Dataset Information

Patent foramen ovale in severe obstructive sleep apnea: clinical features and effects of closure.

ABSTRACT:

Background

Patent foramen ovale (PFO) may contribute to nocturnal desaturation in patients with obstructive sleep apnea (OSA), and the effect of PFO closure in OSA is unknown. Our study tested the hypotheses that: (1) patients with severe OSA have a higher prevalence of PFO compared with healthy control subjects, (2) patients with severe OSA with clinically significant PFO experience more nocturnal desaturation than those without, and (3) PFO closure reduces nocturnal desaturation.

Methods

Patients with severe OSA and healthy control subjects underwent contrast transthoracic echocardiography and transcranial Doppler to detect PFO and determine shunt size. A subgroup of patients with OSA with large shunts underwent percutaneous PFO closure. Polysomnography was performed at baseline and 1, 6, and 12 months postclosure.

Results

One hundred patients with OSA (mean [SD] age, 52 [10] years; apnea-hypopnea index [AHI], 54 [18] events/h) and 50 control subjects (age, 52 [11] years; AHI, 2 [2] events/h) were studied. PFO prevalence was 43% in patients with OSA and 30% in control subjects ( P = .16). Large shunts were detected in 18% of patients with OSA and 6% of control subjects ( P = .049). Patients with OSA with clinically significant shunts had higher oxygen-desaturation index (ODI)/AHI ratios than patients without (ratio, 1.05 [0.27] vs 0.86 [0.26], P = .004). Six patients with OSA underwent PFO closure, which was not associated with a reduction in ODI (baseline, 48 [18]; 12 months, 51 [19] events/h; P = .92) or percentage of the night with arterial oxygen saturation , 90% (baseline, 23% [16%]; 12 months, 20% [22%]; P = .35).

Conclusions

Patients with severe OSA have a higher prevalence of PFO with large shunts compared with control subjects. The ODI/AHI ratio is increased in patients with OSA with clinically significant shunts. PFO closure does not reduce nocturnal desaturation.

SUBMITTER: Shaikh ZF

PROVIDER: S-EPMC5991552 | biostudies-literature | 2013 Jan

REPOSITORIES: biostudies-literature

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Publications

Patent foramen ovale in severe obstructive sleep apnea: clinical features and effects of closure.

Shaikh Zarrin F ZF Jaye Jay J Ward Neil N Malhotra Atul A de Villa Manuel M Polkey Michael I MI Mullen Michael J MJ Morrell Mary J MJ

Chest 20130101 1

<h4>Background</h4>Patent foramen ovale (PFO) may contribute to nocturnal desaturation in patients with obstructive sleep apnea (OSA), and the effect of PFO closure in OSA is unknown. Our study tested the hypotheses that: (1) patients with severe OSA have a higher prevalence of PFO compared with healthy control subjects, (2) patients with severe OSA with clinically significant PFO experience more nocturnal desaturation than those without, and (3) PFO closure reduces nocturnal desaturation.<h4>Me ...[more]

PMID: 22924163

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Project description:OBJECTIVE:To examine the relative impact of three management options in patients aged <60 years with cryptogenic stroke and a patent foramen ovale (PFO): PFO closure plus antiplatelet therapy, antiplatelet therapy alone and anticoagulation alone. DESIGN:Systematic review and network meta-analysis (NMA) supported by complementary external evidence. DATA SOURCES:Medline, EMBASE and Cochrane CENTRAL. STUDY SELECTION:Randomised controlled trials (RCTs) addressing PFO closure and/or medical therapies in patients with PFO and cryptogenic stroke. REVIEW METHODS:We conducted an NMA complemented with external evidence and rated certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS:Ten RCTs in eight studies proved eligible (n=4416). Seven RCTs (n=3913) addressed PFO closure versus medical therapy. Of these, three (n=1257) addressed PFO closure versus antiplatelet therapy, three (n=2303) addressed PFO closure versus mixed antiplatelet and anticoagulation therapies and one (n=353) addressed PFO closure versus anticoagulation. The remaining three RCTs (n=503) addressed anticoagulant versus antiplatelet therapy. PFO closure versus antiplatelet therapy probably results in substantial reduction in ischaemic stroke recurrence (risk difference per 1000 patients over 5 years (RD): -87, 95% credible interval (CrI) -100 to -33; moderate certainty). Compared with anticoagulation, PFO closure may confer little or no difference in ischaemic stroke recurrence (low certainty) but probably has a lower risk of major bleeding (RD -20, 95% CrI -27 to -2, moderate certainty). Relative to either medical therapy, PFO closure probably increases the risk of persistent atrial fibrillation (RD 18, 95% CI +5?to +56, moderate certainty) and device-related adverse events (RD +36, 95%?CI +23?to +50, high certainty). Anticoagulation, compared with antiplatelet therapy, may reduce the risk of ischaemic stroke recurrence (RD -71, 95% CrI -100 to +17, low certainty), but probably increases the risk of major bleeding (RD +12, 95% CrI -5 to +65, moderate certainty). CONCLUSIONS:In patients aged <60 years, PFO closure probably confers an important reduction in ischaemic stroke recurrence compared with antiplatelet therapy alone but may make no difference compared with anticoagulation. PFO closure incurs a risk of persistent atrial fibrillation and device-related adverse events. Compared with alternatives, anticoagulation probably increases major bleeding. PROSPERO REGISTRATION NUMBER:CRD42017081567.

Dataset Information

Patent foramen ovale in severe obstructive sleep apnea: clinical features and effects of closure.

Background

Methods

Results

Conclusions

Publications

Patent foramen ovale in severe obstructive sleep apnea: clinical features and effects of closure.

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