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. 2021 May 10;10(9):2039.
doi: 10.3390/jcm10092039.

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

Muhammed Gerçek  1 , Olaf Oldenburg  2 , Mustafa Gerçek  3 , Henrik Fox  1 , Volker Rudolph  1 , Thomas Puehler  4 , Hazem Omran  1 , Lisa Katharina Wolf  1 , Kavous Hakim-Meibodi  5 , Andreas M Zeiher  6 , Jan Gummert  5 , Zisis Dimitriadis  6
Affiliations

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

Muhammed Gerçek et al. J Clin Med. .

Abstract

Background: Sleep disordered breathing (SDB) is a frequent comorbidity in cardiac disease patients. Nevertheless, the prevalence and relationship between SDB and severe primary mitral regurgitation (PMR) has not been well investigated to date.

Methods: A cohort of 121 patients with significant PMR undergoing mitral valve surgery were prospectively enrolled and received a cardiorespiratory single night polygraphy screening using ApneaLink before surgery. Eighty-two of them underwent a follow-up examination including a follow-up single-night sleep study 3 months after surgery.

Results: The mean age of patients was 65.3 ± 12.0 years. Sixty patients (49.6%) were female. The mean EuroSCORE II was 2.5 ± 2.4%. Initially, 91 (75.2%) patients presented with SDB, among whom 50.4% (46 patients, 38.0% of total cohort) were classified as moderate to severe. These patients tended to require significantly longer postoperative intensive care and mechanical ventilation. Among the 82 patients who completed follow-up exams, mitral valve surgery led to a significant reduction in relevant SDB (20.7%). The apnea-hypopnea index (from 11/h [4;18] to 4/h [3;14] (p = 0.04)), the oxygenation-desaturation index (from 8/h [3;18] to 5/h [3;12] (p = 0.008)) as well as the saturation time below 90% (from 32 min [13;86] to 18 min [5;36] (p = 0.005)), were all shown to be improved significantly.

Conclusion: The prevalence of SDB is very high in patients with severe primary mitral regurgitation and may contribute to postoperative complications and prolonged intensive care. A significantly reduced but still high prevalence of SDB was observed 3 months after mitral valve surgery, highlighting the bidirectional relationship between SDB and heart failure.

Keywords: mitral regurgitation; mitral valve surgery; sleep disordered breathing.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient Enrollment and Follow-up. PMR: primary mitral regurgitation.
Figure 2
Figure 2
Sleep disordered breathing (SDB) parameters improve after elimination of mitral regurgitation. Apnea hypopnea index (A), the oxygenation desaturation index (B) and the oxygen saturation time below 90% (C) improved significantly three months after mitral valve surgery. In addition, the oxygen saturation during sleep did not decrease as much as before surgery (D). The prognostically relevant time of oxygen saturation of 22 min (black line, (C)) was no longer exceeded in most patients after surgery. Scatter dot plots are lined at mean with interquartile range.
Figure 3
Figure 3
Impact of SDB on perioperative outcome.
See this image and copyright information in PMC

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