Transvenous Phrenic Nerve Stimulation (TPNS) therapy for central sleep apnea
740-779-8700What is central sleep apnea?
Central sleep apnea is a condition in which the brain regularly fails to send the right signal to the muscles that control breathing. When this happens, breathing stops temporarily, not because the airway is blocked, but because the body does not get the drive to breathe. The body makes no effort to breathe during these pauses.
This is fundamentally different from obstructive sleep apnea, where the airway collapses and blocks airflow. With central sleep apnea, the airway is clear.
Central sleep apnea is less common than obstructive sleep apnea but is often more difficult to manage. It is more frequently seen in people with heart failure, neurological conditions, or those taking opioid medications long-term. It can also develop in some patients after starting CPAP therapy.
Clinical outcomes
The TPNS system is FDA approved and supported by clinical data from multiple trials, including long-term follow-up results.
Central sleep apnea vs. obstructive sleep apnea
Understanding the difference is important because the two conditions require different treatments. Here is how they compare.
| Central sleep apnea (CSA) | Obstructive sleep apnea (OSA) | |
|---|---|---|
| Cause | The brain fails to send a breathing signal | The airway is physically blocked |
| Airway | Clear and unobstructed | Partially or fully blocked |
| Standard treatment | TPNS system | CPAP, HGNS, BHGNS |
| Does CPAP fix it? | Not always | Yes, for most patients |
| Implant location | Automatically throughout the night | Collarbone (HGNS) or chin (BHGNS) |
| How it activates | Usually covered | Remote or app at bedtime |
| MRI after implant | Not recommended | Conditional (varies by device) |
Who is the TPNS system for?
The TPNS system is best for adults with moderate to severe central sleep apnea. Your diagnosis must be confirmed by a sleep study, and your doctor will evaluate your overall health and current treatment history before recommending the TPNS system.
How it works
The TPNS system treats central sleep apnea by bypassing the brain's faulty signal and stimulating the phrenic nerve directly. The phrenic nerve is responsible for contracting the diaphragm, the muscle that pulls air into your lungs when you breathe.
A small pulse generator is implanted under the skin in the upper chest. Thin wire leads are threaded through the veins near the phrenic nerve. While you sleep, the system continuously monitors your breathing patterns. When it detects that breathing is faltering, it delivers a small, precise electrical pulse to the phrenic nerve, telling the diaphragm to contract and restore normal breathing.
Once activated, the TPNS system works on its own throughout the night. It continuously monitors your breathing and responds automatically without any action needed on your part.
Your Adena sleep medicine team will review your sleep study to confirm your diagnosis of central sleep apnea and evaluate whether the TPNS system is appropriate for you. We may recommend a physical examination and additional testing.
The pulse generator is placed under the skin in the upper chest, typically on the right side, during a minimally invasive outpatient procedure performed under conscious sedation. The procedure takes place in an electrophysiology lab.
Most patients can go home the same day. You will be asked to avoid lifting your arm above shoulder height for a period of time while the implant site heals. Most patients resume normal daily activities within about a week. Your care team will schedule follow-up appointments to activate the device and monitor your progress.
Frequently asked questions
Questions about central sleep apnea or the TPNS system?
Our sleep medicine team is here to help you understand your diagnosis and your options. If your current treatment is not working or you have been told you have central sleep apnea, call us to schedule a consultation.
Call Adena Sleep Medicine: 740-779-8700