title: Sleep Apnea in Patients with and without a Right-to-Left Shunt.
abstract: OBJECTIVE
  To assess the presence of right-to-left shunting (RLS) in patients with obstructive sleep apnea (OSA), and compare clinical characteristics and parameters of the sleep studies of patients with and without RLS.
  
  
  BACKGROUND
  The most common cause of RLS is due to intermittent flow through a patent foramen ovale (PFO). PFO occurs more frequently in patients with OSA and may be involved in the exacerbation of OSA.
  
  
  METHODS
  Patients with an abnormal polysomnogram seen at UCLA-Santa Monica Sleep Medicine Clinic were enrolled. A diagnosis of RLS was made using a transcranial Doppler (TCD) bubble study. Gender and age-matched controls were drawn from patients referred for cardiac catheterization who underwent a TCD. The frequency of RLS in OSA patients and the controls was evaluated. Clinical characteristics and polysomnogram parameters were compared between OSA patients with and without a RLS.
  
  
  RESULTS
  A total of 100 OSA patients and 200 controls participated in the study. The prevalence of RLS was higher in patients with OSA compared to the control group (42% versus 19%; p < 0.0001). Patients with OSA and a RLS had a lower apnea-hypopnea index (AHI), less obstructive apnea, and fewer hypopnea episodes than patients with OSA without a RLS. The baseline and nadir SpO2 were similar in both groups and did not correlate with the level of RLS assessed by TCD. The degree of desaturation for a given respiratory disturbance, as measured by oxygen desaturation index (ODI)/AHI ratio, was higher in OSA patients with RLS versus OSA patients without RLS (0.85 ± 0.07 versus 0.68 ± 0.04; p < 0.0001).
  
  
  CONCLUSIONS
  RLS, most commonly due to a PFO, occurs 2.2 times more frequently in OSA patients compared to a control population that was matched for age and gender. The severity of sleep apnea is not greater in OSA patients who have a PFO. However, patients with OSA and a PFO are more likely to become symptomatic at a younger age with an equivalent decrease in nocturnal SpO2, and have greater arterial desaturation in proportion to the frequency of respiratory disturbances.
authors.affiliation: Program in Interventional Cardiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA.
authors.forename: Mohammad Khalid
authors.initials: MK
authors.lastname: Mojadidi
authors.affiliation: Program in Interventional Cardiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA.
authors.forename: Pooya Isaac
authors.initials: PI
authors.lastname: Bokhoor
authors.affiliation: Program in Interventional Cardiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA.
authors.forename: Rubine
authors.initials: R
authors.lastname: Gevorgyan
authors.affiliation: Program in Interventional Cardiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA.
authors.forename: Nabil
authors.initials: N
authors.lastname: Noureddin
authors.affiliation: Program in Interventional Cardiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA.
authors.forename: W Cameron
authors.initials: WC
authors.lastname: MacLellan
authors.affiliation: UCLA Sleep Disorder Center, University of California at Los Angeles, Los Angeles, CA.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Wen
authors.affiliation: UCLA Sleep Disorder Center, University of California at Los Angeles, Los Angeles, CA.
authors.forename: Ravi
authors.initials: R
authors.lastname: Aysola
authors.affiliation: Program in Interventional Cardiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Tobis
mesh_terms: D005260:Female; D054092:Foramen Ovale, Patent / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D015995:Prevalence; D020181:Sleep Apnea, Obstructive / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D017585:Ultrasonography, Doppler, Transcranial
keywords: patent foramen ovale; right-to-left shunt; sleep apnea