Phrenic nerve stimulation as a novel therapeutic approach for heart failure with central sleep apnea: a systematic review
Bibliographic record
Abstract
Introduction: Heart failure (HF) is a chronic condition associated with significant morbidity and mortality. Phrenic nerve stimulation (PNS) has emerged as a novel therapeutic approach aimed at improving outcomes in patients with heart failure, particularly those suffering from central sleep apnea (CSA). Objectives: This study aims to evaluate the efficacy and safety of PNS in HF patients with CSA, especially its impact on reducing CSA severity and improving the apnea-hypopnea index (AHI) and left ventricular ejection fraction (LVEF). Methods: A comprehensive search was conducted across multiple databases including Pubmed, Web of Science, Science Direct, and ProQuest, following PRISMA guidelines. The search strategy used the MeSH keywords (phrenic nerve stimulation) AND (heart failure). Inclusion criteria encompassed studies published in 2014 - 2023 that evaluated the effects of PNS on patients with HF and reported on relevant clinical outcomes. After a thorough screening process, five studies were identified as relevant and included in the review. Data extraction and quality assessment were independently conducted by three reviewers, with results synthesized using a systematic approach. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). The research protocol was registered at PROSPERO (ID: CRD42024604614). Results: The studies reviewed demonstrated that PNS significantly reduces the central apnea index (CAI), AHI and improves sleep quality in heart failure patients. Moreover, improvements in LVEF and reductions in heart failure-related hospitalizations were observed. Patient satisfaction was generally high, and adverse events were minimal, suggesting that PNS is a safe and effective treatment option for HF patients especially those suffering from CSA. Conclusion: Phrenic nerve stimulation presents a promising therapeutic option for improving cardiac and sleep outcomes in heart failure patients. Further large-scale, randomized controlled trials are warranted to establish the long-term efficacy and safety of PNS in this population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.024 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.006 |
| Bibliometrics | 0.006 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".