title: Severe aortic valve stenosis in the elderly: high prevalence of sleep-related breathing disorders.
abstract: BACKGROUND
  Aortic valve stenosis is common in the elderly, with a prevalence of nearly 3% in patients aged 75 years or older. Despite the fact that sleep-related breathing disorders (SRBD) are thought to be associated with cardiac disease, little is known about their prevalence in this patient cohort. The purpose of this study was to evaluate the prevalence of SRBD in older patients with aortic valve stenosis admitted for transcatheter aortic valve implantation.
  
  
  METHODS
  Forty-eight consecutive patients (mean age 81±6 years; 37.5% male) with symptomatic aortic valve stenosis and considered for transcatheter aortic valve replacement were screened for SRBD. Sleep studies were performed by in-hospital unattended cardiorespiratory polygraphy measuring nasal air flow, chest and abdominal efforts, as well as oxygen saturation and body position. The patients were divided in subgroups dependent on the documented apnea-hypopnea index (AHI; no SRBD was defined as an AHI of <5 events/hour; mild SRBD as AHI 5-15 events/hour, and moderate to severe SRBD as AHI ≥15 events/hour).
  
  
  RESULTS
  Thirty-seven patients (77%) had SRBD defined as an AHI of ≥5 events/hour. Eleven patients had an unremarkable investigation, with AHI <5 events/hour (mean 3.0±1.3 events/hour). Among patients with sleep apnea, 19 patients had mild SRBD, with an AHI of 5-15 events/hour (mean 9.9±3.4 events/hour) and 18 patients had moderate to severe SRBD (mean 26.6±11.3 events/hour). Mainly, obstructive apneas were found. Subgroups were not different regarding EuroSCORE (European System for Cardiac Operative Risk Evaluation) or aortic valve area. Also, no correlations were found between AHI and the additive or logistic EuroSCORE or aortic valve area. Significant correlations were found for AHI and N-terminal of the prohormone brain natriuretic peptide (r=0.53; P=0.003) and for AHI and glomerular filtration rate (r = -0.39; P=0.007).
  
  
  CONCLUSIONS
  SRBD is common in elderly patients with symptomatic aortic valve stenosis admitted for transcatheter aortic valve replacement. Interestingly, this finding is not reflected by the currently used risk scores. Further randomized studies are needed to evaluate the clinical significance of concomitant SRBD in the management of severe aortic stenosis.
authors.affiliation: Department of Cardiology, Pneumology, and Vascular Diseases, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Keymel
authors.affiliation: Department of Cardiology, Pneumology, and Vascular Diseases, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Hellhammer
authors.affiliation: Department of Cardiology, Pneumology, and Vascular Diseases, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Zeus
authors.affiliation: Department of Cardiology, Vascular Diseases and Intensive Care Medicine, KRHKlinikum Robert Koch Gehrden, Gehrden, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Merx
authors.affiliation: Department of Cardiology, Pneumology, and Vascular Diseases, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Malte
authors.initials: M
authors.lastname: Kelm
authors.affiliation: Department of Cardiology, Pneumology and Intensive Care Medicine, St Vincenz Hospital, Limburg, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Steiner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000453:epidemiology / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D006801:Humans; D008297:Male; D015995:Prevalence; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000453:epidemiology*
keywords: aortic valve stenosis; sleep-related breathing disorders; transcatheter aortic valve replacement