High prevalence of obstructive sleep apnea in a surgical aortic valve replacement cohort: an observational study

Abstract

Background A high prevalence of sleep apnea has been reported among transcatheter aortic valve replacement patients; however, the prevalence of sleep apnea in the younger and relatively healthier population of surgical aortic valve replacement (SAVR) patients is unknown. Methods We assessed the prevalence of sleep apnea and overall sleep quality in patients having SAVR. Subjects aged 50–89 were eligible for recruitment. All subjects completed type II home sleep testing before SAVR. Sleep apnea was defined as an apnea-hypopnea index (AHI) ≥ 5 events/hour. Current use of positive airway pressure was exclusionary. Results The 46 subjects (32 males/14 females) had a mean age of 66.6 yrs, body mass index of 30, AHI of 23.5 and obstructive AHI of 22.0. Only four subjects had a prior sleep apnea diagnosis, yet all but one had sleep apnea on type II sleep testing. Two thirds of sleep apnea was moderate or severe (AHI > 15). A quarter of respiratory events were defined by arousals without desaturations. Whereas most sleep parameters resembled those of similarly aged community cohorts, mean percentage of N3 was reduced, accounting for only 3.8% of total sleep time. Conclusions Type II HST revealed a 97.8% prevalence of sleep apnea in this sample, most of which was undiagnosed obstructive sleep apnea. Roughly two thirds of sleep apnea was moderate or severe. Such a high burden of obstructive sleep apnea among patients with severe aortic valve disease deserves further investigation on potential underlying mechanisms and clinical implication.