Case Report: An overweight 48-year-old Thai female presented with syncope while she was lying down and watching television. Telemonitoring during she was unconscious demonstrated that there was long pause due to sinus arrest without escape rhythm. She was inserted with temporary transvenous pacemaker because of profound symptomatic bradycardia during nighttime. She was diagnosed as syncope due to nocturnal bradyarrhythmia. The sleep apnea syndrome (SAS) related bradycardia was the most likely diagnosis. Type 1 polysomnography was performed and compatible with moderate obstructive sleep apnea (OSA). The patient received continuous positive airway pressure (CPAP) for treatment of moderate OSA and remained no syncope or long pause during one year follow-up period.

Conclusion: This was an unusual case of an overweight woman presenting with profound symptomatic nocturnal bradycardia due to moderate OSA treated with CPAP. Patients presenting with nocturnal bradycardia should always be investigated SAS related bradycardia.

Keywords: Nocturnal bradycardia; Overweight; Obstructive sleep apnea; Sleep disordered breathing; Polysomnography

DOI: 10.35755/jmedassocthai.2023.06.13796

Received 9 March 2023 | Revised 30 May 2023 | Accepted 31 May 2023