Skip to main content
SpringerLink
Log in

Sleep-disordered breathing in patients undergoing transfemoral aortic valve implantation for severe aortic stenosis

  • Original Paper
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

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).

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Parish JM, Somers VK (2004) Obstructive sleep apnea and cardiovascular disease. Mayo Clin Proc 79:1036–1046

    Article  PubMed  Google Scholar 

  2. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. New Engl J Med 328:1230–1235

    Article  PubMed  CAS  Google Scholar 

  3. White DP (2005) Pathogenesis of obstructive and central sleep apnea. Am J Resp Crit Care Med 172:1363–1370

    Article  PubMed  Google Scholar 

  4. Abe H, Takahashi M, Yaegashi H et al (2009) Valve repair improves central sleep apnea in heart failure patients with valvular heart diseases. Circ J 73:2148–2153

    Article  PubMed  Google Scholar 

  5. Bradley TD, Floras JS (2003) Sleep apnea and heart failure: part II: central sleep apnea. Circulation 107:1822–1826

    Article  PubMed  Google Scholar 

  6. Vazir A, Hastings PC, Dayer M et al (2007) A high prevalence of sleep disordered breathing in men with mild symptomatic chronic heart failure due to left ventricular systolic dysfunction. Eur J Heart Fail 9:243–250

    Article  PubMed  CAS  Google Scholar 

  7. Iung B, Baron G, Butchart EG et al (2003) (2003) A prospective survey of patients with valvular heart disease in Europe: the Euro heart survey on valvular heart disease. Eur Heart J 24:1231–1243

    Article  PubMed  Google Scholar 

  8. Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M (2006) Burden of valvular heart diseases: a population-based study. Lancet 368:1005–1011

    Article  PubMed  Google Scholar 

  9. Bonow RO, Carabello BA, Kanu C et al (2006) ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 guidelines for the management of patients with valvular heart disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation 114:e84–e231

    Article  PubMed  Google Scholar 

  10. Vahanian A, Baumgartner H, Bax J et al (2007) Guidelines on the management of valvular heart disease: the task force on the management of valvular heart disease of the European Society of Cardiology. Eur Heart J 28:230–268

    PubMed  Google Scholar 

  11. Iung B, Cachier A, Baron G et al (2005) Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery? Eur Heart J 26:2714–2720

    Article  PubMed  Google Scholar 

  12. Sorgato A, Faggiano P, Aurigemma GP, Rusconi C, Gaasch WH (1998) Ventricular arrhythmias in adult aortic stenosis: prevalence, mechanisms, and clinical relevance. Chest 113:482–491

    Article  PubMed  CAS  Google Scholar 

  13. Ludka O, Konecny T, Somers V (2011) Sleep apnea, cardiac arrhythmias, and sudden death. Texas Heart Inst J 38:340–343

    Google Scholar 

  14. Mehra R, Benjamin EJ, Shahar E et al (2006) (2006) Association of nocturnal arrhythmias with sleep-disordered breathing: the Sleep Heart Health Study. Am J Resp Crit Care Med 173:910–916

    Article  PubMed  Google Scholar 

  15. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Brown DL, Block PC, Guyton RA, Pichard AD, Bavaria JE, Herrmann HC, Douglas PS, Petersen JL, Akin JJ, Anderson WN, Wang D, Pocock S,(2010) PARTNER Trial Investigators. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 363:1597–1607

  16. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Williams M, Dewey T, Kapadia S, Babaliaros V, Thourani VH, Corso P, Pichard AD, Bavaria JE, Herrmann HC, Akin JJ, Anderson WN, Wang D, Pocock SJ,(2011) PARTNER Trial Investigators. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 364:2187–2198

  17. Dolliner P, Brammen L, Graf S, et al. (2013) Portable recording for detecting sleep disorder breathing in patients under the care of a heart failure clinic. Clin Res Cardiol. Apr 12. [Epub ahead of print]

  18. Beller CJ, Schmack B, Seppelt P et al (2013) The groin first approach for transcatheter aortic valve implantation: are we pushing the limits for transapical implantation? Clin Res Cardiol 102:111–117

    Article  PubMed  Google Scholar 

  19. Conradi L, Seiffert M, Franzen O et al (2011) First experience with transcatheter aortic valve implantation and concomitant percutaneous coronary intervention. Clin Res Cardiol 100:311–316

    Article  PubMed  Google Scholar 

  20. Figulla L, Neumann A, Figulla HR et al (2011) Transcatheter aortic valve implantation: evidence on safety and efficacy compared with medical therapy. A systematic review of current literature. Clin Res Cardiol. 100:76–265

    Article  Google Scholar 

  21. Solin P, Bergin P, Richardson M, Kaye DM, Walters EH, Naughton MT (1999) Influence of pulmonary capillary wedge pressure on central apnea in heart failure. Circulation 99:1574–1579

    Article  PubMed  CAS  Google Scholar 

  22. Zuern CS, Eick C, Rizas K et al (2012) Prognostic value of mild-to-moderate pulmonary hypertension in patients with severe aortic valve stenosis undergoing aortic valve replacement. Clin Res Cardiol. 101:81–88

    Article  PubMed  Google Scholar 

  23. Oldenburg O, Lamp B, Horstkotte D (2006) Cardiorespiratory screening for sleep-disordered breathing. Eur Respir J 28:1065–1067

    Article  PubMed  CAS  Google Scholar 

  24. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Davidson Ward SL, Tangredi MM, American Academy of Sleep Medicine. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2012. p. 597–619

  25. Cowie MR, Woehrle H, Wegscheider K, Angermann C, d’Ortho M-P, Erdmann E, Levy P, Simonds A, Somers VK, Zannad F, Teschler H. (2013) Rationale and design of the SERVE-HF study: treatment of sleep-disordered breathing with predominant central sleep apnoea with adaptive servo-ventilation in patients with chronic heart failure. Eur J Heart Fail 15:937–943

    Google Scholar 

  26. Grube E, Laborde JC, Zickmann B et al (2005) First report on a human percutaneous transluminal implantation of a self-expanding valve prosthesis for interventional treatment of aortic valve stenosis. Catheter Cardiovasc Interv 66:465–469

    Article  PubMed  Google Scholar 

  27. Webb JG, Chandavimol M, Thompson CR et al (2006) Percutaneous aortic valve implantation retrograde from the femoral artery. Circulation 113:842–850

    Article  PubMed  Google Scholar 

  28. Popescu BA, Andrade MJ, Badano LP et al (2009) European Association of Echocardiography recommendations for training, competence, and quality improvement in echocardiography. Eur J Echocardiogr 10:893–905

    Article  PubMed  Google Scholar 

  29. Villari B, Hess OM, Kaufmann P, Krogmann ON, Grimm J, Krayenbuehl HP (1992) Effect of aortic valve stenosis (pressure overload) and regurgitation (volume overload) on left ventricular systolic and diastolic function. Am J Cardiol 69:927–934

    Article  PubMed  CAS  Google Scholar 

  30. Villari B, Sossalla S, Ciampi Q, Petruzziello B, Turina J, Schneider J, Turina M, Hess OM (2009) Persistent diastolic dysfunction late after valve replacement in severe aortic regurgitation. Circulation 120:2386–2392

    Article  PubMed  Google Scholar 

  31. Oldenburg O, Faber L, Vogt J et al (2007) Influence of cardiac resynchronisation therapy on different types of sleep disordered breathing. Eur J Heart Fail 9:820–826

    Article  PubMed  Google Scholar 

  32. Krahn AD, Yee R, Erickson MK, Markowitz T, Gula LJ, Klein GJ, Skanes AC, George CFP, Ferguson KA (2006) Physiologic pacing in patients with obstructive sleep ApneaA prospective, randomized crossover trial. J Am Coll Cardiol 47:379–383

    Article  PubMed  Google Scholar 

  33. Simantirakis EN, Schiza SE, Chrysostomakis SI, Chlouverakis GI, Klapsinos NC, Siafakas NM, Vardas PE (2005) Atrial overdrive pacing for the obstructive sleep apnea-hypopnea syndrome. N Engl J Med 353:2568–2577

    Article  PubMed  CAS  Google Scholar 

  34. Garrigue S, Bordier P, Jaïs P, Shah DC (2002) Benefit of atrial pacing in sleep apnea syndrome. N Engl J Med 346:404–412

    Article  PubMed  Google Scholar 

  35. Prinz C, Bitter T, Oldenburg O, Faber L, Horstkotte D, Piper C (2010) central sleep apnea in patients due to severe aortic stenosis. Case Report Med 952634

  36. Kodali SKS, Williams MRM, Smith CRC, Svensson LGL, Webb JGJ, Makkar RRR, Fontana GPG, Dewey TMT, Thourani VHV, Pichard ADA, Fischbein MM, Szeto WYW, Lim SS, Greason KLK, Teirstein PSP, Malaisrie SCS, Douglas PSP, Hahn RTR, Whisenant BB, Zajarias AA, Wang DD, Akin JJJ, Anderson WNW, Leon MBM (2012) Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med 366:1686–1695

    Article  PubMed  CAS  Google Scholar 

  37. Rallidis LS, Moyssakis IE, Ikonomidis I, Nihoyannopoulos P (1999) Natural history of early aortic paraprosthetic regurgitation: a five-year follow-up. Am Heart J 138:351–357

    Article  PubMed  CAS  Google Scholar 

  38. Gotzmann M, Lindstaedt M, Mugge A (2012) From pressure overload to volume overload: aortic regurgitation after transcatheter aortic valve implantation. Am Heart J 163:903–911

    Article  PubMed  Google Scholar 

  39. Sinning JM, Hammerstingl C, Vasa-Nicotera M et al (2012) Aortic regurgitation index defines severity of peri-prosthetic regurgitation and predicts outcome in patients after transcatheter aortic valve implantation. J Am Coll Cardiol 59:1134–1141

    Article  PubMed  Google Scholar 

  40. Anselm AH, Gauthier N, Beanlands RS, Haddad H (2008) Sleep apnea in chronic heart failure. Curr Opin Cardiol 23:121–126

    Article  PubMed  Google Scholar 

  41. Moat NE, Ludman P, de Belder MA et al (2011) Long-term outcomes after transcatheter aortic valve implantation in high-risk patients with severe aortic stenosis: the U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) Registry. J Am Coll Cardiol 58:2130–2138

    Article  PubMed  Google Scholar 

  42. Dingli K, Coleman EL, Vennelle M, Finch SP, Wraith PK, Mackay TW, Douglas NJ (2003) Evaluation of a portable device for diagnosing the sleep apnoea/hypopnoea syndrome. Eur Respir J 21:253–259

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

All authors declare that there is no conflict of interest

Author information

Authors and Affiliations

  1. Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany

    Zisis Dimitriadis, Marcus Wiemer, Werner Scholtz, Lothar Faber, Cornelia Piper, Thomas Bitter, Kevin Bullert, Christian Prinz, Dieter Horstkotte & Olaf Oldenburg

  2. Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany

    Jochen Boergermann & Georg Kleikamp

  3. Department of Clinical Bacteriology, Parasitology and Geographical Medicine, University Hospital of Heraklion, Heraklion, Greece

    Ippokratis Messaritakis

Authors
  1. Zisis Dimitriadis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marcus Wiemer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Werner Scholtz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lothar Faber
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Cornelia Piper
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Thomas Bitter
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ippokratis Messaritakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kevin Bullert
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jochen Boergermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Georg Kleikamp
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Christian Prinz
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Dieter Horstkotte
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Olaf Oldenburg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zisis Dimitriadis.

Glossary

Glossary

AASM:

American Academy of Sleep Medicine

AI:

Apnea index

AR:

Aortic regurgitation

AS:

Aortic valve stenosis

AHI:

Apnea–hypopnea index

PG:

Cardiorespiratory polygraphy

CRT:

Cardiac resynchronization therapy

CAI:

Central apnea index

CSA:

Central sleep apnea

CT:

Computed tomography

EDP:

Enddiastolic pressure

EDV:

Enddiastolic volume

HI:

Hypopnea index

LVEF:

Left ventricular ejection fraction

LVEDP:

Left ventricular end diastolic pressure

MAI:

Mixed apnea index

OAI:

Obstructive apnea index

OSA:

Obstructive sleep apnea

PCWP:

Pulmonary capillary wedge pressure

SDB:

Sleep-disordered breathing

TAVI:

Transfemoral aortic valve implantation

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dimitriadis, Z., Wiemer, M., Scholtz, W. et al. Sleep-disordered breathing in patients undergoing transfemoral aortic valve implantation for severe aortic stenosis. Clin Res Cardiol 102, 895–903 (2013). https://doi.org/10.1007/s00392-013-0603-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-013-0603-0

Keywords

Search

Navigation