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Samii S, McKane S, Meyer TE, Shah N. Analysis by sex of safety and effectiveness of transvenous phrenic nerve stimulation. Sleep Breath 2024; 28:165-171. [PMID: 37436669 PMCID: PMC10954976 DOI: 10.1007/s11325-023-02882-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE Little is known about sex differences in the treatment of central sleep apnea (CSA). Our post hoc analysis of the remedē System Pivotal Trial aimed to determine sex-specific differences in the safety and effectiveness of treating moderate to severe CSA in adults with transvenous phrenic nerve stimulation (TPNS). METHODS Men and women enrolled in the remedē System Pivotal Trial were included in this post hoc analysis of the effect of TPNS on polysomnographic measures, Epworth Sleepiness Scale, and patient global assessment for quality of life. RESULTS Women (n = 16) experienced improvement in CSA metrics that were comparable to the benefits experienced by men (n = 135), with central apneas being practically eliminated post TPNS. Women experienced improvement in sleep quality and architecture that was comparable to men post TPNS. While women had lower baseline apnea hypopnea index than men, their quality of life was worse at baseline. Additionally, women reported a 25-percentage point greater improvement in quality of life compared to men after 12 months of TPNS therapy. TPNS was found to be safe in women, with no related serious adverse events through 12 months post-implant, while men had a low rate of 10%. CONCLUSION Although women had less prevalent and less severe CSA than men, they were more likely to report reduced quality of life. Transvenous phrenic nerve stimulation may be a safe and effective tool in the treatment of moderate to severe CSA in women. Larger studies of women with CSA are needed to confirm our findings. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT01816776; March 22, 2013.
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Affiliation(s)
- Soraya Samii
- Heart and Vascular Institute, Hershey Medical Center, Penn State University College of Medicine, Penn State Hershey HVI Mailcode H047, 500 University Drive, Hershey, PA, 17033, USA.
| | - Scott McKane
- ZOLL Respicardia, Inc., 12400 Whitewater Dr #150, Minnetonka, MN, 55343, USA.
| | - Timothy E Meyer
- ZOLL Respicardia, Inc., 12400 Whitewater Dr #150, Minnetonka, MN, 55343, USA
| | - Neomi Shah
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Giannoni A, Borrelli C, Gentile F, Sciarrone P, Spießhöfer J, Piepoli M, Richerson GB, Floras JS, Coats AJS, Javaheri S, Emdin M, Passino C. Autonomic and respiratory consequences of altered chemoreflex function: clinical and therapeutic implications in cardiovascular diseases. Eur J Heart Fail 2023; 25:642-656. [PMID: 36907827 PMCID: PMC10989193 DOI: 10.1002/ejhf.2819] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/10/2023] [Accepted: 02/26/2023] [Indexed: 03/14/2023] Open
Abstract
The importance of chemoreflex function for cardiovascular health is increasingly recognized in clinical practice. The physiological function of the chemoreflex is to constantly adjust ventilation and circulatory control to match respiratory gases to metabolism. This is achieved in a highly integrated fashion with the baroreflex and the ergoreflex. The functionality of chemoreceptors is altered in cardiovascular diseases, causing unstable ventilation and apnoeas and promoting sympathovagal imbalance, and it is associated with arrhythmias and fatal cardiorespiratory events. In the last few years, opportunities to desensitize hyperactive chemoreceptors have emerged as potential options for treatment of hypertension and heart failure. This review summarizes up to date evidence of chemoreflex physiology/pathophysiology, highlighting the clinical significance of chemoreflex dysfunction, and lists the latest proof of concept studies based on modulation of the chemoreflex as a novel target in cardiovascular diseases.
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Affiliation(s)
- Alberto Giannoni
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, Pisa, Italy
- Fondazione Toscana G. Monasterio, Pisa, Italy
| | | | - Francesco Gentile
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, Pisa, Italy
| | | | - Jens Spießhöfer
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, Pisa, Italy
- University of Aachen, Aachen, Germany
| | | | | | - John S Floras
- Division of Cardiology, Mount Sinai Hospital, University of Toronto, Ontario, Canada
| | | | - Shahrokh Javaheri
- Division of Pulmonary and Sleep Medicine, Bethesda North Hospital, Cincinnati, Ohio, Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, Ohio, and Division of Cardiology, The Ohio State University, Columbus, Ohio USA
| | - Michele Emdin
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, Pisa, Italy
- Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Claudio Passino
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, Pisa, Italy
- Fondazione Toscana G. Monasterio, Pisa, Italy
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Baumert M, Immanuel S, McKane S, Linz D. Transvenous phrenic nerve stimulation for the treatment of central sleep apnea reduces episodic hypoxemic burden. Int J Cardiol 2023; 378:89-95. [PMID: 36841294 DOI: 10.1016/j.ijcard.2023.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/19/2023] [Accepted: 02/22/2023] [Indexed: 02/26/2023]
Abstract
STUDY OBJECTIVES To determine the effect of transvenous phrenic nerve stimulation (TPNS) on the composition of the nocturnal hypoxemic burden in patients with CSA. METHODS We analysed oximetry data from baseline and follow-up overnight polysomnograms (PSG) in 134 CSA patients with implanted TPNS randomised (1:1) to neurostimulation (treatment group; TPNS on) or no stimulation (control group; TPNS off) from the remedē System Pivotal Trial. The hypoxemic burden was quantified using a battery of metrics, including the oxygen desaturation index (ODI), the relative sleep time spent below 90% SpO2 (T90) due to acute episodic desaturations (T90desat) and due to non-specific and non-cyclic drifts of SpO2 (T90non-specific). Mean change from baseline is provided. RESULTS TPNS titrated to reduce respiratory events significantly reduced the ODI in the treatment group by -15.85 h-1 ± 1.99 compared to the control group, which increased 1.32 h-1 ± 1.85 (p 〈0001) and shortened the relative T90 duration by -3.81 percentage points ± 1.23 vs. 0.49 percentage points ± 1.14 increase (p = 0.012). This shortening of T90 was primarily accomplished by reducing the brief cyclic desaturations (T90desaturation: -4.32 percentage points ± 0.98 vs. 0.52 percentage points ± 0.91, p = 0.0004) while notable non-specific drifts in SpO2 remained unchanged (T90non-specific: 0.18 percentage points ± 0.62 vs. -0.13 percentage points ± 0.57, p = 0.72). CONCLUSIONS TPNS appears to significantly reduce the nocturnal hypoxemic burden due to sleep-disordered breathing, but a considerable nocturnal hypoxemic burden from other sources remains. Further investigations are warranted to identify the best strategy to reduce the nocturnal hypoxemic burden beyond preventing respiratory events.
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Affiliation(s)
- Mathias Baumert
- Discipline of Biomedical Engineering, School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, Australia.
| | - Sarah Immanuel
- Discipline of Biomedical Engineering, School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, Australia; School of Business Information Systems, Torrens University, Adelaide, Australia
| | | | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute, Maastricht, the Netherlands; Centre for Heart Rhythm Disorders, The University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Spiesshoefer J, Giannoni A, Borrelli C, Sciarrone P, Husstedt I, Emdin M, Passino C, Kahles F, Dawood T, Regmi B, Naughton M, Dreher M, Boentert M, Macefield VG. Effects of hyperventilation length on muscle sympathetic nerve activity in healthy humans simulating periodic breathing. Front Physiol 2022; 13:934372. [PMID: 36134331 PMCID: PMC9483206 DOI: 10.3389/fphys.2022.934372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Periodic breathing (PB) is a cyclical breathing pattern composed of alternating periods of hyperventilation (hyperpnea, HP) and central apnea (CA). Differences in PB phenotypes mainly reside in HP length. Given that respiration modulates muscle sympathetic nerve activity (MSNA), which decreases during HP and increases during CA, the net effects of PB on MSNA may critically depend on HP length.Objectives: We hypothesized that PB with shorter periods of HP is associated with increased MSNA and decreased heart rate variability.Methods: 10 healthy participants underwent microelectrode recordings of MSNA from the common peroneal nerve along with non-invasive recording of HRV, blood pressure and respiration. Following a 10-min period of tidal breathing, participants were asked to simulate PB for 3 min following a computed respiratory waveform that emulated two PB patterns, comprising a constant CA of 20 s duration and HP of two different lengths: short (20 s) vs long (40 s). Results: Compared to (3 min of) normal breathing, simulated PB with short HP resulted in a marked increase in mean and maximum MSNA amplitude (from 3.2 ± 0.8 to 3.4 ± 0.8 µV, p = 0.04; from 3.8 ± 0.9 to 4.3 ± 1.1 µV, p = 0.04, respectively). This was paralleled by an increase in LF/HF ratio of heart rate variability (from 0.9 ± 0.5 to 2.0 ± 1.3; p = 0.04). In contrast, MSNA response to simulated PB with long HP did not change as compared to normal breathing. Single CA events consistently resulted in markedly increased MSNA (all p < 0.01) when compared to the preceding HPs, while periods of HP, regardless of duration, decreased MSNA (p < 0.05) when compared to normal breathing.Conclusion: Overall, the net effects of PB in healthy subjects over time on MSNA are dependent on the relative duration of HP: increased sympathetic outflow is seen during PB with a short but not with a long period of HP.
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Affiliation(s)
- Jens Spiesshoefer
- Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
- *Correspondence: Jens Spiesshoefer,
| | - Alberto Giannoni
- Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Chiara Borrelli
- Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy
| | | | - Imke Husstedt
- Department of Neurology with Institute for Translational Neurology, University of Muenster, Muenster, Germany
| | - Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Claudio Passino
- Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Florian Kahles
- Department of Cardiology and Vascular Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Tye Dawood
- Human Autonomic Neurophysiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Binaya Regmi
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Matthew Naughton
- Department of Respiratory Medicine, The Alfred Hospital, Melbourne, VIC, Australia
- Department of Medicine, Monash University, Melbourne, VIC, Australia
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Matthias Boentert
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
- Department of Medicine, UKM Marienhospital Steinfurt, Steinfurt, Germany
| | - Vaughan G. Macefield
- Human Autonomic Neurophysiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Department of Anatomy & Physiology, University of Melbourne, Melbourne, VIC, Australia
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Gentile F, Emdin M, Passino C, Giannoni A. Sex-related difference in sympathetic chemoreflex response: Does it matter in clinical disease? J Physiol 2022; 600:4247-4248. [PMID: 35969001 DOI: 10.1113/jp283643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Francesco Gentile
- Cardiology Division, Pisa University Hospital, Pisa, Italy.,Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Michele Emdin
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy.,Health Sciences Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Claudio Passino
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy.,Health Sciences Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Alberto Giannoni
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy.,Health Sciences Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
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Aktuelle Entwicklungen in der Schlafforschung und Schlafmedizin – eine Einschätzung der AG „Pathophysiologie und Schlaf“. SOMNOLOGIE 2022. [DOI: 10.1007/s11818-022-00365-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Wang Z, Yang W, Li X, Qi X, Pan KY, Xu W. Association of Sleep Duration, Napping, and Sleep Patterns With Risk of Cardiovascular Diseases: A Nationwide Twin Study. J Am Heart Assoc 2022; 11:e025969. [PMID: 35881527 PMCID: PMC9375484 DOI: 10.1161/jaha.122.025969] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Although sleep disorders have been linked to cardiovascular diseases (CVDs), the association between sleep characteristics and CVDs remains inconclusive. We aimed to examine the association of nighttime sleep duration, daytime napping, and sleep patterns with CVDs and explore whether genetic and early‐life environmental factors account for this association. Methods and Results In the Swedish Twin Registry, 12 268 CVD‐free twin individuals (mean age=70.3 years) at baseline were followed up to 18 years to detect incident CVDs. Sleep duration, napping, and sleep patterns (assessed by sleep duration, chronotype, insomnia, snoring, and daytime sleepiness) were self‐reported at baseline. CVDs were ascertained through the Swedish National Patient Registry and the Cause of Death Register. Data were analyzed using a Cox model. In the multiadjusted Cox model, compared with 7 to 9 hours/night, the hazard ratios (HRs) of CVDs were 1.14 (95% CI, 1.01–1.28) for <7 hours/night and 1.10 (95% CI, 1.00–1.21) for ≥10 hours/night, respectively. Compared with no napping, napping 1 to 30 minutes (HR, 1.11 [95% CI, 1.03–1.18]) and >30 minutes (HR, 1.23 [95% CI, 1.14–1.33]) were related to CVDs. Furthermore, a poor sleep pattern was associated with CVDs (HR, 1.22 [95% CI, 1.05–1.41]). The co‐twin matched control analyses showed similar results as the unmatched analyses, and there was no significant interaction between sleep characteristics and zygosity (P values >0.05). Conclusions Short or long sleep (<7 or ≥10 hours/night), napping, and poor sleep patterns are associated with an increased CVD risk. Genetic and early‐life environmental factors may not account for the sleep–CVD association.
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Affiliation(s)
- Zhiyu Wang
- Department of Epidemiology and Biostatistics, School of Public Health Tianjin Medical University Tianjin China.,Tianjin Key Laboratory of Environment Nutrition and Public Health Tianjin China.,Center for International Collaborative Research on Environment Nutrition and Public Health Tianjin China
| | - Wenzhe Yang
- Department of Epidemiology and Biostatistics, School of Public Health Tianjin Medical University Tianjin China.,Tianjin Key Laboratory of Environment Nutrition and Public Health Tianjin China.,Center for International Collaborative Research on Environment Nutrition and Public Health Tianjin China
| | - Xuerui Li
- Department of Epidemiology and Biostatistics, School of Public Health Tianjin Medical University Tianjin China.,Tianjin Key Laboratory of Environment Nutrition and Public Health Tianjin China.,Center for International Collaborative Research on Environment Nutrition and Public Health Tianjin China
| | - Xiuying Qi
- Department of Epidemiology and Biostatistics, School of Public Health Tianjin Medical University Tianjin China.,Tianjin Key Laboratory of Environment Nutrition and Public Health Tianjin China.,Center for International Collaborative Research on Environment Nutrition and Public Health Tianjin China
| | - Kuan-Yu Pan
- Department of Psychiatry, Amsterdam Public Health Amsterdam University Medical Center, Vrije Universiteit Amsterdam The Netherlands
| | - Weili Xu
- Department of Epidemiology and Biostatistics, School of Public Health Tianjin Medical University Tianjin China.,Tianjin Key Laboratory of Environment Nutrition and Public Health Tianjin China.,Center for International Collaborative Research on Environment Nutrition and Public Health Tianjin China.,Aging Research Center, Department of Neurobiology, Health Care Sciences and Society Karolinska Institutet and Stockholm University Stockholm Sweden
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