Phrenic Nerve Stimulation for Central Sleep Apnoea: When and Why?

Central sleep apnoea (CSA) is a sleep-disordered breathing condition characterised by diminished or absent respiratory effort during sleep due to instability in the respiratory control system. While various treatments exist, ranging from positive airway pressure therapy to pharmacological interventions, many patients' symptoms remain refractory to standard therapies. Phrenic nerve stimulation, particularly through devices such as the remedē System, represents a novel, evidence-based therapeutic avenue for patients with moderate to severe CSA. This review provides a comprehensive overview of CSA, explores the underlying pathophysiology, evaluates conventional treatments, and examines the mechanisms, efficacy and limitations of phrenic nerve stimulation based on current literature.