Cargando…

Transvenous phrenic nerve stimulation is associated with normalization of nocturnal heart rate perturbations in patients with central sleep apnea

STUDY OBJECTIVES: To determine the effect of transvenous phrenic nerve stimulation (TPNS) on nocturnal heart rate perturbations in patients with CSA. METHODS: In this ancillary study of the remedē System Pivotal Trial, we analyzed electrocardiograms from baseline and follow-up overnight polysomnogra...

Descripción completa

Detalles Bibliográficos
Autores principales: Baumert, Mathias, Linz, Dominik, McKane, Scott, Immanuel, Sarah
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10485567/
https://www.ncbi.nlm.nih.gov/pubmed/37284759
http://dx.doi.org/10.1093/sleep/zsad166
_version_ 1785102816353714176
author Baumert, Mathias
Linz, Dominik
McKane, Scott
Immanuel, Sarah
author_facet Baumert, Mathias
Linz, Dominik
McKane, Scott
Immanuel, Sarah
author_sort Baumert, Mathias
collection PubMed
description STUDY OBJECTIVES: To determine the effect of transvenous phrenic nerve stimulation (TPNS) on nocturnal heart rate perturbations in patients with CSA. METHODS: In this ancillary study of the remedē System Pivotal Trial, we analyzed electrocardiograms from baseline and follow-up overnight polysomnograms (PSG) in 48 CSA patients in sinus rhythm with implanted TPNS randomized to stimulation (treatment group; TPNS on) or no stimulation (control group; TPNS off). We quantified heart rate variability in the time and frequency domain. Mean change from baseline and standard error is provided. RESULTS: TPNS titrated to reduce respiratory events is associated with reduced cyclical heart rate variations in the very low-frequency domain across REM (VLFI: 4.12 ± 0.79% vs. 6.87 ± 0.82%, p = 0.02) and NREM sleep (VLFI: 5.05 ± 0.68% vs. 6.74 ± 0.70%, p = 0.08) compared to the control group. Further, low-frequency oscillations were reduced in the treatment arm in REM (LFn: 0.67 ± 0.03 n.u. vs. 0.77 ± 0.03 n.u., p = 0.02) and NREM sleep (LFn: 0.70 ± 0.02 n.u. vs. 0.76 ± 0.02 n.u., p = 0.03). CONCLUSION: In adult patients with moderate to severe central sleep apnea, transvenous phrenic nerve stimulation reduces respiratory events and is associated with the normalization of nocturnal heart rate perturbations. Long-term follow-up studies could establish whether the reduction in heart rate perturbation by TPNS also translates into cardiovascular mortality reduction. CLINICAL TRIAL: A Randomized Trial Evaluating the Safety and Effectiveness of the remedē® System in Patients With Central Sleep Apnea, ClinicalTrials.gov, NCT01816776
format Online
Article
Text
id pubmed-10485567
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-104855672023-09-09 Transvenous phrenic nerve stimulation is associated with normalization of nocturnal heart rate perturbations in patients with central sleep apnea Baumert, Mathias Linz, Dominik McKane, Scott Immanuel, Sarah Sleep Sleep Disordered Breathing STUDY OBJECTIVES: To determine the effect of transvenous phrenic nerve stimulation (TPNS) on nocturnal heart rate perturbations in patients with CSA. METHODS: In this ancillary study of the remedē System Pivotal Trial, we analyzed electrocardiograms from baseline and follow-up overnight polysomnograms (PSG) in 48 CSA patients in sinus rhythm with implanted TPNS randomized to stimulation (treatment group; TPNS on) or no stimulation (control group; TPNS off). We quantified heart rate variability in the time and frequency domain. Mean change from baseline and standard error is provided. RESULTS: TPNS titrated to reduce respiratory events is associated with reduced cyclical heart rate variations in the very low-frequency domain across REM (VLFI: 4.12 ± 0.79% vs. 6.87 ± 0.82%, p = 0.02) and NREM sleep (VLFI: 5.05 ± 0.68% vs. 6.74 ± 0.70%, p = 0.08) compared to the control group. Further, low-frequency oscillations were reduced in the treatment arm in REM (LFn: 0.67 ± 0.03 n.u. vs. 0.77 ± 0.03 n.u., p = 0.02) and NREM sleep (LFn: 0.70 ± 0.02 n.u. vs. 0.76 ± 0.02 n.u., p = 0.03). CONCLUSION: In adult patients with moderate to severe central sleep apnea, transvenous phrenic nerve stimulation reduces respiratory events and is associated with the normalization of nocturnal heart rate perturbations. Long-term follow-up studies could establish whether the reduction in heart rate perturbation by TPNS also translates into cardiovascular mortality reduction. CLINICAL TRIAL: A Randomized Trial Evaluating the Safety and Effectiveness of the remedē® System in Patients With Central Sleep Apnea, ClinicalTrials.gov, NCT01816776 Oxford University Press 2023-06-07 /pmc/articles/PMC10485567/ /pubmed/37284759 http://dx.doi.org/10.1093/sleep/zsad166 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of Sleep Research Society. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Sleep Disordered Breathing
Baumert, Mathias
Linz, Dominik
McKane, Scott
Immanuel, Sarah
Transvenous phrenic nerve stimulation is associated with normalization of nocturnal heart rate perturbations in patients with central sleep apnea
title Transvenous phrenic nerve stimulation is associated with normalization of nocturnal heart rate perturbations in patients with central sleep apnea
title_full Transvenous phrenic nerve stimulation is associated with normalization of nocturnal heart rate perturbations in patients with central sleep apnea
title_fullStr Transvenous phrenic nerve stimulation is associated with normalization of nocturnal heart rate perturbations in patients with central sleep apnea
title_full_unstemmed Transvenous phrenic nerve stimulation is associated with normalization of nocturnal heart rate perturbations in patients with central sleep apnea
title_short Transvenous phrenic nerve stimulation is associated with normalization of nocturnal heart rate perturbations in patients with central sleep apnea
title_sort transvenous phrenic nerve stimulation is associated with normalization of nocturnal heart rate perturbations in patients with central sleep apnea
topic Sleep Disordered Breathing
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10485567/
https://www.ncbi.nlm.nih.gov/pubmed/37284759
http://dx.doi.org/10.1093/sleep/zsad166
work_keys_str_mv AT baumertmathias transvenousphrenicnervestimulationisassociatedwithnormalizationofnocturnalheartrateperturbationsinpatientswithcentralsleepapnea
AT linzdominik transvenousphrenicnervestimulationisassociatedwithnormalizationofnocturnalheartrateperturbationsinpatientswithcentralsleepapnea
AT mckanescott transvenousphrenicnervestimulationisassociatedwithnormalizationofnocturnalheartrateperturbationsinpatientswithcentralsleepapnea
AT immanuelsarah transvenousphrenicnervestimulationisassociatedwithnormalizationofnocturnalheartrateperturbationsinpatientswithcentralsleepapnea