Patent Foramen Ovale in Severe Obstructive Sleep Apnea

Shaikh, Zarrin F.; Jaye, Jay; Ward, NR; Malhotra, Atul; Villa, Manuel De; Polkey, Michael I.; Mullen, Michael; Morrell, Mary J.

doi:10.1378/chest.12-0334

Cited by 32 publications

(26 citation statements)

References 37 publications

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“…12 Shaikh and colleagues also demonstrated lower AHI and higher ODI/AHI ratio (p = 0.004) in OSA patients with clinically significant shunts. 13 Our study corroborates these results with a significantly higher ODI/AHI ratio in OSA patients with RLS versus OSA patients without RLS (0.85 ± 0.07 versus 0.68 ± 0.04, respectively; p < 0.0001). Despite the similarity of symptoms by the ESS score, the ODI/ AHI difference suggests that there is more hypoxemia for a given level of hypopnea in those subjects with a RLS.…”

Section: Discussionsupporting

confidence: 90%

“…The AHI and obstructive apneas were lower in the sleep apnea with RLS subgroup (p = 0.028 and p = 0.001, respectively). However, this group still had recorded low oxygen saturations (86% ± 4.0%), and they were just as symptomatic based on their ESS scores, which is consistent with findings by Shaikh et al 13 These observations describe a subgroup of patients with sleep apnea and RLS without the high frequency of expected risk factors (high BMI, large neck circumference, or high rate of obstructive apneas) who still have hypoxemia and significant frequency of arousals. This suggests that the RLS contributes to producing hypoxemia and symptoms at a lower level of obstruction to airflow resulting in presentation at a younger age.…”

Section: Discussionsupporting

confidence: 89%

“…9,25,28 In contrast, using both contrast TCD and transthoracic echocardiography, Shaikh et al reported no significant difference in the prevalence of PFO in 100 OSA patients compared to 50 controls matched for age and gender. 13 They reported a PFO prevalence of 43% in the OSA patients compared to 30% in the control subjects, which did not reach statistical significance (p = 0.16). Their data are Values are expressed as mean ± standard deviation except as noted.…”

Section: Discussionmentioning

confidence: 89%

“…12 The ODI/AHI ratio was also calculated as a marker for the amount of desaturation for a given degree of respiratory disturbance. 12,13 Sleep staging was scored using conventional criteria.…”

Section: Methodsmentioning

confidence: 99%

“…[15][16][17][18][19][20][21][22] Transthoracic echocardiography (TTE) with agitated saline has decreased sensitivity of detecting an intracardiac shunt in OSA patients with elevated BMI and large body habitus secondary to limited acoustic windows. 13,21 Using passage of a guide wire across the atrial septum during cardiac catheterization with intracardiac echocardiography guidance as the standard for diagnosing a PFO, TCD has a 98% sensitivity for making the diagnosis of PFO. 20,23,24 For contrast, a mixture of saline, blood, and air was used, which is reported to be more effective than agitated saline alone.…”

Section: Methodsmentioning

confidence: 99%

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Sleep Apnea in Patients with and without a Right-to-Left Shunt

Mojadidi

Bokhoor

Gevorgyan

et al. 2015

Journal of Clinical Sleep Medicine

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BRIEF SUMMARYCurrent Knowledge/Study Rationale: Right-to-left shunt (RLS) occurs more frequently in patients with sleep apnea, and may be involved in the pathophysiology of sleep apnea. In this observational study, we determined the prevalence of RLS among patients with sleep apnea and compared clinical characteristics and the results of sleep studies of patients with and without RLS. Study Impact: Patients with OSA and RLS have hypoxemia out of proportion to the observed respiratory disturbance, highlighting the likely role of RLS in the resultant nocturnal desaturation. Such observational studies support the hypothesis that the presence of a RLS from a PFO may exacerbate sleep apnea symptoms Objectives: 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 fl ow 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 SpO 2 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). Conclusion: 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 SpO 2 , and have greater arterial desaturation in proportion to the frequency of respiratory disturbances. Keywords: sleep apnea, patent foramen ovale, right-to-left shunt Citation: Mojadidi MK, Bokhoor PI, Gevorgyan R, Noureddin N, MacLellan WC, Wen E, Aysola R, Tobis JM. Sleep apnea in patients with and without a right-to-left shunt. J Clin Sleep Med 2015;11(11):1299 -...

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Sleep Apnea in Patients with and without a Right-to-Left Shunt

Mojadidi

Bokhoor

Gevorgyan

et al. 2015

Journal of Clinical Sleep Medicine

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Relationship between right‐to‐left shunt, hypoxia, and epilepsy

Dong

et al. 2023

Epilepsia Open

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Objective: A right-to-left shunt (RLS) can mediate the hypoxic state, and hypoxemia is relevant for the development of drug-resistant epilepsy (DRE). The objective of this study was to identify the relationship between RLS and DRE and further investigate the contribution of RLS to the oxygenation state in patients with epilepsy (PWEs). Methods:We performed a prospective observational clinical study of PWEs who underwent contrast medium transthoracic echocardiography (cTTE) between January 2018 and December 2021 at West China Hospital. The collected data included demographics, clinical features of epilepsy, antiseizure medications (ASMs), RLS identified by cTTE, electroencephalography (EEG), and magnetic resonance imaging (MRI). Arterial blood gas was also assessed in PWEs with or without RLS. The association between DRE and RLS was quantified using multiple logistic regression, and the parameters of oxygen levels were furtherly analyzed in PWEs with or without RLS.Results: A total of 604 PWEs who completed cTTE were included in the analysis, of which 265 were diagnosed with RLS. The proportion of RLS was 47.2% in the group of DRE, and the proportion of RLS was 40.3% in the group of non-DRE.Having RLS was associated with DRE in multivariate logistic regression analysis (adjusted OR = 1.53, P = 0.045). In the analysis of blood gas, the partial oxygen pressure in PWEs with RLS was lower than those without RLS (88.74 mmHg versus 91.84 mmHg, P = 0.044).

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