The Latest Trends in Sleep Medicine

Transvenous Phrenic Nerve Stimulation for Central Sleep Apnea

Author(s): William J. Healy* and Rami Khayat

Pp: 90-105 (16)

DOI: 10.2174/9789815051032122010009

* (Excluding Mailing and Handling)

Abstract

Central sleep apnea (CSA) occurs when there is a recurrent temporary failure of the pontomedullary breathing pacemaker and subsequent cessation of breathing during sleep. The pathophysiological changes of low cardiac output states are the most common causes of CSA. Thus, CSA occurs most frequently in patients with underlying cardiovascular disease and specifically heart failure (HF). However, cessation of inspiratory effort is also observed in other physiologic and pathophysiologic states such as high-altitude induced periodic breathing, narcotic induced CSA, and idiopathic CSA, along with any processes that may compress the brainstem. CSA is associated with immediate negative consequences, including intermittent hypoxia and sympathetic activation. Several studies have reported an association between CSA and worsened mortality in HF patients. Therefore, the treatment of CSA has been considered part of standard care, especially in patients with HF. In these patients, treatment of CSA can improve sympathetic activation, quality of life and decrease arrhythmias. Previously, the mainstay of treatment for CSA was continuous positive airway pressure (CPAP) therapy and then, as technology evolved, Adaptive Servo Ventilation (ASV). Recent data have suggested increased mortality in patients with HF with reduced ejection fraction (HFrEF) treated with ASV for CSA with EF <45, excluding this otherwise efficacious modality from usage in the majority of patients with CSA. Upon this background, the recent introduction of a novel therapeutic modality, transvenous phrenic nerve stimulation (TPNS), provides a valid treatment option that should be considered in all patients with CSA. In this chapter, we will introduce this treatment modality to the reader and attempt to provide a comprehensive overview of its operation, efficacy data, and application to the treatment of patients with CSA.


Keywords: Adaptive Servo, Cardiac Surgery, Central sleep apnea, Cheyne-stokes respiration, CPAP, Heart failure with a preserved ejection fraction, Heart failure with a reduced ejection fraction, Hypersomnia, Perioperative evaluation, Remedē ® , Sleep disordered breathing, Snoring, Ventilation

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      • 13. app/Models/UserAccess/UserAccess.php:1266
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      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 316582179 and j.to_ip >=316582179 )) and ((j.from_date <= 1740677381 and j.to_date >= 1740677381 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 16750) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 316582179 and j.to_ip >=316582179 )) and ((j.from_date <= 1740677381 and j.to_date >= 1740677381 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 16750) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 316582179 and j.to_ip >=316582179 )) and ((j.from_date <= 1740677381 and j.to_date >= 1740677381 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 16750)
      980μsalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 3326 and `b`.`banner_from_date` <= 1740677381 and `b`.`banner_to_date` >= 1740677381 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.16msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 3326
      • 3: 1740677381
      • 4: 1740677381
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='5545dec99639761b8dff6494fd4e591e'
      240μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:260
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    13Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        gJZqxS0t31n8HG4K88CdLlnpFps696DNGatXoDy2
        uc_cart_id
        5545dec99639761b8dff6494fd4e591e
        _previous
        array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/16750" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/16750
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
        array:16 [ "x-https" => array:1 [ 0 => "1" ] "host" => array:1 [ 0 => "alpha.eurekaselect.com" ] "priority" => array:1 [ 0 => "u=0, i" ] "accept-encoding" => array:1 [ 0 => "gzip, deflate, br, zstd" ] "sec-fetch-dest" => array:1 [ 0 => "document" ] "sec-fetch-user" => array:1 [ 0 => "?1" ] "sec-fetch-mode" => array:1 [ 0 => "navigate" ] "sec-fetch-site" => array:1 [ 0 => "none" ] "accept" => array:1 [ 0 => "text/html,application/xhtml+xml,application/xml;q=0.9,image/avif,image/webp,image/apng,*/*;q=0.8,application/signed-exchange;v=b3;q=0.7" ] "user-agent" => array:1 [ 0 => "Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)" ] "upgrade-insecure-requests" => array:1 [ 0 => "1" ] "sec-ch-ua-platform" => array:1 [ 0 => ""Windows"" ] "sec-ch-ua-mobile" => array:1 [ 0 => "?0" ] "sec-ch-ua" => array:1 [ 0 => ""HeadlessChrome";v="129", "Not=A?Brand";v="8", "Chromium";v="129"" ] "cache-control" => array:1 [ 0 => "no-cache" ] "pragma" => array:1 [ 0 => "no-cache" ] ]
        request_cookies
        []
        
        response_headers
        0 of 0
        array:5 [ "content-type" => array:1 [ 0 => "text/html; charset=UTF-8" ] "cache-control" => array:1 [ 0 => "no-cache, private" ] "date" => array:1 [ 0 => "Thu, 27 Feb 2025 17:29:41 GMT" ] "set-cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6IkI1WWFYZWpIVkNDMHZnc2NWVVZjNVE9PSIsInZhbHVlIjoiVWJXc2tsSFRQdHRBbFlwb1YwaVgwNXE3dDVOK2FaZGVtb1VxTmthM0sydmJWZlZxZ1gzZU1sdmdzVlRvaDBuRTgxTE1Nb1pZaU95K1BycXVPZzhQdVplUkNiZWU0M1Q1YjdLRjc0TU1aSFRpK2tjcFp3QXRFWjlGd3p6NVVQNE8iLCJtYWMiOiIwYTY4ZDhlMDA4NjQwYjc3ZDlkYjkzM2ZjMmM2M2ZlYzAzN2I5YTAzNjhkMGFmZDZmNGQ3MjFhMWVmMzFlY2RmIiwidGFnIjoiIn0%3D; expires=Sun, 02 Mar 2025 05:29:41 GMT; Max-Age=216000; path=/; secure; samesite=laxXSRF-TOKEN=eyJpdiI6IkI1WWFYZWpIVkNDMHZnc2NWVVZjNVE9PSIsInZhbHVlIjoiVWJXc2tsSFRQdHRBbFlwb1YwaVgwNXE3dDVOK2FaZGVtb1VxTmthM0sydmJWZlZxZ1gzZU1sdmdzVlRvaDBuRTgxTE1Nb" 1 => "alphaeurekaselectnet_session=eyJpdiI6IlF0UEcxR0lNU0c1Nmh0em5Ed0dsTmc9PSIsInZhbHVlIjoiU2VMOXBjSWZETWZobVdFR2Vhc1hKTjhSV1AzNlFrWDlkb1NjQzN5ZGRBR1Y1L0JjSFp6Ui9POWUzcGxEQk5MSnlkTEhkeEQycS9Tbk1LcFFURDFhMUNMSWRHdlQzcXR6VVlEdGxyQWlBN3pNUitQS01PRVRvWmdxSUY5L0xzeWUiLCJtYWMiOiI0NTU4M2I3MjBiNmNmN2UwYmM4ZWUyYTQxNWI3NzEwOTU4YjhlZDk3ODI0YmJkMjhkMTM3OGZjODM3YTRlN2ZlIiwidGFnIjoiIn0%3D; path=/; secure; httponly; samesite=laxalphaeurekaselectnet_session=eyJpdiI6IlF0UEcxR0lNU0c1Nmh0em5Ed0dsTmc9PSIsInZhbHVlIjoiU2VMOXBjSWZETWZobVdFR2Vhc1hKTjhSV1AzNlFrWDlkb1NjQzN5ZGRBR1Y1L0JjSFp6Ui9POWU" ] "Set-Cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6IkI1WWFYZWpIVkNDMHZnc2NWVVZjNVE9PSIsInZhbHVlIjoiVWJXc2tsSFRQdHRBbFlwb1YwaVgwNXE3dDVOK2FaZGVtb1VxTmthM0sydmJWZlZxZ1gzZU1sdmdzVlRvaDBuRTgxTE1Nb1pZaU95K1BycXVPZzhQdVplUkNiZWU0M1Q1YjdLRjc0TU1aSFRpK2tjcFp3QXRFWjlGd3p6NVVQNE8iLCJtYWMiOiIwYTY4ZDhlMDA4NjQwYjc3ZDlkYjkzM2ZjMmM2M2ZlYzAzN2I5YTAzNjhkMGFmZDZmNGQ3MjFhMWVmMzFlY2RmIiwidGFnIjoiIn0%3D; expires=Sun, 02-Mar-2025 05:29:41 GMT; path=/; secureXSRF-TOKEN=eyJpdiI6IkI1WWFYZWpIVkNDMHZnc2NWVVZjNVE9PSIsInZhbHVlIjoiVWJXc2tsSFRQdHRBbFlwb1YwaVgwNXE3dDVOK2FaZGVtb1VxTmthM0sydmJWZlZxZ1gzZU1sdmdzVlRvaDBuRTgxTE1Nb" 1 => "alphaeurekaselectnet_session=eyJpdiI6IlF0UEcxR0lNU0c1Nmh0em5Ed0dsTmc9PSIsInZhbHVlIjoiU2VMOXBjSWZETWZobVdFR2Vhc1hKTjhSV1AzNlFrWDlkb1NjQzN5ZGRBR1Y1L0JjSFp6Ui9POWUzcGxEQk5MSnlkTEhkeEQycS9Tbk1LcFFURDFhMUNMSWRHdlQzcXR6VVlEdGxyQWlBN3pNUitQS01PRVRvWmdxSUY5L0xzeWUiLCJtYWMiOiI0NTU4M2I3MjBiNmNmN2UwYmM4ZWUyYTQxNWI3NzEwOTU4YjhlZDk3ODI0YmJkMjhkMTM3OGZjODM3YTRlN2ZlIiwidGFnIjoiIn0%3D; path=/; secure; httponlyalphaeurekaselectnet_session=eyJpdiI6IlF0UEcxR0lNU0c1Nmh0em5Ed0dsTmc9PSIsInZhbHVlIjoiU2VMOXBjSWZETWZobVdFR2Vhc1hKTjhSV1AzNlFrWDlkb1NjQzN5ZGRBR1Y1L0JjSFp6Ui9POWU" ] ]
        session_attributes
        0 of 0
        array:5 [ "_token" => "gJZqxS0t31n8HG4K88CdLlnpFps696DNGatXoDy2" "uc_cart_id" => "5545dec99639761b8dff6494fd4e591e" "_previous" => array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/16750" ] "_flash" => array:2 [ "old" => [] "new" => [] ] "PHPDEBUGBAR_STACK_DATA" => [] ]
        ClearShow all
        Date ↕MethodURLData
        #12025-02-27 17:29:41GET/chapter/167501121915