title: Transcatheter valve implantation improves central sleep apnoea in severe aortic stenosis.
abstract: OBJECTIVE
  Severe cardiac disorders predispose to central sleep apnoea (CSA). We sought to examine the relationship between severe aortic stenosis, sleep disordered breathing (SDB), and CSA before and after transcatheter aortic valve implantation (TAVI).
  
  
  RESULTS
  Twenty-nine patients (81±6 yrs, 41% male, LVEF 48±14%) with severe aortic stenosis and high surgical risk underwent polygraphy before and three months after TAVI. Patients with an apnoea-hypopnoea index (AHI) >5/hr were considered to have SDB. SDB with ≥50% absence of both airflow and ventilatory effort was defined as CSA. Twenty-one of 29 patients (72%) had SDB (6/6/9 mild, moderate, and severe, respectively), 12 (41%) with CSA (0/4/8) and 9 (31%) with obstructive sleep apnoea (7/2/0). There was a strong correlation of CSA with LVEDP before TAVI (r=0.74, p=0.024), but not with LVEF, systolic pulmonary artery pressure or NT pro-BNP. After TAVI, AHI improved significantly, particularly in the CSA group (from 43.5±17.5 to 19.4±12.9/hr, p<0.001). Prevalence and severity of SDB were reduced from 72% to 59% (6/6/9 to 7/8/2 patients), triggered by the significant improvement of CSA.
  
  
  CONCLUSIONS
  Patients with severe aortic stenosis display a high prevalence of SDB, particularly of CSA. Definitive treatment with TAVI greatly resolved SDB in the CSA subgroup.
authors: Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn, Germany.
authors: Markus
authors: M
authors: Linhart
authors: Stefan
authors: S
authors: Pabst
authors: Rebecca
authors: R
authors: Fistéra
authors: Alexander
authors: A
authors: Ghanem
authors: Jan-Malte
authors: JM
authors: Sinning
authors: Christoph
authors: C
authors: Hammerstingl
authors: Finny
authors: F
authors: Kozhuppakalam
authors: Eberhard
authors: E
authors: Grube
authors: Nikos
authors: N
authors: Werner
authors: Georg
authors: G
authors: Nickenig
authors: Dirk
authors: D
authors: Skowasch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D018570:Risk Assessment; D020182:Sleep Apnea, Central / Q000453:epidemiology / Q000209:etiology*; D016896:Treatment Outcome