O'Neill's first nine matches in charge of the national side had yielded five draws and four defeats, but his first taste of success at the highest level was a sweet one as his men got the better of former England boss Fabio Capello and his highly-rated charges in Belfast.
The tireless Paterson, only starting because of an injury to Kyle Lafferty, delivered the result by nodding home Niall McGinn's 43rd-minute cross - his second goal for Northern Ireland and first in competitive action.
It was the least his energetic and passionate display deserved and he might have had another when his 58th-minute header was chalked off to a tight offside flag.
The day had started inauspiciously for the hosts, with Manchester United defender Jonny Evans missing from the squad due to a stomach bug.
Craig Cathcart was drafted in at centre-half as a result, with Jamie Ward and Paterson given the attacking roles in place of Lafferty (Achilles) and Chris Brunt (suspended).
Northern Ireland started with intent as Ward, McGinn and Paterson all got shots away inside the first five minutes.
None caused Igor Akinfeev serious concern, but it at least showed belief.
Russia responded with a couple of early counter attacks - one falling to Aleksandr Kerzhakov in the area and the other seeing Alan Dzagoev line up a shot from 10 yards.
Gareth McAuley ended both, a brave block and a sliding tackle keeping his side in it.
Source: PA
Source: PA