New AASM treatment guidelines for central sleep apnea include the Zoll remedē System’s transvenous phrenic nerve stimulation.


Transvenous phrenic nerve stimulation (TPNS) offered exclusively by the Zoll remedē System is now included in the updated American Academy of Sleep Medicine (AASM) guidelines for treatment of central sleep apnea (CSA), according to Zoll.

Central sleep apnea occurs when the brain does not properly signal the body to stimulate a regular breathing pattern,2 and is a serious condition that is often associated with heart failure, coronary artery disease, and certain cardiac arrhythmias.

The remedē System is an implantable device that automatically stimulates the phrenic nerve to stabilize breathing and is the first and only FDA-approved non-mask TPNS therapy for CSA. The remedē System is clinically proven to improve sleep, breathing, and quality of life. Quality of life improvements were reported by 78% of remedē patients after receiving their implant, and 95% reported that they would elect to have the procedure again, according to Zoll.3

The AASM recognizes the patient benefits of TPNS, highlighting the improvements in central event indices, oxygen desaturation index, quality of life, and several sleep architecture measures. TPNS is recommended both in primary central sleep apnea and central sleep apnea due to heart failure.

“The new guidelines call on clinicians to reframe central sleep apnea management, moving toward individualized care that centers on improving quality of life,” says Dr. Nancy Collop, Professor of Medicine, Director of the Emory Sleep Center and past President of the American Academy of Sleep Medicine. “TPNS is recognized as an important innovation backed by clinical data that shows a real patient benefit.”

TPNS is the only new therapy added to the guidelines since the last update in 2012. The AASM noted the development of TPNS and additional data on adaptive servo ventilation (ASV) as the primary drivers behind the updated guidelines. TPNS is also one of only two guideline-recommended therapies to show improved clinical outcomes in disease severity, excessive sleepiness, and cardiovascular health.

The AASM emphasizes a patient-centered approach in managing CSA. Rather than focusing solely on reducing breathing irregularities, the guidelines advocate for:

  • Focus on patient-reported outcomes over disease process metrics: “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.”1
  • Consideration of alternative therapies for patients where central events persist: “Persistence of central respiratory events should prompt re-evaluation of the underlying risk factors and consideration of alternative treatment options.”1

The updated AASM central sleep apnea guidelines can be found here.


References from Zoll

1 M. Safwan Badr, MD, MBA; Rami N. Khayat, MD; J. Shirine Allam, MD; et al. Treatment of central sleep apnea in adults: an American Academy of Sleep Medicine clinical practice guideline JCSM. 2025.
2 Costanzo M.R., Khayat R., Ponikowski P., et al. Mechanisms and clinical consequences of untreated central sleep apnea in heart failure. J Am Coll Cardiol. 2015; 65:72–84.
3 Costanzo MR, Ponikowski P, Javaheri S, et al. Sustained Twelve Month Benefit of Phrenic Nerve Stimulation for Central Sleep Apnea. Am J Cardiol. 2018. pii: S0002-9149(18)30258-3. doi: 10.1016/j.amjcard.2018.02.022.