Abstract
Background: Permanent cardiac pacemaker is indicated in patients with symptomatic bradycardia. Its role in sleep disorder is unknown, however some patient report improvement in their sleep habit after permanent cardiac pacemaker implant. We examined the role of permanent cardiac pacemaker in relation to patients’ sleeping habits. Methods: Total of 174 patients who agreed to participate in the study were included (21 Implantable Cardioverter Defibrillator (ICD) and 153 pacemaker implants). The ICD group was used as the control group. Patients with bi-ventricular pacemaker implants for cardiac re-synchronization therapy were excluded from the study. Questionnaires about the sleep habit were evaluated before and after the device implant and analyzed using paired T test and Chi square test. Results: The indications for permanent pacemaker therapy were high grade AV block (33%), sick sinus syndrome (64%) and syncope (1%). Indications of ICD were primary or secondary sudden cardiac death prevention without history of known symptomatic bradycardia (100%). Mean Ventricular pacing was 40.39% (interquartile range: 97%) of the time in the pacemaker group. There were no baseline differences in sleep duration and quality of sleep in both the ICD and pacemaker group prior to device implant. Improved sleep habit (46% in pacemaker vs 23% in the ICD group, P=0.04) and better quality of sleep (44% in pacemaker vs 19% in ICD, P=0.01) were reported after device implant. The patients in pacemaker group reported much improvement in sleep duration (average by 30 minutes in Pacemaker vs 15 minutes in ICD, P=0.002). Conclusions: Patients who had permanent pacemaker implant for symptomatic bradycardia showed improved sleep quality and duration than the patients with ICD implant for primary or secondary sudden cardiac death prevention. Mechanisms of improved sleep habit in pacemaker group are unclear, but possibly associated with improved cardiac output with consistent heat rate during sleep from the pacemaker. Further large-scale studies are needed to validate this concept.
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