Transvenous Phrenic Nerve Stimulation Safe, Efficacious in Central Sleep Apnea

This article is part of Pulmonology Advisor’s coverage of the CHEST Virtual 2020 meeting.

Transvenous phrenic nerve stimulation (TPNS) therapy is both safe and effective for patients with central sleep apnea, according to research presented at the CHEST Annual Meeting held virtually October 18 to 21. Researchers relied on data from 32 of 53 enrolled individuals who completed study testing. After undergoing TPNS, their apnea hypopnea index (AHI) decreased by a median of 24 per hour of sleep at 5 years (median residual AHI, 16/h). The median reduction in the central apnea index was 24 per hour (median residual, 1/h).¹

The distribution of sleep stages as a percentage of total sleep times at baseline was N1=33%±18%, N2=49%±16%, N3=4%±8% and rapid eye movement (REM) sleep=13%±6%. The investigators considered repetitive arousals following central apneas, light sleep stages, and deep sleep when evaluating sleep architecture.¹ At 5 years, paired absolute changes from baseline revealed: N1 decreased by 20±13 percentage points, whereas N2 increased by 12±20, N3 by 2±17, and REM by 6±9.¹ The arousal index decreased by 14 per hour and 4% oxygen desaturation index by 22 per hour.¹ In addition to improved sleep architecture, the Epworth Sleepiness Scale scores decreased significantly from a median of 11 at baseline to 4.¹

The participants experienced no unexpected safety events throughout the course of the study. Overall, the individuals in the trial showed improvements in sleep architecture and daytime sleepiness.¹

TPNS therapy is delivered via an implantable device — a battery pack that is implanted under the skin of the upper chest with thin wires inserted into blood vessels near the phrenic nerve.² The device stimulates a nerve in the chest that transmits signals to the diaphragm, with the goal of inducing diaphragmatic contraction and producing a negative intrathoracic pressure similar to normal breathing. During sleep, the patient’s respiratory signals are monitored by the device and the system stimulates the nerve to move the diaphragm for normal breathing.²

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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References

1. Javaheri S, Schwartz A, Abraham W, et al. Effects of transvenous phrenic nerve stimulation on central sleep apnea and sleep architecture: the 5 year analysis. Presented at: the CHEST Virtual Annual Meeting; October 18-21, 2020. Abstract 2412.

2. Respicardia’s remedē^® system receives FDA approval [news release]. Minnetonka, MN: Respicardia, Inc. https://www.respicardia.com/press-releases/respicardias-remede-system-receives-fda-approval/. Published October 10, 2017. Accessed October 14, 2020.

This article originally appeared on Pulmonology Advisor