From the Guidelines
Treating sleep apnea with continuous positive airway pressure (CPAP) therapy is strongly recommended for patients with premature ventricular contractions (PVCs) and sleep apnea, as it can significantly reduce the frequency of PVCs. PVCs are common and increase in frequency with age, and their presence is associated with increased risk of cardiovascular events and mortality 1. Sleep apnea, on the other hand, is linked with morbidity and mortality, which can be improved with CPAP therapy 1. The use of CPAP during sleep, typically starting at pressures of 5-10 cmH2O, can help reduce the frequency of PVCs by improving oxygenation and reducing sympathetic nervous system activation.
Some key points to consider when treating PVCs and sleep apnea include:
- Using CPAP consistently every night for at least 4-6 hours for optimal results
- Adjusting CPAP pressures based on individual needs, as determined by a sleep specialist
- Implementing lifestyle modifications, such as weight loss, avoiding alcohol before bedtime, and sleeping on your side, to complement CPAP therapy and further reduce both sleep apnea severity and PVC frequency
- Recognizing that sleep apnea causes intermittent oxygen drops and stress on the heart during sleep, which can trigger electrical instability in the heart and lead to PVCs 1
It is essential to note that treatment of PVCs with antiarrhythmic medications has not been shown to reduce mortality, and in some cases, may even increase the risk of death 1. Therefore, treating sleep apnea with CPAP therapy is a crucial step in managing PVCs and reducing the risk of cardiovascular events and mortality. By prioritizing CPAP therapy and lifestyle modifications, patients with PVCs and sleep apnea can experience a significant reduction in PVC burden, improved oxygenation, and reduced sympathetic nervous system activation, ultimately leading to better outcomes and improved quality of life 1.
From the Research
Relationship between PVC and Sleep Apnea
- Premature ventricular complexes (PVCs) are common arrhythmias observed in patients with obstructive sleep apnea (OSA) 2.
- Studies have shown that OSA is strongly associated with arrhythmias, including PVCs, with up to two-thirds of patients with OSA experiencing PVCs 3.
- The treatment of OSA with continuous positive airway pressure (CPAP) therapy has been shown to reduce ventricular arrhythmias, including PVCs, in some patients 4, 3, 5.
Effect of CPAP Therapy on PVCs
- CPAP therapy has been found to decrease PVCs in OSA patients, especially those with severe desaturations and nocturnal domination of PVCs 5.
- However, one case report found that CPAP therapy increased the frequency of PVCs and non-sustained ventricular tachycardia in a patient with idiopathic dilated cardiomyopathy 4.
- Another study found that CPAP therapy improved PVC-induced cardiomyopathy in a patient with severe OSA, with a reduction in frequent PVCs without ablation of the PVCs 3.