0424T Insertion or replacement of neurostimulator system for treatment of central sleep apnea; complete system (transvenous placement of right or left stimulation lead, sensing lead, implantable pulse generator)

Name of the Procedure:

Insertion or Replacement of Neurostimulator System for Treatment of Central Sleep Apnea (transvenous placement of right or left stimulation lead, sensing lead, implantable pulse generator).

Summary

This procedure involves placing or replacing a neurostimulator system to help manage central sleep apnea. The system includes leads and a pulse generator implanted in the body to stimulate nerves and regulate breathing during sleep.

Purpose

The aim is to treat central sleep apnea, a condition where the brain fails to send the correct signals to the muscles that control breathing. The neurostimulator helps restore normal breathing patterns during sleep, reducing symptoms like frequent awakenings, excessive daytime sleepiness, and improving overall sleep quality.

Indications

• Diagnosed central sleep apnea not effectively managed by other treatments.
• Symptoms such as loud snoring, gasping for air during sleep, frequent nighttime awakenings, and excessive daytime sleepiness.
• Patients who have not responded to or are intolerant of CPAP therapy or other conventional treatments.

Preparation

• Fasting for at least 8 hours prior to the procedure.
• Adjustments to medications as directed by the healthcare provider.
• Pre-procedure assessments such as an ECG, blood tests, and possibly imaging studies to evaluate the heart and surrounding structures.

Procedure Description

1. The patient is given general anesthesia or sedation.
2. A small incision is made near the collarbone to create a pocket for the implantable pulse generator.
3. Using fluoroscopic guidance, the leads are threaded through a vein to the appropriate location in the chest.
4. The leads are placed: one near the phrenic nerve to stimulate breathing and the other in a location to sense respiratory patterns.
5. The leads are connected to the pulse generator, which is then placed in the pocket under the skin.
6. The system is tested to ensure proper functioning before closing the incisions with sutures.

Duration

The procedure typically takes 2 to 3 hours.

Setting

This procedure is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Cardiac electrophysiologist or trained surgeon
• Anesthesiologist
• Nursing staff
• Technicians for intraoperative monitoring

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma
• Lead dislodgement or malfunction
• Pain at the implant site
• Rarely, nerve damage or pneumothorax (collapsed lung)

Benefits

• Improved regulation of breathing patterns during sleep.
• Reduction in symptoms of central sleep apnea.
• Enhanced quality of sleep and overall quality of life.
• Benefits may be noticed within a few weeks after the procedure.

Recovery

• Hospital stay for 1 to 2 days for monitoring.
• Instructions on wound care, activity restrictions, and medication regimen.
• Avoid strenuous activity and heavy lifting for several weeks.
• Follow-up appointments to check the system and make any necessary adjustments.

Alternatives

• Continuous Positive Airway Pressure (CPAP)
• Adaptive Servo-Ventilation (ASV)
• Medications like acetazolamide or theophylline
• Surgical interventions such as Uvulopalatopharyngoplasty (UPPP) or tracheostomy, though these are less commonly used.

Patient Experience

Patients may feel some discomfort and mild pain at the incision sites, which can be managed with pain medication. Sleeping positions might need adjustment initially. Most patients adapt well to the implant and experience significant improvement in sleep patterns and daytime alertness within weeks. Regular follow-ups are important to ensure optimal functioning of the device and to make any necessary adjustments.