCs (P = 0.002) and with desaturations equal to or below 80% (P = 0.001). PVC reduction rate (PVC at follow‑up / PVC at baseline) correlated inversely with night / day PVC ratio at baseline (R = -0.36; P = 0.02) and the lowest saturation (R = 0.32; P = 0.03) in the CPAP group. After adjustment for clinical data, night / day PVC ratio was an independent predictor of PVC reduction rate (unstandardized coefficient B = -0.19; 95% CI, -0.37 to -0.01; P <0.05). Its value equal to or greater than 1.16 predicted good antiarrhythmic treatment response with sensitivity and specificity of 83% and 70%, respectively.

Conclusions: CPAP treatment decreases VAs in OSA patients, especially those with severe desaturations and nocturnal domination of PVCs. Night / day PVC ratio might be a useful clinical parameter predicting reduction of PVCs in these patients.