Transvenous neurostimulation in central sleep apnea associated with heart failure

Abstract

Sleep-related breathing disorders can be classified as either obstructive (OSA) or central sleep apnea (CSA). Whereas there is substantial knowledge about the pathophysiology and sound recommendations for the diagnosis and treatment of OSA, the origin of CSA is still incompletely understood, patient identification is difficult and the necessity for specific treatment is under debate. CSA often accompanies heart failure and is associated with an adverse prognosis. Optimized heart failure treatment reduces CSA and is thus the cornerstone of CSA treatment. In contrast to OSA, noninvasive ventilation does not lead to prognostic improvement in CSA and ASV ventilation may even lead to an increase in mortality. Transvenous neurostimuation of the phrenic nerve is currently under clinical investigation as anew therapeutic modality for CSA. Early results demonstrate positive effects on sleep parameters and quality of life without any evidence for anegative impact on mortality. However, these results await confirmation in larger studies before this new approach can be advocated for routine clinical use.