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Transvenous phrenic nerve stimulation: setting up a clinical program.

Julie Mease1, Ralph Augostini1, Meena Khan2

  • 1Division of Cardiology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.

Sleep & Breathing = Schlaf & Atmung
|November 14, 2023
PubMed
Summary
This summary is machine-generated.

Phrenic nerve stimulation (PNS) effectively treats central sleep apnea (CSA) by restoring the drive to breathe. Establishing a joint cardiology and sleep medicine program improves patient care and satisfaction for this sleep-disordered breathing condition.

Keywords:
Central sleep apneaNeuromodulationObstructive sleep apneaPhrenic nerve stimulationSleep medicine

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Area of Science:

  • Sleep Medicine
  • Cardiology
  • Neuromodulation

Background:

  • Central sleep apnea (CSA) is a sleep-disordered breathing condition resulting from a diminished respiratory drive during sleep.
  • Phrenic nerve stimulation (PNS) gained FDA approval in 2017 for treating moderate to severe CSA.
  • Limited guidance exists on establishing successful PNS programs, necessitating practical frameworks.

Purpose of the Study:

  • To describe the development and implementation of a multidisciplinary PNS program for CSA.
  • To provide a model for integrating PNS therapy into clinical practice.
  • To bridge the gap between research findings and clinical application of PNS.

Main Methods:

  • A joint program was established between cardiology and sleep medicine departments.
  • A multidisciplinary team including specialists, advanced practice providers, and clinic managers collaborated.
  • The team managed patient evaluation, device implantation, and ongoing care.

Main Results:

  • 33 patients have undergone PNS implantation at the institution.
  • PNS therapy resulted in the resolution of central apneas and improved patient sleep symptoms.
  • The collaborative, multidisciplinary approach led to high patient satisfaction and strong team cohesion.

Conclusions:

  • Phrenic nerve stimulation is a viable treatment for CSA, though it does not address upper airway obstruction.
  • Effective patient selection and coordinated management between cardiology and sleep medicine are crucial for optimal outcomes.
  • Despite challenges in program establishment (provider identification, space, scheduling), a multidisciplinary PNS program offers vital care to patients with CSA.