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26 t m c » p u l s e | n o v e m b e r 2 0 1 9 B y B r i t n i R . M c A s h a n Helping Veterans Breathe Easier Implant treats central sleep apnea H ouston's VA is the first in the country to treat patients suffering from central sleep apnea with an implanted device that regulates breathing muscles. The remedē system restores normal breathing patterns by stimulating a nerve that runs from the neck down to the diaphragm. Essentially a pacemaker for the lungs, the device treats the least common type of sleep apnea. "There are two forms of sleep apnea: obstruc- tive, which is the larger patient population, and central, which accounts for about 5 to 10 percent of the sleep apnea population," said Joshua A. Gonzalez, a spokesperson for Respicardia, the company that manufactures the remedē system. Obstructive sleep apnea occurs when throat muscles and soft tissue in the mouth relax, which narrows or blocks the airway enough to disrupt normal breathing patterns. Typically, this type of sleep apnea is treated with continuous positive airway pressure (CPAP) machines and mouthpieces. By contrast, central sleep apnea occurs because the brain does not send the appropriate signals to the respiratory muscles. Those who suffer from this type of sleep apnea have few treatment options. "When they sleep, there is no nerve that stimulates the diaphragm, so there is no oxygen in and out of the lung," explained Hamid Afshar, M.D., a cardiologist at the Michael E. DeBakey VA Medical Center. "That is the rea- son why the oxygen drops." The remedē system stimulates the phrenic nerve to send signals to the diaphragm to restore and regulate normal breathing patterns. Implanted by a cardiologist during a minimally invasive outpatient procedure, the system includes a battery-powered device placed under the skin in the upper chest area with two thin wires that attach to blood vessels—one to deliver the therapy and the other to sense breathing. Veterans are four times more likely than members of the general public to suffer from some form of sleep apnea, according to the