2025 American Academy of Sleep Medicine CSA treatment guidelines

Transvenous Phrenic Nerve Stimulation (TPNS) recommended as a treatment option in the 2025 AASM CSA guidelines¹

In 2025, the American Academy of Sleep Medicine updated its guidelines for evidence-based treatment of central sleep apnea to include remedē System as a treatment option.

As cited in the updated guidelines, the period since the last AASM guidelines on CSA was notable for two important developments featured in these guidelines. “The first is the development of the TPNS, a fully implantable neurostimulator that became Food and Drug Administration (FDA) approved and commercially available (remedē^®, Zoll) in 2017″

Badr MS et al. Treatment of central sleep apnea in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med 2025 in press.

Summary of recommendations for adults with Central Sleep Apnea¹

Intervention	Strenth of recommendation	Critical Outcomes Meeting the Clinical Significance Threshold²
Intervention	Strenth of recommendation	Excessive sleepiness	Disease severity	Cardiovascular Disease
TPNS³	Conditional for	✔	✔	✔
CPAP⁴	Conditional for		✔
BPAP w/ backup rate⁵	Conditional for	✔	✔	✔
BPAP w/o backup rate⁴	Conditional against		✔	✔
ASV⁴	Conditional for		✔
Low-flow oxygen⁶	Conditional for		✔
Acetazolamide⁴	Conditional for	✔	✔

Does not include central sleep apnea due to high altitude
Excluded hospitalizations, sleep quality, and mortality, for which no intervention met the Clinical Significance Threshold or could not be assessed
Primary CSA and CSA due to heart failure
Primary CSA, CSA due to HF, CSA due to medication or substance use, treatment-emergent CSA, and CSA due to a medical condition or disorder
Primary CSA, CSA due to medication or substance use, treatment-emergent CSA, and CSA due to a medical condition or disorder
CSA due to heart failure

The conditional recommendation suggests most patients in the appropriate population should be offered TPNS as an option.

It’s time to ACT on the CSA guidelines: help your patients learn about TPNS

A

TPNS was added into the new guidelines
“The AASM suggest using transvenous phrenic nerve stimulation (TPNS) over no TPNS in adults with CSA due to the following etiologies: primary CSA and CSA due to heart failure therapies.”

C

The conditional recommendation means most eligible patients should be offered TPNS
“Most patients should be offered the suggested course of action” (Table 1—Implications of strong and conditional recommendations)

T

Try alternatives when central events or symptoms persist
“Persistence of central respiratory events should prompt re-evaluation of the underlying risk factors and consideration of alternative treatment options.”

“Clinicians must prioritize optimizing therapy for the conditions contributing to central apneas and improving patient-reported outcomes rather than solely focusing on eliminating disordered breathing events”