Emerging treatments

Benzodiazepines

Benzodiazepines, such as temazepam, may reduce the arousal frequency but do not appear to alter the apnea-hypopnea 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.[80]

Supplemental CO₂

Supplemental CO₂ decreases the AHI but does not reliably alter arousal frequency in primary CSA.[81][82] 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.[83]

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 apnea-hypopnea index.[84]

Phrenic nerve stimulation

Unilateral transvenous phrenic nerve stimulation (PNS) in patients with CHF and CSB showed a trend toward stabilization of breathing and improvement in respiratory events, oxygen saturation, and arousals at up to 12 months of follow-up. Favorable effects on quality of life and sleepiness were also noted. 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.[85] 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 predetermined time.[86][87] One such device was approved by the 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% percent in patients without an implanted device. 

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