Classifying hypopneas as obstructive or central can enhance transvenous phrenic nerve stimulation therapy patient selection and outcomes.

IF 2.9 3区医学 Q1 CLINICAL NEUROLOGY

Journal of Clinical Sleep Medicine Pub Date : 2025-09-30 DOI:10.5664/jcsm.11904

Kara Dupuy-McCauley, Alan R Schwartz, Shahrokh Javaheri, Robin Germany, Scott McKane, Timothy I Morgenthaler

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Abstract

Study objectives: While not all sleep laboratories distinguish between obstructive and central hypopneas, recent research suggests that patients may receive an incorrect primary diagnosis without this effort. The remedē System Pivotal Trial studied transvenous phrenic nerve stimulation in patients with moderate-to-severe central sleep apnea (CSA). Entry criteria required apnea-hypopnea index (AHI) ≥ 20 with central apnea index greater than obstructive apnea index and obstructive apneas < 20% of AHI but did not classify hypopneas. This analysis re-examined sleep studies from the trial to assess hypopnea classification impact on candidacy and treatment outcomes.

Methods: Hypopneas were classified as central versus obstructive by a sleep core laboratory following a modified version of AASM recommended criteria. AHI composition was assessed pre/post treatment.

Results: At baseline, 91% (138/151) of patients had ≥ 50% of events classified as central accounting for hypopnea classification. If all hypopneas were assumed obstructive, only 63% (95/151) would have had ≥ 50% central events. The likelihood of achieving ≥ 50% AHI reduction increased with the percentage of baseline events that were central: responder rates were 37.5% for patients with < 50% central events, incrementally increasing to 76.5% for those with ≥ 90% central events. At 6 months, residual AHI predominantly consisted of obstructive hypopneas. Central events decreased by 89% with treatment (baseline median 32 events/h). Obstructive apneas and hypopneas increased by 2 events/h and 3 events/h, respectively.

Conclusions: Distinguishing central from obstructive hypopneas is required to accurately determine the proportion of central and obstructive breathing events, and is crucial for appropriate therapy selection and managing patient expectations about treatment outcomes.

Clinical trial registration: Registry: ClinicalTrials.gov; Identifier: NCT01816776.

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将低通气分为阻塞性或中枢性，可提高经静脉膈神经刺激治疗患者的选择和疗效。

研究目的：虽然并不是所有的睡眠实验室都能区分阻塞性和中枢性低睡，但最近的研究表明，如果不进行区分，患者可能会得到不正确的初步诊断。补救系统关键试验研究经静脉膈神经刺激患者的中度至重度中枢性睡眠呼吸暂停（CSA）。入组标准为呼吸暂停低通气指数(AHI)≥20，中枢性呼吸暂停指数大于阻塞性呼吸暂停指数，阻塞性呼吸暂停指数< AHI的20%，但未对低通气进行分类。本分析重新检查了试验中的睡眠研究，以评估低通气分级对候选资格和治疗结果的影响。方法：睡眠核心实验室根据AASM推荐标准的修改版本将睡眠不足分为中枢性和阻塞性。治疗前后评估AHI组成。结果：在基线时，91%（138/151）的患者有≥50%的事件被归类为低通气分类的中心因素。如果假设所有的低呼吸都是阻塞性的，只有63%（95/151）会有≥50%的中枢事件。达到≥50% AHI降低的可能性随着基线中心事件百分比的增加而增加：< 50%中心事件的患者应答率为37.5%，≥90%中心事件的患者应答率逐渐增加到76.5%。6个月时，残留AHI主要由阻塞性低通气组成。治疗后中心事件减少89%（基线中位数32事件/小时）。阻塞性呼吸暂停和呼吸不足分别增加2次/小时和3次/小时。结论：区分中枢性和阻塞性呼吸不足是准确确定中枢性和阻塞性呼吸事件比例的必要条件，对于适当的治疗选择和管理患者对治疗结果的期望至关重要。临床试验注册：注册：ClinicalTrials.gov；标识符:NCT01816776。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Sleep Medicine CLINICAL NEUROLOGY-

CiteScore

6.20

自引率

7.00%

发文量

321

审稿时长

1 months

期刊介绍： Journal of Clinical Sleep Medicine focuses on clinical sleep medicine. Its emphasis is publication of papers with direct applicability and/or relevance to the clinical practice of sleep medicine. This includes clinical trials, clinical reviews, clinical commentary and debate, medical economic/practice perspectives, case series and novel/interesting case reports. In addition, the journal will publish proceedings from conferences, workshops and symposia sponsored by the American Academy of Sleep Medicine or other organizations related to improving the practice of sleep medicine.