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. 2013 Jan;143(1):56-63.
doi: 10.1378/chest.12-0334.

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

Zarrin F Shaikh  1 , Jay Jaye  2 , Neil Ward  2 , Atul Malhotra  3 , Manuel de Villa  4 , Michael I Polkey  5 , Michael J Mullen  6 , Mary J Morrell  7
Affiliations

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

Zarrin F Shaikh et al. Chest. 2013 Jan.

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.

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Figures

Figure 1
Figure 1
A, Diagram illustrating recruitment of patients with severe OSA and healthy control subjects in the case-finding study. B, Diagram illustrating recruitment of patients with severe OSA in the closure study. AHI = apnea-hypopnea index; CVA = cerebrovascular accident; NPSG = nocturnal polysomnography; OSA = obstructive sleep apnea; PFO = patent foramen ovale; TIA = transient ischemic attack.
Figure 2
Figure 2
A, ODI at baseline and 1, 6, and 12 mo following PFO closure. ○ = individual values for patients with sealed PFO/small residual shunt; □ = individual values for patients with residual large shunts; • = mean value. B, The percentage of overnight time spent with arterial oxygen saturation < 90% was recorded at baseline and 1, 6, and 12 mo later. ▵ = individual values for patients with sealed PFO/small residual shunt; ◊ = individual value for patients with residual large shunts; ▴ = mean value. ODI = oxygen-desaturation index. See Figure 1 legend for expansion of other abbreviation.
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