Bekfani Tarek, Abraham Joseph D, Abraham William T
Department of Cardiology and Angiology, University Hospital Magdeburg Magdeburg, Germany.
Department of Internal Medicine, The Jewish Hospital, Cincinnati OH, US.
Card Fail Rev. 2025 Aug 20;11:e22. doi: 10.15420/cfr.2025.07. eCollection 2025.
Central sleep apnoea (CSA) is a common comorbidity in patients with heart failure. Due to its insidious and chronic nature, CSA often remains unrecognised. Patients with CSA typically present with symptoms, such as daytime fatigue, recurrent heart failure decompensations and cardiac arrhythmias. Although the pathophysiology of CSA is not yet fully understood, the most widely accepted theory suggests that fluctuations in PaCO levels, particularly crossing the apnoeic threshold, play a central role in its development. CSA is associated with various changes, including activation of the sympathetic nervous system, neurohormonal disturbances and haemodynamic perturbations, all of which contribute to increased morbidity and mortality. Transvenous phrenic nerve stimulation (TPNS) has been demonstrated to be a safe and effective therapy for reducing the apnoea-hypopnoea index and improving both left ventricular ejection fraction and quality of life in patients with CSA. These benefits have been validated in randomised clinical trials (RCTs). New methods of analysing RCTs were recently introduced. Applying the win ratio method in a post hoc analysis of the primary RCTs evaluating TPNS suggested that TPNS may also contribute to reduced mortality and fewer heart failure hospitalisations. In this article we explore the pathophysiology of CSA and evaluate the existing evidence on therapeutic options, with a particular focus on TPNS.
中枢性睡眠呼吸暂停（CSA）是心力衰竭患者常见的合并症。由于其隐匿性和慢性特点，CSA常常未被识别。CSA患者通常表现出如日间疲劳、反复的心衰失代偿和心律失常等症状。尽管CSA的病理生理学尚未完全明确，但最广泛接受的理论认为，动脉血二氧化碳分压（PaCO）水平的波动，尤其是超过呼吸暂停阈值，在其发病过程中起核心作用。CSA与多种变化相关，包括交感神经系统激活、神经激素紊乱和血流动力学扰动，所有这些都导致发病率和死亡率增加。经静脉膈神经刺激（TPNS）已被证明是一种安全有效的治疗方法，可降低呼吸暂停低通气指数，并改善CSA患者的左心室射血分数和生活质量。这些益处已在随机临床试验（RCT）中得到验证。最近引入了分析RCT的新方法。在对评估TPNS的主要RCT进行事后分析时应用胜率法表明，TPNS可能还有助于降低死亡率和减少因心力衰竭住院的次数。在本文中，我们探讨了CSA的病理生理学，并评估了现有治疗选择的证据，特别关注TPNS。
