1246 Resolution of Cyclical Ventricular Ectopy with ASV Therapy in a Patient with Cheyne-Stokes Respirations

Abstract

Abstract Introduction Nocturnal cardiac arrhythmias, ranging from ventricular ectopy to heart blocks, have been commonly reported in patients with obstructive sleep apnea syndrome (OSAS). Potential mechanisms for these rhythm disturbances include OSA-associated hypoxemia, arousal trigger increased sympathetic activity and alterations in intrathoracic pressures leading to cardiac mechanical structural changes. A beneficial effect of CPAP treatment on rhythm abnormalities in patients with obstructive sleep apnea has also been demonstrated. However, the relationship of cardiac arrhythmias and central sleep apnea is not well established. Report of Case We report an 82-year-old male with CAD and Atrial fibrillation s/p PPM who presented for management of his sleep disordered breathing (SDB). Upon review, his original sleep studies performed at an outside facility revealed obstructive sleep apnea and central sleep apnea with Cheyne-Stokes Respirations. The patient presented to us on treatment with an auto-adjusting PAP (APAP) of 7-15 cmH2O with an average delivered pressure of 12 cmH2O. A re-titration study was recommended and demonstrated persistent central sleep apnea with Cheyne-Stokes breathing despite treatment with CPAP 12-18 cmH2O. During this time, EKG monitoring revealed an atrial paced rhythm with frequent premature ventricular beats (PVBs) which occurred in a cyclical pattern. After initiation of Adaptive Servo-Ventilation (ASV), periodic breathing was well controlled and cyclical ventricular ectopy had completely resolved. Conclusion Although CPAP therapy has been shown to improve nocturnal arrhythmias in patients with obstructive sleep apnea, the same relationship, to our knowledge, has not been reported in patients with central sleep apnea and Cheyne-Stokes breathing. This case demonstrates the improvement of cyclical ventricular ectopy with ASV therapy.