Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Jul 18:2:1214363.
doi: 10.3389/frsle.2023.1214363. eCollection 2023.

Phrenic nerve stimulation for treatment of central sleep apnea

Shahrokh Javaheri  1   2   3 , Robin Elizabeth Germany  4   5 , Kara Dupuy-McCauley  6
Affiliations
Review

Phrenic nerve stimulation for treatment of central sleep apnea

Shahrokh Javaheri et al. Front Sleep. .

Abstract

The prevalence of central sleep apnea (CSA) is rare in general population. However, CSA is prevalent in those with cardiovascular and cerebrovascular disorders. CSA may persist or even worsen with positive airway pressure therapy in some patients and phrenic nerve stimulation (PNS) offers an alternative treatment for patients with CSA. The device is implanted similar to a cardiac pacemaker and typically followed in the sleep clinic. Multiple studies have described the efficacy and safety of PNS. Improvements were seen in apnea hypopnea events, central events, arousals, and daytime sleepiness and maintained through 5 years. Safety demonstrated a 91% freedom from serious adverse events through 1 year. The physiologic approach and improvement in sleep metrics and quality of life with a strong safety profile make this therapy a good option for many patients with central sleep apnea.

Keywords: cardiovascular disease; central sleep apnea; heart failure; neurostimulation; phrenic nerve; sleep disordered breathing.

PubMed Disclaimer

Conflict of interest statement

SJ and KD-M are consultants to ZOLL Respicardia. RG is an employee of ZOLL Respicardia. The authors declare that this study received funding from ZOLL Respicardia. The funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article, or the decision to submit it for publication, but they did fund some of the studies referenced in the article. SJ declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Prevalence of central sleep apnea in heart failure.
Figure 2
Figure 2
Transvenous phrenic nerve stimulation system.
Figure 3
Figure 3
Sample diagnostic information from the remedē® system.
Figure 4
Figure 4
Sample diagnostic information: DRēAM view screen.
Figure 5
Figure 5
Example of therapy Off-On during overnight polysomnogram. Picture courtesy ZOLL Respicardia: This is an individual patient example and does not provide any indication, guide, warranty or guarantee as to the response other patients may have to the therapy. Individual results may vary.
Figure 6
Figure 6
Proposed CSA treatment algorithm. Treatment should always start with guideline directed medical therapy (GDMT) and options for treatment include continuous positive airway pressure (CPAP), phrenic nerve stimulation (PNS), medications and oxygen.
See this image and copyright information in PMC

References

    1. Abraham W. T., Jagielski D., Oldenburg O., Augostini R., Krueger S., Kolodziej A., et al. (2015). Phrenic nerve stimulation for the treatment of central sleep apnea. J. Am. Coll. Cardiol. HF 5, 360–369. 10.1016/j.jchf.2014.12.013 - DOI - PubMed
    1. Augostini R. S., Afzal M. R., Costanzo M. R., Westlund R., Stellbrink C., Gutleben K., et al. (2019). How to implant a phrenic nerve stimulator for the treatment of central sleep apnea. J. Cardiovasc. Electrophysiol. 30, 792–799. 10.1111/jce.13898 - DOI - PMC - PubMed
    1. Beyerbach D., Fricke J., James K., Kanagarajan K. (2019). Phrenic nerve stimulation and automatic positive airway pressure therapy for treating central sleep apnea and residual obstructive sleep apnea: a case study. J. Cardiac. Failure. 25, 547. 10.1016/j.cardfail.2019.07.132 - DOI
    1. Bitter T., Langer C., Vogt J., Lange M., Horstkotte D., Oldenburg O. (2009). Sleep-disordered breathing in patients with atrial fibrillation and normal systolic left ventricular function. Dtsch. Arztebl. Int. 106, 164–170. 10.3238/arztebl.2009.0164 - DOI - PMC - PubMed
    1. Bradley T. D., Logan A. G., Kimoff R. J., Sériès F., Morrison D., Ferguson K., et al. (2005). Continuous positive airway pressure for central sleep apnea and heart failure. N. Engl. J. Med. 353, 2025–2033. 10.1056/NEJMoa051001 - DOI - PubMed

LinkOut - more resources