Emerging treatments

Benzodiazepines

Benzodiazepines, such as temazepam, may reduce the arousal frequency but do not appear to alter the apnoea-hypopnoea index (AHI). In one study, temazepam reduced high-altitude periodic breathing without adverse effect, but there was no real improvement in oxygenation or daytime symptoms.[79]

Supplemental CO₂

Supplemental CO₂ decreases the AHI but does not reliably alter arousal frequency in primary CSA.[80][81] There is anecdotal support for use in Cheyne-Stokes breathing (CSB).

Atrial overdrive pacing

Has been shown to only marginally reduce the AHI and cannot be recommended at this time as standard therapy for CSA.[82]

Cardiac valve replacement

In patients with congestive heart failure (CHF) secondary to valvular heart disease, improvement of CHF after valve replacement is associated with improved apnoea-hypopnoea index.[83]

Phrenic nerve stimulation

Unilateral transvenous phrenic nerve stimulation (PNS) in patients with CHF and CSB showed a trend towards stabilisation of breathing and improvement in respiratory events, oxygen saturation, and arousals at up to 12 months of follow-up. Favourable effects on quality of life and sleepiness were also noted.[84] Furthermore, the beneficial effects of long-term PNS in patients with CSA appear to sustain for up to 36 months with no new safety concerns.[84] The therapy uses a pacemaker-like device that induces a breath by stimulation of the phrenic nerve when no impulse has been sent within a pre-determined time.[85][86] One such device was approved by the US Food and Drug Administration in 2017 for patients with moderate to severe CSA. The approval was based on data from 141 patients. After 6 months, AHI was reduced by at least 50% in about half of patients with an implanted device. AHI decreased by 11% in patients without an implanted device.

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