Transvenous phrenic nerve stimulation for the treatment of central sleep apnea reduces episodic hypoxemic burden
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Transvenous phrenic nerve stimulation for the treatment of central sleep apnea reduces episodic hypoxemic burden. / Baumert, Mathias; Immanuel, Sarah; McKane, Scott; Linz, Dominik.
In: International Journal of Cardiology, Vol. 378, 2023, p. 89-95.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Transvenous phrenic nerve stimulation for the treatment of central sleep apnea reduces episodic hypoxemic burden
AU - Baumert, Mathias
AU - Immanuel, Sarah
AU - McKane, Scott
AU - Linz, Dominik
N1 - Publisher Copyright: © 2023 The Author(s)
PY - 2023
Y1 - 2023
N2 - Study objectives: To determine the effect of transvenous phrenic nerve stimulation (TPNS) on the composition of the nocturnal hypoxemic burden in patients with CSA. Methods: We analysed oximetry data from baseline and follow-up overnight polysomnograms (PSG) in 134 CSA patients with implanted TPNS randomised (1:1) to neurostimulation (treatment group; TPNS on) or no stimulation (control group; TPNS off) from the remedē System Pivotal Trial. The hypoxemic burden was quantified using a battery of metrics, including the oxygen desaturation index (ODI), the relative sleep time spent below 90% SpO2 (T90) due to acute episodic desaturations (T90desat) and due to non-specific and non-cyclic drifts of SpO2 (T90non-specific). Mean change from baseline is provided. Results: TPNS titrated to reduce respiratory events significantly reduced the ODI in the treatment group by −15.85 h−1 ± 1.99 compared to the control group, which increased 1.32 h−1 ± 1.85 (p 〈0001) and shortened the relative T90 duration by −3.81 percentage points ± 1.23 vs. 0.49 percentage points ± 1.14 increase (p = 0.012). This shortening of T90 was primarily accomplished by reducing the brief cyclic desaturations (T90desaturation: −4.32 percentage points ± 0.98 vs. 0.52 percentage points ± 0.91, p = 0.0004) while notable non-specific drifts in SpO2 remained unchanged (T90non-specific: 0.18 percentage points ± 0.62 vs. -0.13 percentage points ± 0.57, p = 0.72). Conclusions: TPNS appears to significantly reduce the nocturnal hypoxemic burden due to sleep-disordered breathing, but a considerable nocturnal hypoxemic burden from other sources remains. Further investigations are warranted to identify the best strategy to reduce the nocturnal hypoxemic burden beyond preventing respiratory events.
AB - Study objectives: To determine the effect of transvenous phrenic nerve stimulation (TPNS) on the composition of the nocturnal hypoxemic burden in patients with CSA. Methods: We analysed oximetry data from baseline and follow-up overnight polysomnograms (PSG) in 134 CSA patients with implanted TPNS randomised (1:1) to neurostimulation (treatment group; TPNS on) or no stimulation (control group; TPNS off) from the remedē System Pivotal Trial. The hypoxemic burden was quantified using a battery of metrics, including the oxygen desaturation index (ODI), the relative sleep time spent below 90% SpO2 (T90) due to acute episodic desaturations (T90desat) and due to non-specific and non-cyclic drifts of SpO2 (T90non-specific). Mean change from baseline is provided. Results: TPNS titrated to reduce respiratory events significantly reduced the ODI in the treatment group by −15.85 h−1 ± 1.99 compared to the control group, which increased 1.32 h−1 ± 1.85 (p 〈0001) and shortened the relative T90 duration by −3.81 percentage points ± 1.23 vs. 0.49 percentage points ± 1.14 increase (p = 0.012). This shortening of T90 was primarily accomplished by reducing the brief cyclic desaturations (T90desaturation: −4.32 percentage points ± 0.98 vs. 0.52 percentage points ± 0.91, p = 0.0004) while notable non-specific drifts in SpO2 remained unchanged (T90non-specific: 0.18 percentage points ± 0.62 vs. -0.13 percentage points ± 0.57, p = 0.72). Conclusions: TPNS appears to significantly reduce the nocturnal hypoxemic burden due to sleep-disordered breathing, but a considerable nocturnal hypoxemic burden from other sources remains. Further investigations are warranted to identify the best strategy to reduce the nocturnal hypoxemic burden beyond preventing respiratory events.
KW - Central sleep apnea
KW - Hypoxemic burden
KW - Transvenous phrenic nerve stimulation
UR - http://www.scopus.com/inward/record.url?scp=85149701710&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2023.02.041
DO - 10.1016/j.ijcard.2023.02.041
M3 - Journal article
C2 - 36841294
AN - SCOPUS:85149701710
VL - 378
SP - 89
EP - 95
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
ER -
ID: 340363835