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Current Heart Failure Reports
Published in: Current Heart Failure Reports 5/2020

01-10-2020 | Sleep Apnea | Devices (C Veltmann, Section Editor)

Central Sleep Apnea in Patients with Heart Failure—How to Screen, How to Treat

Author: Maria Rosa Costanzo

Published in: Current Heart Failure Reports | Issue 5/2020

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Abstract

Purpose of Review

Central sleep apnea occurs in up to 50% of heart failure patients and worsens outcomes. Established therapies are limited by minimal supporting evidence, poor patient adherence, and potentially adverse cardiovascular effects. However, transvenous phrenic nerve stimulation, by contracting the diaphragm, restores normal breathing throughout sleep and has been shown to be safe and effective. This review discusses the mechanisms, screening, diagnosis, and therapeutic approaches to CSA in patients with HF.

Recent Findings

In a prospective, multicenter randomized Pivotal Trial (NCT01816776) of transvenous phrenic nerve stimulation with the remedē System, significantly more treated patients had a ≥ 50% reduction in apnea-hypopnea index compared with controls, with a 41 percentage point difference between group difference at 6 months (p < 0.0001). All hierarchically tested sleep, quality of life, and daytime sleepiness endpoints were significantly improved in treated patients. Freedom from serious related adverse events at 12 months was 91%. Benefits are sustained to 36 months.

Summary

Transvenous phrenic nerve stimulation improves quality of life in patients with heart failure and central sleep apnea. Controlled trials evaluating the impact of this therapy on mortality/heart failure hospitalizations and “real world” experience are needed to confirm safety and effectiveness.
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Metadata
Title
Central Sleep Apnea in Patients with Heart Failure—How to Screen, How to Treat
Author
Maria Rosa Costanzo
Publication date
01-10-2020
Publisher
Springer US
Published in
Current Heart Failure Reports / Issue 5/2020
Print ISSN: 1546-9530
Electronic ISSN: 1546-9549
DOI
https://doi.org/10.1007/s11897-020-00472-0

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WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

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