A novel therapeutic approach for central sleep apnea: Phrenic nerve stimulation by the remedē® System

Joseph, Susan; Costanzo, María Rosa

doi:10.1016/j.ijcard.2016.02.121

Cited by 11 publications

(3 citation statements)

References 45 publications

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“…Future studies should also address the optimal settings for VNS and the best site to stimulate the vagus nerve. Parkinson's disease Approved [94][95][96] Vagus nerve stimulation (VNS) Epilepsy Approved [97,98] Depression Approved [93,99] Tinnitus Approved [100] Stroke Under investigation [101] Rheumatoid arthritis Under investigation [78] Crohn's disease Under investigation [89,102] Heart failure Under investigation [103,104] Baroreceptor stimulation Hypertension and heart failure Approved [105] Phrenic nerve stimulation Central sleep apnoea Approved [106] Sacral nerve stimulation Over Active Bladder and urinary incontinence Approved [107] Hypoglossal nerve stimulation (HNS) Obstructive Sleep Apnoea Approved [108] Spinal cord stimulation (SCS) Chronic pain Approved [109] Vagus nerve block (vBloc) Obesity Approved [110] Vagus nerve stimulation in RA / F…”

Section: The Effects Of Vagus Nerve Stimulation On Inflammation In Humentioning

confidence: 99%

Balancing the autonomic nervous system to reduce inflammation in rheumatoid arthritis

et al. 2017

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Imbalance in the autonomic nervous system (ANS) has been observed in many established chronic autoimmune diseases, including rheumatoid arthritis (RA), which is a prototypic immune‐mediated inflammatory disease (IMID). We recently discovered that autonomic dysfunction precedes and predicts arthritis development in subjects at risk of developing seropositive RA. In addition, RA patients with relatively high vagus nerve tone (higher parasympathetic parameters, measured by heart rate variability) respond better to antirheumatic therapies. Together, these data suggest that the ANS may control inflammation in humans. This notion is supported by experimental studies in animal models of RA. We have found that stimulation of the so‐called cholinergic anti‐inflammatory pathway by efferent electrical vagus nerve stimulation (VNS) or pharmacological activation of the alpha7 subunit of nicotinic acetylcholine receptors (α7nAChR) improves clinical signs and symptoms of arthritis, reduces cytokine production and protects against progressive joint destruction. Conversely, increased arthritis activity was observed in alpha7nAChR knockout mice. These studies together with previous work in animal models of sepsis and other forms of inflammation provided the rationale for an experimental clinical trial in patients with RA. We could for the first time show that an implantable vagus nerve stimulator inhibits peripheral blood cytokine production in humans. VNS significantly inhibited TNF and IL‐6 production and improved RA disease severity, even in some patients with therapy‐resistant disease. This work strongly supports further studies using a bioelectronic approach to treat RA and other IMIDs.

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Section: The Effects Of Vagus Nerve Stimulation On Inflammation In Humentioning

confidence: 99%

Balancing the autonomic nervous system to reduce inflammation in rheumatoid arthritis

et al. 2017

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“…Accordingly, high PAP leads to high intrathoracic pressure, in turn leading to decrease in venous return, decreasing thereby the right ventricular stroke volume and consequently decreasing LV lling and cardiac output and eventually tipping the sympathovagal balance in these HF patients to the sympathetic side, which can be deleterious to HF patients. [37] A recent proof-of-concept study showed that neither nocturnal CPAP nor ASV favorably altered the sympathetic tone at night in CSA patients with systolic HF and patients on ASV had a signi cantly lower CI as compared to those on CPAP. [38] Not only that, but another recent study [39] showed that use of ASV in these patients signi cantly decreased N3 sleep (during which vagal tone predominates) and signi cantly increased REM (during which sympathetic nervous activity is known to be highest or close to wakefulness activity) and N2 sleep (during which burst of sympathetic activity have been known to occur).…”

Section: Discussionmentioning

confidence: 99%

Transvenous Phrenic Nerve Stimulation and Positive Airway Pressure devices for Central Sleep Apnea in Patients with Heart Failure with Reduced Ejection Fraction: A Network Meta-analysis

Iftikhar

Khayat

2021

Preprint

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Purpose: Adaptive servo-ventilation (ASV) is contraindicated for central sleep apnea (CSA) treatment in patients with heart failure with reduced ejection fraction (HFrEF) limiting treatment options. Though, continuous positive airway pressure (CPAP), bi-level PAP with back-up rate (BPAP-BUR) and transvenous phrenic nerve stimulation (TPNS) are alternatives, not much is known about their comparative efficacies, which formed the basis of this network meta-analysis, in which their effects on apnea hypopnea index (AHI) and subjective daytime sleepiness (based on Epworth sleepiness score (ESS)), were analyzed.Methods: PubMed was searched for potentially includable randomized controlled trials and network meta-analysis was conducted in R program using package netmeta.Results: Network meta-analysis showed no statistically significant differences between interventions in AHI reduction. In exploring heterogeneity, sensitivity analysis elicited statistically significant differences in AHI reduction between ASV and TPNS (-18.30 [-27.8; -8.79]), with BPAP-BUR (-21.90 [-30.79; -13.01]) and CPAP (-23.10 [-29.22; -16.98]), favoring ASV. Of all the interventions, only TPNS showed a statistically significant decrease in ESS (-3.70 (-5.58; -1.82)) when compared to guideline directed medical therapy (used as a common comparator across trials), while also showing significant differences when compared with ASV (-3.20 (-5.86; -0.54)), BPAP-BUR (-4.00 (-7.33; -0.68)), and CPAP (-4.45 (-7.75; -1.14)). Hasse diagram, accounting for both AHI and ESS as outcomes for relative hierarchy showed relative superiority of both ASV and TPNS over BPAP-BUR and CPAP.Conclusions: Results indicate relative superiority of TPNS and ASV to BPAP-BUR and CPAP in their effects on AHI and ESS reduction in patients with CSA and HFrEF.

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“…Stimulation of the phrenic nerve has also been explored as a method to treat sleep apnea, by stimulating the diaphragm to restore a normal, physiological breathing pattern during sleep (Abraham et al 2015). Stimulation of the phrenic nerve has been used as treatment for diaphragmatic paralysis from cervical spine injuries for over 50 years (Joseph and Costanzo 2016). Phrenic nerve stimulation systems are similar to hypoglossal nerve stimulation systems, consisting of a pulse generator, stimulation lead, and sensing lead (Abraham et al 2015).…”

Section: Electrical Stimulation Of the Hypoglossal And Phrenic Nervesmentioning

confidence: 99%

Sleep apnea: a review of diagnostic sensors, algorithms, and therapies

et al. 2017

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A novel therapeutic approach for central sleep apnea: Phrenic nerve stimulation by the remedē® System

Cited by 11 publications

References 45 publications

Balancing the autonomic nervous system to reduce inflammation in rheumatoid arthritis

Balancing the autonomic nervous system to reduce inflammation in rheumatoid arthritis

Transvenous Phrenic Nerve Stimulation and Positive Airway Pressure devices for Central Sleep Apnea in Patients with Heart Failure with Reduced Ejection Fraction: A Network Meta-analysis

Sleep apnea: a review of diagnostic sensors, algorithms, and therapies

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