Phrenic Nerve Stimulation for the Treatment of Central Sleep Apnea: A Pooled Cohort Analysis

Study Objectives:Early evidence with transvenous phrenic nerve stimulation (PNS) demonstrates improved disease severity and quality of life (QOL) in patients with central sleep apnea (CSA). The goal of this analysis is to evaluate the complete prospective experience with PNS in order to better characterize its efficacy and safety, including in patients with concomitant heart failure (HF).Methods:Using pooled individual data from the pilot (n = 57) and pivotal (n = 151) studies of the remedÄ“ System in patients with predominant moderate to severe CSA, we evaluated 12-month safety and 6- and 12-month effectiveness based on polysomnography data, QOL, and cardiac function.Results:Among 208 combined patients (June 2010 to May 2015), a remedÄ“ device implant was successful in 197 patients (95%), 50/57 pilot study patients (88%) and 147/151 pivotal trial patients (97%). The pooled cohort included patients with CSA of various etiologies, and 141 (68%) had concomitant HF. PNS reduced apnea-hypopnea index (AHI) at 6 months by a median of−22.6 episodes/h (25th and 75th percentile;−38.6 and−8.4, respectively) (median 58% reduction from baseline,P
Source: Journal of Clinical Sleep Medicine : JCSM - Category: Sleep Medicine Source Type: research

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Conclusion: Chronic SF mimicking OSA did not induce echocardiographic changes in cardiac structure and function in both healthy and HF mice. Thus, the deleterious cardiac consequences of OSA are likely induced by other perturbations associated with this prevalent condition, or result from interactions with underlying comorbidities in OSA patients.
Source: Frontiers in Neurology - Category: Neurology Source Type: research
ConclusionAs expected, OSA is frequent in coronary artery disease patients (early after ACS in this study). High prevalence of CSA was less expected. Our results suggest that, before looking for another (neurological) cause, confirmation of CSA should be done at least 2 months after the ACS.
Source: Archives of Cardiovascular Diseases Supplements - Category: Cardiology Source Type: research
ConclusionAmong patients with AF, OSA is an independent risk factor for MACNE and, more specifically, stroke/SE.Graphical Abstract
Source: American Heart Journal - Category: Cardiology Source Type: research
CONCLUSION: Severe OSA is independently associated with miRNAs that are involved in heart failure (miR-1254), myocardial ischemia/reperfusion (miR-320e), and cell proliferation in some cancer types (miR-1254 and miR-320e). Future investigations addressing whether these miRs may provide prognostic information in OSA are needed. PMID: 31898194 [PubMed - as supplied by publisher]
Source: Sleep and Breathing - Category: Sleep Medicine Authors: Tags: Sleep Breath Source Type: research
ConclusionSevere OSA is independently associated with miRNAs that are involved in heart failure (miR-1254), myocardial ischemia/reperfusion (miR-320e), and cell proliferation in some cancer types (miR-1254 and miR-320e). Future investigations addressing whether these miRs may provide prognostic information in OSA are needed.
Source: Sleep and Breathing - Category: Respiratory Medicine Source Type: research
In conclusion, continually high RDI was associated with HF development in patients w ith CIEDs equipped with the AP Scan algorithm. Therefore, an elevated RDI may be a risk factor for the development of HF in patients with CIEDs.
Source: Heart and Vessels - Category: Cardiology Source Type: research
Publication date: Available online 24 December 2019Source: Heart &LungAuthor(s): Sikandar H Khan, Shalini Manchanda, Ninotchka L Sigua, Erika Green, Philani B Mpofu, Siu Hui, Babar A. KhanAbstractBackgroundIn-hospital respiratory outcomes of non-surgical patients with undiagnosed obstructive sleep apnea (OSA), particularly those with significant comorbidities are not well defined. Undiagnosed and untreated OSA may be associated with increased cardiopulmonary morbidity.Study objectivesEvaluate respiratory failure outcomes in patients identified as at-risk for OSA by the Berlin Questionnaire (BQ).MethodsThis was a retros...
Source: Heart and Lung: The Journal of Acute and Critical Care - Category: Respiratory Medicine Source Type: research
AbstractHeart failure with reduced ejection fraction (HFrEF) is common in patients with adult congenital heart disease. Many of the most common congenital defects have a high prevalence of HFrEF, including left-sided obstructive lesions (aortic stenosis, coarctation of the aorta, Shone complex), tetralogy of Fallot, Ebstein anomaly, lesions in which there is a systemic right ventricle, and lesions palliated with a Fontan circulation. However, heart failure with preserved ejection fraction (HFpEF) is also prevalent in all these lesions. Comprehensive evaluation includes physical exam, biomarkers, echocardiography and advanc...
Source: Heart Failure Reviews - Category: Cardiology Source Type: research
Authors: von Kodolitsch Y, Demolder A, Girdauskas E, Kaemmerer H, Kornhuber K, Muino Mosquera L, Morris S, Neptune E, Pyeritz R, Rand-Hendriksen S, Rahman A, Riise N, Robert L, Staufenbiel I, Szöcs K, Vanem TT, Linke SJ, Vogler M, Yetman A, De Backer J Abstract Introduction: The revised Ghent nosology presents classical features of Marfan syndrome. However, behind its familiar face, Marfan syndrome hides less well-known features.Areas covered: The German Marfan Organization listed unusual symptoms and clinical experts reviewed the literature on clinical features of Marfan syndrome not listed in the Ghent nosol...
Source: Expert Review of Cardiovascular Therapy - Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research
Roever L, Tse G, Biondi-Zoccai G. Continuous positive airway pressure and adaptive servoventilation in heart failure patients with central sleep apnea with Cheyne Stokes respiration: are they useful in ameliorating cardiac systolic dysfunction?J Clin Sleep Med. 2019;15(12):1715–1716.
Source: Journal of Clinical Sleep Medicine : JCSM - Category: Sleep Medicine Source Type: research
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