Central Sleep Apnea in Heart Failure Patients Treated with Implantable Device

Patients who experience sleep apnea are observed to have daytime sleepiness and fatigue due to interrupted sleep. This in turn is caused by snorting or gasping noises that affected individuals make during their sleep.

Although viewed primarily as a mere nuisance, it is actually more serious than that. Central sleep apnea, which is known to be caused by the inability of the brain to control breathing patterns properly during sleep, can lead to comorbidities including hypertension and heart disease. Due to the general feeling of fatigue from lack of sleep, patients also experience memory problems, as well as mood shifts and changes.

One of the known traditional therapies for Central Sleep Apnea (CSA) is through wearing a continuous positive airway pressure (CPAP) mask. As the name implies, the latter provides the airway with constant positive flow of air through the nasal airways.

A recent biomedical engineering research presented in the annual meeting of the Heart Failure Association of the European Society of Cardiology in Athens, Greece showed the capability of an innovative implantable device to effectively treat heart failure patients who also have central sleep apnea.

Lead author and presenter of the research Prof. William T. Abraham, from Ohio State University, explains that this biomedical engineering breakthrough is the result of a 1-year cohort study made for the Remede system. He stressed the importance of the study by pointing out that CSA is a known comorbidity of 35% of heart failure patients increasing the mortality risk two-folds.

A total of 46 patients were enrolled in the prospective, multicenter trial. The subjects were classified to have moderate to severe CSA.

The implantable device was implanted under the skin just below the collar bone. The pulse generator was then connected to a vein proximal to the phrenic nerve through a wire threaded in the location.

According to Professor Abraham, what the device is does is that it effectively stimulates the diaphragm via its connection with the phrenic nerve. The diaphragm then contracts. This way, the pace generator was able to regulate the breathing patterns of the patient during sleep.

A year after the implantation of the device, the researchers observed significant improvement in sleep, reduction in the apnea-hypopnea index and improvements in REM sleep in the study participants. Evidently, Abraham states that the individuals who participated in the study tell their team how the device has significantly improved their energy levels and their activities of daily living.

The team also found that the patients had improved cardiac status as shown by the improvement in their heart rate variability and the beneficial effects of the device on their heart structure and function.

The results of this study not only prove as a promising addition to current biomedical innovations in heart failure patients, but also have high potential as treatment for sleep apnea, which affects more than 18 million adults in the US.

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