Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
Ludgerus-Kliniken Münster, Clemenshospital, Münster, Germany.
J Cardiovasc Transl Res. 2021 Apr;14(2):377-385. doi: 10.1007/s12265-020-10061-0. Epub 2020 Aug 12.
Nocturnal hypoxemic burden is established as a robust prognostic metric of sleep-disordered breathing (SDB) to predict mortality and treating hypoxemic burden may improve prognosis. The aim of this study was to evaluate improvements in nocturnal hypoxemic burden using transvenous phrenic nerve stimulation (TPNS) to treat patients with central sleep apnea (CSA). The remedē System Pivotal Trial population was examined for nocturnal hypoxemic burden. The minutes of sleep with oxygen saturation < 90% significantly improved in Treatment compared with control (p < .001), with the median improving from 33 min at baseline to 14 min at 6 months. Statistically significant improvements were also observed for average oxygen saturation and lowest oxygen saturation. Hypoxemic burden has been demonstrated to be more predictive for mortality than apnea-hypopnea index (AHI) and should be considered a key metric for therapies used to treat CSA. Transvenous phrenic nerve stimulation is capable of delivering meaningful improvements in nocturnal hypoxemic burden. There is increasing interest in endpoints other than apnea-hypopnea index in sleep-disordered breathing. Nocturnal hypoxemia burden may be more predictive for mortality than apnea-hypopnea index in patients with poor cardiac function. Transvenous phrenic nerve stimulation is capable of improving nocturnal hypoxemic burden. Graphical Abstract.
夜间低氧血症负担被确立为睡眠呼吸障碍（SDB）的一个强大预后指标，用于预测死亡率，而治疗低氧血症负担可能改善预后。本研究旨在评估使用经静脉膈神经刺激（TPNS）治疗中枢性睡眠呼吸暂停（CSA）患者时夜间低氧血症负担的改善情况。对 remedē 系统关键试验人群进行了夜间低氧血症负担评估。与对照组相比，治疗组的睡眠中氧饱和度<90%的分钟数显著改善（p<.001），中位数从基线时的 33 分钟改善至 6 个月时的 14 分钟。平均氧饱和度和最低氧饱和度也观察到了统计学上的显著改善。已经证明，低氧血症负担比呼吸暂停低通气指数（AHI）更能预测死亡率，应被视为治疗 CSA 所使用疗法的关键指标。经静脉膈神经刺激能够显著改善夜间低氧血症负担。在睡眠呼吸障碍中，除了呼吸暂停低通气指数之外，其他终点也越来越受到关注。在心脏功能较差的患者中，夜间低氧血症负担可能比呼吸暂停低通气指数更能预测死亡率。经静脉膈神经刺激能够改善夜间低氧血症负担。
