Diagnosis and treatment of obstructive sleep apnea in patients with pauses in Holter ECG monitoring: case series

Abstract

Obstructive sleep apnea (OSA) is a common disease in today's society and may affect even more of the population in the near future. Ailments and complications of OSA result from a decrease in the muscle tone of the soft palate, which causes shallow breathing or complete apnea. The consequences of such episodes may be the development of arterial hypertension, the occurrence of cardiac arrhythmias, and also a deterioration in the quality of life. Diagnosis is based on polysomnography in people with suspected OSA. Continuous Positive Airway Pressure (CPAP) therapy is the most effective treatment for OSA. We present a case series in which patients with OSA risk factors and nocturnal pauses in Holter ECG monitoring (HEM) were diagnosed due to suspected OSA. In the polysomnographic test, severe OSA was diagnosed and CPAP therapy was introduced. Follow-up HEM performed during treatment showed complete resolution or significant reduction in the number and length of nocturnal pauses. Based on the case series, current medical knowledge and guidelines for pacemaker implantation, we concluded that in the event of pauses in the HEM, the diagnosis of OSA should be considered in each patient, especially if the pauses occur mainly at night and the patient is at high risk of OSA. Such a procedure may protect the patient from serious complications related to the pacemaker implantation. It should be emphasized, however, that CPAP therapy requires close cooperation of the patient, because it brings effects only when it is used for each sleep.