Correlatio between apnea and bradycardia

This may be a clinical question and I will be discussing with my PCP next week. I was rushed to hospital Sunday night and after multiple tests a pacemaker was implanted. I mentioned to them several times that I have complex apnea but cardiologist said I had heart stoppages as high as 7 seconds. I have been checked for bradycardia in the past and nothing was done. This time was way different as I passed out and was unresponsive for several minutes. Is there a correlation between complex apnea and bradycardia? If so, what do I need to know?

andycole wrote:This may be a clinical question and I will be discussing with my PCP next week. I was rushed to hospital Sunday night and after multiple tests a pacemaker was implanted. I mentioned to them several times that I have complex apnea but cardiologist said I had heart stoppages as high as 7 seconds. I have been checked for bradycardia in the past and nothing was done. This time was way different as I passed out and was unresponsive for several minutes. Is there a correlation between complex apnea and bradycardia? If so, what do I need to know?

Yikes, Andy... I hope you're on the mend now. Don't really have a comment on your question but keep us updated.

Thanks. I will definely keep the forum posted. There are some discussions on the internet that there is a correlation and I'm hopeful that I didn't get a device I didn't need. I may end up having to change my posting name to "bionic" man - LOL. And this pacemaker is MRI compliant as I have other issues requiring annual MRI's.

Bradycardia causes shortness of breath, which is the essence of apnoea.

If your heart paused for 7 seconds between beats then you would not have been breathing either. If you had less dramatic drops in pulse overnight before that, then that probably caused at least hypopneas. Hence, the bradycardia could have been a contributor to your complex apnoea.

It'll be interesting for you what, if any, change you have in your AHI post pacemaker. Hopefully, any element caused by bradycardia will be fixed. Your next sleep study should give you the answer.

But 7 seconds of asystole indicates you need a pacemaker. Bradycardia alone may not. Hope you feel better for it.

I saw probably all the same studies you did and their conclusion is that they aren't sure if bradycardia causes apnea or if apnea causes bradycardia. Or whether the two have anything to do with each other.

I have very mild apnea that only occurs in REM, yet I have bradycardia just from lying down for 10-15 minutes (heart rate drops to low 40s resulting in low oxygen). I would never have known I had bradycardia had I not had to go in for overnight antibiotics. I wonder how many people are told to see a cardiologist after a sleep study? Although I knew going in that I had the condition, it was just a quirk of fate that I found out about it just a few months before the sleep study.

I saw probably all the same studies you did and their conclusion is that they aren't sure if bradycardia causes apnea or if apnea causes bradycardia. Or whether the two have anything to do with each other.

I suppose it depends what’s meant by ‘causing’ apnoea. While a low heart rate can cause shortness of breath, I’m not sure that would have anything to do with obstructive or central sleep apnoea (while acknowledging OSA may cause heart disease tha might casue bradycardia). I do wonder how CPAP machines report nocturnal shortness of breath as a cardiac symptom as compared to a hypopnea of obstructive origin?

The OP reports losing consciousness, being unresponsive and heart 'stoppages' for up to 7 seconds. Personally, I had a similar experience, got a pacemaker and I was super lucky that my hypopneas and apnoeas ended that day. I only hope the OP’s complex apnoea symptoms become less complex for resolving whatever was going on with his heart.

Greendirt - My AHI has been all over the place since the pacemaker. I have appt this Thursday with Interventional Cardiologist who did implant and have "hard" question for him. Brought into the hospital Sunday evening and don't remember anything until woke(?) in telemetry bed on Monday. A Cardiologist came in with strip from Holter monitor who said he would not release me without pacemaker due to multiple 5 and 7 second pauses. BUT that strip was done while I was NOT on any PAP device. Pacemaker was implanted Tuesday morning. I have had Bradycardia for years and had a cardiologist who did stress tests, pulmonary function tests, and others but did not see need for treatment. He retired some time ago and don't know if new Cardiologist realized I was a past patient of the group. I had lung cancer and too much radiation causing issues which is why I have a pulmonologist who sent me to my 3rd sleep study and as of Aug 2015 am on ASV with complex apnea. I flunked 1st and 2nd studies. The "hard" question is: Could Apnea events have been misinterpreted as Cardiac pauses and did I really need the pacer?

I'm thinking that only a second opinion would disclose that.
Yeah, more tests, and a total crap shoot to find a cardio who won't back up the first doc.
Your best bet would be in a teaching hospital, where many eyes see what happens.

There is a difference between your heart stopping and stopping breathing.

There was another member diagnosed with OSA and it turned out he needed a pacemaker. If your heart stops, your breathing stops too. So it could be your OSA diagnosis/ titration was what was wrong.

With my level of bradycardia, I have an overall low level of oxygen. My overall was in the low 80s. With CPAP, it maxes at 91% oxygen. I agree with the other poster though - a heart stoppage is different from a breathing stoppage. Your breathing can stop for awhile before that affects your heart rate. They are using different equipment as well to confirm that. But, see now, you have STOPPAGE while I just have a low rate of heart beat. Perhaps you changed from a low heart rate to stoppage. And YES, you should have your cpap needs re-evaluated since it was originally determined while you had the bradycardia without the pacemaker. In fact, the sleep PA TOLD me that if I do get a pacemaker, that I need to make an appointment for a new sleep study (although in the meantime, I would just use the apap settings).

AndyCole, asystole (flatline, or pause between beats, which I assume is what you mean by 'stoppage') isn't any symptom of SA I've ever heard of! And if by any chance it is, then a pacemaker would be the treatment, not an air pump.


Bradycardia won't usually get you a pacemaker, as SewTired said, but recorded asystole will. Very different things to have a pulse (bradycardia) and not to have one (asystole). I had 10.4 seconds of asystole to get my PM. As a bonus it kicks in every two hours on average to resolve rate drops and slow pulse.But it's not there for bradycardia, only to stop asystole occurring - and any benefit to bradycardia is a happy coincidence. Hence your two cardiologists both came to the accepted position based on what was before them at the time, it was new info that led to a different outcome.

I really hope you get an improvement in health and peace of mind that the pacemaker is helpful to you and that you need it to keep you well. Flatline is very unhealthy, whatever the cause!

Saw interventional cardiologist yesterday and here's the scoop. I was diagnosed with Sick Sinus Syndrome. Seems I had multiple pauses in my heart beat ranging from 3seconds to 7seconds and a 5sec and 7sec within a 20sec period. While I have been monitored for bradycardia for years, the doctor attributes this episode to my age (74). I attribute part of it to the sudden change from working 24/7/365 to 0/0/0 as I am not as physically active as I had been. He does not 'think' there is a correlation because of the lack of test data. I was NOT on any pap machine when they got those results.

Now that I have a pacemaker I have appt with sleep medicine doctor 4/24 to discuss the need for a new study. Wonder if I can have them do ekg along with eeg although that may be useless with the pacer.