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. 2023 May;27(2):599-610.
doi: 10.1007/s11325-022-02667-2. Epub 2022 Jun 20.

Prevalence of sleep-disordered breathing in patients with mitral regurgitation and the effect of mitral valve repair

Leonie Biener #  1 , Johanna Vogelhuber #  2 , Haron Alboany  2 , Vedat Tiyerili  2 , Marcel Weber  2 , Markus Linhart  2   3 , Marc Ulrich Becher  2 , Alina Schenk  4 , Georg Nickenig  2 , Dirk Skowasch  2 , Carmen Pizarro  2
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Prevalence of sleep-disordered breathing in patients with mitral regurgitation and the effect of mitral valve repair

Leonie Biener et al. Sleep Breath. 2023 May.

Abstract

Purpose: The relationship between chronic heart failure and sleep-disordered breathing (SDB) has been frequently described. However, little is known about the association of mitral regurgitation (MR) and SDB or the impact of transcatheter mitral valve repair (TMVR) on SDB. Our aims were first to determine the prevalence of SDB in patients with MR, and second to determine the effect of TMVR on SDB.

Methods: Patients with MR being evaluated for TMVR at the University Hospital Bonn underwent polygraphy (PG) to determine the prevalence of SDB. After TMVR, a subset of patients was followed up with transthoracic echocardiography (TTE) and PG to evaluate the effect of TMVR on SDB.

Results: In 53 patients, mean age was 76.0 ± 8.5 years and 62% were male. Patients predominantly had more than moderate mitral regurgitation (94%). SDB was highly prevalent (68%) with predominantly central sleep apnoea (CSA, 67%). After TMVR in 15 patients, the apnoea/hypopnoea index (AHI) and central apnoea index (AI) were significantly reduced among patients with SDB (AHI - 8.0/h, p = 0.021; central AI - 6.9/h, p = 0.046). The left atrial volume index (LAVI) at baseline was significantly higher in patients with CSA than in patients with obstructive sleep apnoea (OSA) and was significantly reduced after TMVR (63.5 ml/m2 ± 27.2 vs. 38.3 ml/m2 ± 13.0; - 18.4 ml/m2, p = 0.027).

Conclusion: SDB, especially CSA, is highly prevalent in patients with mitral regurgitation. In the follow-up cohort TMVR led to a significant reduction of the AHI, predominantly of central events. The findings of the study suggest that TMVR may be a suitable therapy not only for MR but also for the accompanying CSA. LAVI may be a useful indicator for CSA in patients with MR.

Keywords: Central sleep apnoea; Mitral regurgitation; Mitral valve repair; Obstructive sleep apnoea; Sleep-disordered breathing.

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