Potratz Max, Sohns Christian, Dumitrescu Daniel, Sommer Philipp, Fox Henrik
Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany.
Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany.
J Clin Med. 2021 Jan 8;10(2):202. doi: 10.3390/jcm10020202.
Central sleep apnea (CSA) is a common comorbidity in patients with heart failure (HF) and has been linked to increased morbidity and mortality risk. In addition, CSA is associated with impaired quality of life, reduced physical performance capacity, and hypoxemia. Phrenic nerve stimulation (PNS) is a novel approach to the treatment of CSA and has been shown to be safe and effective in this indication. However, there are currently no data on the effects of PNS on physical performance and hypoxia in CSA HF patients, both of which have been shown to be linked to mortality in HF.
This prospective study enrolled patients with HF and CSA diagnosed using polysomnography. All were implanted with a PNS system (remedē system, Respicardia Inc., Minnetonka, MN, USA) for the treatment of CSA. Examinations included polysomnography (to determine hypoxemic burden), echocardiography and a standardized 6-min walk test prior to device implantation (baseline) and after 6 months of follow-up.
A total of 24 patients were enrolled (mean age 67.1 ± 11.2 years, 88% male). The 6-min walk distance was 369.5 ± 163.5 m at baseline and significantly improved during follow-up (to 410 ± 169.7 m; = 0.035). Hypoxemic burden, determined based on time with oxygen saturation < 90% improved from 81 ± 55.8 min at baseline to 27.9 ± 42.8 min during PNS therapy ( < 0.01).
In addition to safely and effectively treating CSA, PNS is also associated with improved physical performance capacity and reduced hypoxemic burden in patients with HF.
中枢性睡眠呼吸暂停（CSA）是心力衰竭（HF）患者常见的合并症，与发病率和死亡率风险增加相关。此外，CSA还与生活质量受损、身体运动能力下降和低氧血症有关。膈神经刺激（PNS）是一种治疗CSA的新方法，已被证明在该适应症中安全有效。然而，目前尚无关于PNS对CSA HF患者身体运动能力和低氧血症影响的数据，而这两者均已被证明与HF患者的死亡率相关。
这项前瞻性研究纳入了通过多导睡眠图诊断为HF和CSA的患者。所有患者均植入PNS系统（remedē系统，美国明尼苏达州明尼通卡市Respicardia公司）以治疗CSA。检查包括多导睡眠图（以确定低氧血症负担）、超声心动图以及在设备植入前（基线）和随访6个月后的标准化6分钟步行试验。
共纳入24例患者（平均年龄67.1±11.2岁，88%为男性）。基线时6分钟步行距离为369.5±163.5米，随访期间显著改善（至410±169.7米；P = 0.035）。基于血氧饱和度<90%的时间确定的低氧血症负担从基线时的81±55.8分钟改善至PNS治疗期间的27.9±42.8分钟（P<0.01）。
除了安全有效地治疗CSA外，PNS还与HF患者身体运动能力改善和低氧血症负担减轻相关。
