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Prevalence of sleep-disordered breathing in patients with mitral regurgitation and the effect of mitral valve repair

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

The relationship between chronic heart failure and sleep-disordered breathing (SDB) has been frequently described. However, little is known about the association of mitral regurgitation (MR) and SDB or the impact of transcatheter mitral valve repair (TMVR) on SDB. Our aims were first to determine the prevalence of SDB in patients with MR, and second to determine the effect of TMVR on SDB.

Methods

Patients with MR being evaluated for TMVR at the University Hospital Bonn underwent polygraphy (PG) to determine the prevalence of SDB. After TMVR, a subset of patients was followed up with transthoracic echocardiography (TTE) and PG to evaluate the effect of TMVR on SDB.

Results

In 53 patients, mean age was 76.0 ± 8.5 years and 62% were male. Patients predominantly had more than moderate mitral regurgitation (94%). SDB was highly prevalent (68%) with predominantly central sleep apnoea (CSA, 67%). After TMVR in 15 patients, the apnoea/hypopnoea index (AHI) and central apnoea index (AI) were significantly reduced among patients with SDB (AHI − 8.0/h, p = 0.021; central AI − 6.9/h, p = 0.046). The left atrial volume index (LAVI) at baseline was significantly higher in patients with CSA than in patients with obstructive sleep apnoea (OSA) and was significantly reduced after TMVR (63.5 ml/m2 ± 27.2 vs. 38.3 ml/m2 ± 13.0; − 18.4 ml/m2, p = 0.027).

Conclusion

SDB, especially CSA, is highly prevalent in patients with mitral regurgitation. In the follow-up cohort TMVR led to a significant reduction of the AHI, predominantly of central events. The findings of the study suggest that TMVR may be a suitable therapy not only for MR but also for the accompanying CSA. LAVI may be a useful indicator for CSA in patients with MR.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

AHI:

Apnoea/hypopnoea index

AI:

Apnoea index

AS:

Aortic valve stenosis

CPAP:

Continuous positive airway pressure

CSA:

Central sleep apnoea

ESS:

Epworth Sleepiness Scale

HF:

Heart failure

LAVI:

Left atrial volume index

LVEF:

Left ventricular ejection fraction

MR:

Mitral regurgitation

OSA:

Obstructive sleep apnoea

PG:

Cardiorespiratory polygraphy

SDB:

Sleep-disordered breathing

TMVR:

Transcatheter mitral valve repair

TTE:

Transthoracic echocardiography

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Acknowledgements

We thank Mrs. Karin Springmann for her support in the sleep study laboratory of the University Hospital of Bonn, Germany.

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Author notes

  1. LB and JV contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine II – Cardiology, Pneumology and Angiology, University Hospital Bonn, Bonn, Germany

    Leonie Biener, Johanna Vogelhuber, Haron Alboany, Vedat Tiyerili, Marcel Weber, Markus Linhart, Marc Ulrich Becher, Georg Nickenig, Dirk Skowasch & Carmen Pizarro

  2. Servei de Cardiologia, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain

    Markus Linhart

  3. Institute of Medical Biometry, Medical Informatics, and Epidemiology, Medical Faculty, University of Bonn, Bonn, Germany

    Alina Schenk

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  1. Leonie Biener
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Correspondence to Leonie Biener.

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The research was conducted according to the principles of the Declaration of Helsinki. Written informed consent was obtained from all subjects. The study was approved by the local ethics committee (Ethics committee of the Medical Faculty, Rheinische Friedrich-Wilhelms-Universität Bonn).

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Biener, L., Vogelhuber, J., Alboany, H. et al. Prevalence of sleep-disordered breathing in patients with mitral regurgitation and the effect of mitral valve repair. Sleep Breath 27, 599–610 (2023). https://doi.org/10.1007/s11325-022-02667-2

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  • DOI: https://doi.org/10.1007/s11325-022-02667-2

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