0598 A Retrospective Comparison of Continuous Positive Airway Pressure and Phrenic Nerve Stimulation in the Treatment of Central Sleep Apnea

Abstract Introduction Treatment of central sleep apnea (CSA) has mainly been positive airway pressure (PAP). In 2017, the US Food and Drug Administration approved a transvenous phrenic nerve stimulation (TPNS) device for the treatment of moderate to severe CSA. We conducted a retrospective study comparing one-year outcomes in patients with moderate to severe central sleep apnea who were prescribed PAP vs TPNS. Methods We assessed one year outcomes of patients with CSA initiating treatment with either PAP or TPNS between Feb 1, 2018 to December 31, 2023 at our institution. We evaluated reduction in apnea hypopnea index (AHI), oxygen desaturation index (ODI), Epworth sleepiness scale (ESS), functional outcomes of sleep questionnaire (FOSQ), and adherence. Patient demographic and clinical characteristics were summarized using descriptive statistics, Wilcoxon rank-sum tests were used to analyze continuous variables, and Fisher’s exact tests were used to analyze categorical variables. Results We analyzed 45 patients, with 48.9% (22) receiving PAP and 51.1% (23) receiving TNPS. The median age was 72 years. The patients were mainly male (75.6%) and white (88.9%). At one-year, both groups had a statistically significant decrease in AHI and ODI. The TPNS group had a significant decrease in CAI and ESS. CAI at one year could not be obtained from PAP group as it was based on PAP downloads. The TPNS group did have a significantly higher treatment AHI compared to PAP group (PAP 40.5 to 3.80 vs. TPNS: 40.2 to 18.00). There was no significant difference between ESS, FOSQ, and adherence rates between the two groups at one year. Conclusion This study suggests that TPNS is similar to PAP for treating patients with moderate to severe CSA in terms of reducing symptom burden. Limitations include retrospective nature, low sample size, and missing data. A higher treatment AHI in the TPNS group is expected as PAP can treat obstructive and central sleep apnea while TPNS can only treat central events. Despite this, overall AHI and CAI were significantly reduced in the TPNS group, similar to other studies. For those with moderate to severe central sleep apnea, TPNS is an effective treatment option. Support (if any)