title: Sleep-disordered breathing in patients undergoing transfemoral aortic valve implantation for severe aortic stenosis.
abstract: BACKGROUND
  We examined the prevalence of sleep-disordered breathing (SDB) in patients with severe aortic valve stenosis (AS) and the impact of transfemoral aortic valve implantation (TAVI) on SDB.
  
  
  METHODS
  79 patients underwent cardiorespiratory polygraphy (PG) before TAVI (CoreValve™), 62 of them a second PG after the procedure.
  
  
  RESULTS
  Forty-nine (62 %) patients had obstructive sleep apnea (OSA), 25 (32 %) central sleep apnea (CSA), and 5 (6 %) presented without significant SDB (apnea-hypopnea index (AHI) < 5/h). Among the 62 patients evaluated before and after TAVI, 36 (58 %) had OSA, 22 (36 %) CSA, and 4 patients (7 %) no SDB. AHI was significantly higher in CSA patients than in OSA patients (34.5 ± 18.3 vs. 18.0 ± 12.6/h, p < 0.001). Successful TAVI had a significant impact on CSA but not on OSA: CSA patients with optimal TAVI results experienced a significant reduction in central respiratory events (AHI 39.6 ± 19.6-23.1 ± 16.0/h, p = 0.035), while no changes were detected in OSA patients (AHI 18.8 ± 13.0-20.25 ± 13.4/h, p = 0.376). In contrast, in patients who developed at least moderate periprosthetic aortic regurgitation (AR > I), CSA increased significantly (AHI 26.3 ± 13.2-39.2 ± 18.4/h, p = 0.036), whereas no acute change was seen in patients with OSA (AHI 10.5 ± 7.8-12.5 ± 5.0/h, p = 0.5).
  
  
  CONCLUSIONS
  OSA and CSA are prevalent in more than 90 % of patients undergoing TAVI for severe aortic valve stenosis. Successful TAVI had no significant impact on OSA but improved CSA. In case of an acute change from pressure overload (aortic stenosis) to acute volume overload (aortic regurgitation after TAVI), central, but not obstructive, sleep apnea deteriorated.
authors: Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany, zdimitriadis@hdz-nrw.de.
authors: Zisis
authors: Z
authors: Dimitriadis
authors: Marcus
authors: M
authors: Wiemer
authors: Werner
authors: W
authors: Scholtz
authors: Lothar
authors: L
authors: Faber
authors: Cornelia
authors: C
authors: Piper
authors: Thomas
authors: T
authors: Bitter
authors: Ippokratis
authors: I
authors: Messaritakis
authors: Kevin
authors: K
authors: Bullert
authors: Jochen
authors: J
authors: Boergermann
authors: Georg
authors: G
authors: Kleikamp
authors: Christian
authors: C
authors: Prinz
authors: Dieter
authors: D
authors: Horstkotte
authors: Olaf
authors: O
authors: Oldenburg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000473:pathology / Q000601:surgery*; D005260:Female; D005263:Femoral Artery; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D015995:Prevalence; D012720:Severity of Illness Index; D020182:Sleep Apnea, Central / Q000453:epidemiology*; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology*
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