Prevalence of Sleep Disordered Breathing in Patients with Primary Mitral Regurgitation Undergoing Mitral Valve Surgery

Gerçek, Muhammed; Oldenburg, Olaf; Gerçek, Mustafa; Fox, Henrik; Rudolph, Volker; Puehler, Thomas; Omran, Hazem; Wolf, Lisa Katharina; Hakim‐Meibodi, Kavous; Zeiher, Andreas M.; Gummert, Jan; Dimitriadis, Zisis

doi:10.3390/jcm10092039

Cited by 7 publications

(7 citation statements)

References 29 publications

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“…Similar to above findings, AHI, central apnoea events, and CSR significantly decreased from baseline to four weeks after TEER. Yet, we also observed a trend towards a reduction of obstructive apnoeas from baseline to follow-up (2 [1][2][3][4][5] vs. 1 [0-3]/h, p = 0.056).…”

Section: Respiratory Parametersmentioning

confidence: 52%

“…In the follow-up examination 4 weeks after TEER, the number of patients with moderateto-severe SDB was reduced by more than half to 9 (24%, p = 0.007). Alongside, AHI decreased substantially from a median of 16 to 7 [4][5][6][7][8][9][10][11][12][13][14][15]/h (p = 0.007). This reduction was driven by a decrease of central events: central apnoea index significantly decreased by a median of 75% In contrast, the frequency of obstructive apnoeas remained similar (p = 0.153).…”

Section: Respiratory Parametersmentioning

confidence: 99%

“…In patients with symptomatic mitral regurgitation (MR), previous studies evaluating the effect of surgical or transcatheter edge-to-edge mitral valve repair (TEER) are contradicting. While surgery has been shown to effectively reduce SDB and eliminate CSA in individual patients [5][6][7], a small case series of patients undergoing MitraClip implantation did not detect a reduction of SDB severity [8]. With another study demonstrating modest SDB amelioration after TEER in a population largely suffering from OSA [9], the value of minimal-invasive MR therapy in reducing CSA, particularly in comparison to surgery, remains to be established.…”

Section: Introductionmentioning

confidence: 99%

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Impact of transcatheter edge-to-edge mitral valve repair on central sleep apnoea

et al. 2022

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Aims Sleep-disordered breathing (SDB) and its subtype central sleep apnoea (CSA) are highly prevalent in patients with heart failure and associated with worse prognosis. Whereas pharmacological therapy of heart failure has been shown to ameliorate CSA, results from previous studies on the effect of mitral regurgitation therapy on SDB are contradicting. The aim of this study was to assess the impact of transcatheter edge-to-edge mitral valve repair (TEER) on prevalence and severity of CSA. Methods and results We enrolled 47 patients undergoing TEER for symptomatic mitral regurgitation in a prospective study. Secondary mitral regurgitation and left ventricular ejection fraction < 50% were present in 79% and 68% of patients, respectively. Respiratory polygraphy was performed before TEER in a compensated condition and four weeks after the procedure. 34 patients completed the follow-up. At baseline, 19 (56%) patients showed moderate-to-severe SDB, of whom 13 (68%) were classified as CSA. Both apnoea-hypopnoea index and percentage of recorded time spent in Cheyne-Stokes respiration strongly decreased from baseline to follow-up (median [IQR] 16 [7–30] vs. 7 [4–15] /h, p = 0.007; 6 [0–34] vs. 0 [0–8] %, p = 0.008). Median relative reduction of central apnoea index was 75% (p = 0.023), while obstructive apnoea index did not change significantly. Increase in stroke volume after TEER and high systolic pulmonary artery pressure at baseline predicted a > 50% reduction of both Apnoea-hypopnoea index and Cheyne-Stokes respiration. Conclusion TEER is associated with a significant short-term reduction of CSA and Cheyne-Stokes respiration in high-risk patients, strengthening its value as an effective treatment option for advanced heart failure. Graphical abstract

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Section: Respiratory Parametersmentioning

confidence: 52%

Section: Respiratory Parametersmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of transcatheter edge-to-edge mitral valve repair on central sleep apnoea

et al. 2022

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“…However, SDB, defined as episodes of apnea and hypopnea, has mainly attracted attention as a risk factor for cardiovascular events, hypertension, recurrent sympathetic activation and impairments of cardiac function [ 4 ]. SDB was also shown to predispose patients to peri- and postoperative complications, particularly in cardiac surgery, such as myocardial infarction, bleeding, prolonged hospital stay and respiratory complications [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of Sleep-Disordered Breathing Treatment on Ventricular Tachycardia in Patients with Heart Failure

Gerçek

Gerçek²,

Alzein

et al. 2022

JCM

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Background: Sleep-disordered breathing (SDB) is a highly common comorbidity in patients with heart failure (HF), and a known risk factor for ventricular tachycardia (VT) development. However, little is known about the impact of SDB treatment on VT burden in HF patients to date. Therefore, this study investigated VT burden, as well as implantable cardioverter-defibrillator (ICD) therapies in HF patients with SDB treatment, in comparison to untreated SDB HF patients. Methods: This retrospective study analyzed VT burden, rate of antitachycardia pacing (ATP), and the number of shocks delivered in a propensity score-matched patient cohort of patients with SDB treatment or control. Patients had moderate or severe SDB (n = 73 per each group; standardized mean difference of 0.08) and were followed for a minimum of one year. In addition, survival over 4 years was assessed. Results: Mean patient age was 67.67 ± 10.78 and 67.2 ± 10.10, respectively, with 15.06% and 10.95% of the patients, respectively, being female. Regarding SDB subtypes in the control and SDB treatment group, central sleep apnea was present in 42.46% and 41.09% of the patients, respectively, and obstructive sleep apnea was present in 26.02% and 31.50% of the patients, respectively. Mixed type sleep disorder was present in 31.50% and 27.40% of cases. Among the SDB treatment group, a significantly lower number of VTs (28.8% vs. 68.5%; p = 0.01), ATP (21.9% vs. 50.7%; p = 0.02), as well as a lower shock rate (5.5% vs. 31.5%; p < 0.01), was observed compared to the control group. Furthermore, the VT burden was significantly lower in the SDB treatment group when compared to the time prior to SDB treatment (p = 0.02). Event-free survival was significantly higher in the SDB treatment group (Log-rank p < 0.01). Conclusion: SDB treatment in HF patients with ICD leads to significant improvements in VT burden, ATP and shock therapy, and may even affect survival. Thus, HF patients should be generously screened for SDB and treated appropriately.

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“…It is associated with sleepiness, chronic bronchitis, peripheral edema, and dyspnea (10). SDB could be mainly classified into two types, obstructive sleep apnea (OSA) and central sleep apnea (CSA) (11). OSA is an increasingly prevalent sleep disorder characterized by repeated episodes of upper airway collapse and obstruction during sleep, associated with breathing pauses or oxygen desaturation (12).…”

Section: Introductionmentioning

confidence: 99%

Management of Obstructive Sleep Apnea in Patients With Heart Failure

2022

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Sleep apnea is traditionally classified as obstructive sleep apnea (OSA), which occurs when the upper airway collapses due to the relaxation of oropharyngeal musculature, and central sleep apnea occurs when the brainstem cannot stimulate breathing. Most sleep apnea in patients with heart failure (HF) results from coexisting OSA and central sleep apnea (CSA), or complex sleep apnea syndrome. OSA and CSA are common in HF and can be involved in its progression by exposure to the heart to intermittent hypoxia, increased preload and afterload, activating sympathetic, and decreased vascular endothelial function. A majority of treatments have been investigated in patients with CSA and HF; however, less or short-term randomized trials demonstrated whether treating OSA in patients with HF could improve morbidity and mortality. OSA could directly influence the patient's recovery. This review will focus on past and present studies on the various therapies for OSA in patients with HF and summarize CSA treatment options for reasons of reference and completeness. More specifically, the treatment covered include surgical and non-surgical treatments and reported the positive and negative consequences for these treatment options, highlighting possible implications for clinical practice and future research directions.

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Prevalence of Sleep Disordered Breathing in Patients with Primary Mitral Regurgitation Undergoing Mitral Valve Surgery

Cited by 7 publications

References 29 publications

Impact of transcatheter edge-to-edge mitral valve repair on central sleep apnoea

Impact of transcatheter edge-to-edge mitral valve repair on central sleep apnoea

Impact of Sleep-Disordered Breathing Treatment on Ventricular Tachycardia in Patients with Heart Failure

Management of Obstructive Sleep Apnea in Patients With Heart Failure

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