Transvenous Phrenic Nerve Stimulation Improves Central Sleep Apnea In Heart Failure Patients

Introduction Central sleep apnea (CSA) and heart failure (HF) often present with similar symptoms. Treatment of CSA primarily focuses on management of CSA-related symptoms such as frequent night-time awakenings or arousals, daytime sleepiness and reduced quality of life (QoL). Transvenous phrenic nerve stimulation (TPNS) has demonstrated improvements in sleep metrics and patient reported outcomes (PROs). Hypothethis To identify symptoms experienced by patients with HF and CSA and determine what types of improvements occur in the most symptomatic patients using TPNS. Methods Post-hoc analysis of baseline and 12-month data collected from patients (N = 75) with HF and moderate to severe CSA from the remedē System Pivotal Trial. Responses to questions pertaining to PROs (Epworth Sleepiness Scale [ESS] and Minnesota Living with Heart Failure Questionnaire [MLHFQ]) and clinical symptoms were analyzed to assess impact of TPNS therapy. Results Baseline clinical symptoms including nocturia (72%), reduced exercise capacity (61%), fatigue or weakness (69%), daytime sleepiness (77%), difficulty falling or staying asleep (52%), snoring (56%) and insomnia/fragmented sleep (51%) were reported by over half of the patients. By 12 months, 24%, 41%, 44%, 45%, 51%, 60% and 66% of the patients, respectively, no longer reported these specific clinical symptoms. On the baseline ESS, > = 50% of patients with HF reported moderate to high (2-3 on the scale) chance of dozing while sitting and reading (55%), watching television (56%) and lying down to rest in the afternoon (68%). For these patients with > = moderate at baseline, 71%, 52% and 35%, respectively, improved to less than moderate chance at 12 months. On the MLHFQ, 6/21 questions had > = 50% of subjects report that HF prevented them from living as they wanted moderately to very much (3-5 on the scale). Following 12 months of TPNS therapy, 33% to 71% of subjects improved from > = moderate at baseline to below moderate (Figure). NYHA functional class improved or remained stable in 89% (67/75) of subjects. Conclusion In the most symptomatic patients with CSA and HF, TPNS may improve symptoms and QoL, specifically related to sleep, sleepiness and fatigue. Heart failure patients with these symptoms may benefit from screening and subsequent treatment of CSA with TPNS.