Joseph Susan, Costanzo Maria Rosa
Baylor University Medical Center, Dallas, United States.
Advocate Heart Institute, United States.
Int J Cardiol. 2016 Mar;206 Suppl:S28-34. doi: 10.1016/j.ijcard.2016.02.121. Epub 2016 Feb 23.
Central sleep apnea is a devastating disease which occurs in approximately 40% of patients with heart failure as well as patients with a history of stroke, opioid use and neurological conditions. It is associated with increased morbidity and mortality in heart failure likely due to the recurrent episodes of hypoxia and nor-epinephrine release. There have historically been few therapeutic options; positive airway pressure therapies have been the most common treatment to date. However, the adoption of positive airway pressure therapies has been limited due to poor patient adherence and acceptance and recent evidence of increased cardiovascular mortality in low ejection fraction heart failure patients with CSA. The remedē® System, utilizing transvenous stimulation of the phrenic nerve, offers a novel physiologic approach to therapy that eliminates the need for positive airway pressure and patient adherence. Studies have shown that this therapy improves sleep, oxygenation, and quality of life and ongoing trials are expected to give additional randomized data to support the therapeutic benefit of the remedē® System.
中枢性睡眠呼吸暂停是一种严重疾病，约40%的心力衰竭患者以及有中风、使用阿片类药物和神经系统疾病病史的患者会发生这种疾病。它与心力衰竭患者发病率和死亡率增加相关，这可能是由于反复出现的缺氧和去甲肾上腺素释放所致。从历史上看，治疗选择很少；气道正压疗法是迄今为止最常见的治疗方法。然而，由于患者依从性和接受度差，以及最近有证据表明射血分数低的心力衰竭合并中枢性睡眠呼吸暂停患者心血管死亡率增加，气道正压疗法的采用受到限制。remedē®系统利用经静脉刺激膈神经，提供了一种新颖的生理治疗方法，无需气道正压和患者依从性。研究表明，这种疗法可改善睡眠、氧合和生活质量，正在进行的试验预计将提供更多随机数据以支持remedē®系统的治疗益处。
