Abstract
Abstract Introduction Central sleep apnea (CSA) is a recognized complication of cerebrovascular accidents (CVA), although CSA treatment in this setting is of uncertain benefit. A recent randomized clinical trial showed that transvenous phrenic nerve stimulation (TPNS, remedē system, Respicardia Inc.) treats CSA. The clinical impact of TPNS on CSA outcomes in the subgroup of patients with prior CVA was studied. Methods Six subjects with predominantly CSA and history of CVA >6 months prior to enrollment in the remedē System Pivotal Trial were analyzed. Patients underwent attended full-night polysomnography prior to TPNS implantation and 6, 12 and 18 months on TPNS therapy. Apnea-hypopnea index (AHI) and sleep metrics were evaluated. The Epworth Sleepiness Scale (ESS) and Patient Global Assessment (PGA) questionnaire were completed at 12 months. Treated patients and former controls (therapy was turned on after 6 months) with 18 months of TPNS therapy were pooled for analysis based on months of therapy. Results Apnea-hypopnea index decreased from a median of 47 events/hour [interquartile range: 23, 71] at baseline to 15 [4,24], 17 [6,48], and 12 [8,27] at 6, 12, and 18 months. Comparable improvements were also seen in oxygen desaturation index (4%) and arousal index. Central apnea index decreased from 30 [21,61] to ≤3/hour at each follow up. Compared to baseline, ESS decreased by 5 [-10,-3] and 4 [-8,-4] points at 6 and 12 months, while moderate or markedly improved overall health per the PGA was reported by 4/6 and 3/6 patients, respectively. No patient reported recurrent CVA or transient ischemic attack. Conclusion Transvenous phrenic nerve stimulation improved sleep, daytime somnolence and quality of life in patients with CSA and prior CVA. Transvenous phrenic nerve stimulation is a novel therapy that may be an option for treating patients with CSA and prior CVA. Support Respicardia and NIH R01 HL 144859
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
