Severe aortic valve stenosis in the elderly: high prevalence of sleep-related breathing disorders

Figures & data

Table 1 Baseline characteristics of the study groups

	No SRBD (AHI ≥5 events/hour)	Mild SRBD (AHI 5–15 events/hour)	Moderate to severe SRBD (AHI >15 events/hour)	P-value
n	11	19	18
Age (years)	80±5	82±4	81±8	0.51
Body mass index (kg/m^2)	25±3	26±6	26±5	0.85
CAD (%)	82	63	79
Atrial fibrillation (%)	36	39	47
Glomerular filtration rate (mL/min)	67±28	60±20	55±19	0.34
Systolic blood pressure (mmHg)	156±20	143±28	147±21	0.38
Diastolic blood pressure (mmHg)	74±15	66±8	66±13	0.21
Mean arterial pressure (mmHg)	101±16	91±13	93±14	0.23
NTproBNP (pg/mL)	986±862	2,337±2,758	4,270±4,421	0.10
FEV1 (L)	1.77±0.80	1.48±0.55	1.64±0.55	0.46
FEV1 predicted (%)	79±25	75±20	81±27	0.79
AHI (per hour)	3±1	10±3	27±11
Central apnea index (per hour)	0.7±1.2	0.3±0.9	1.4±2.4
Obstructive apnea index (per hour)	1.8±1.2	8.1±3.8	21.1±13.4
Mean minimal oxygen saturation (%)	89±2	89±3	88±5	0.60
Time below 90% (minutes)	6.8±7.0	30.8±70.5	33.8±28.3	0.37

Abbreviations: AHI, apnea–hypopnea index; SRBD, sleep-related breathing disorders; CAD, coronary artery disease; NTproBNP, n-terminal of the prohormone brain natriuretic peptide; FEV₁, forced expiratory volume after 1 second.

Figure 1 Comparison of logistic EuroSCORE and aortic valve area between study groups.

Notes: (A) The logistic EuroSCORE was comparable between the study groups, which were stratified by the severity of sleep apnea. (B) The aortic valve area was comparable between the study groups. NS = not significant at P>0.05.
Abbreviations: EuroSCORE, European System for Cardiac Operative Risk Evaluation; SRBD, sleep-related breathing disorders.

Table 2 Preoperative echocardiographic and hemodynamic data

	No SRBD (AHI ≥5 events/hour)	Mild SRBD (AHI 5–15 events/hour)	Moderate to severe SRBD (AHI >15 events/hour)	P-value
Ejection fraction (%)	57±5	51±8	52±10	0.22
AVA echocardiography (cm^2)	0.82±0.13	0.73±0.17	0.70±0.20	0.34
dPmax (mmHg)	72±13	70±27	70±16	0.95
dPmean (mmHg)	39±12	41±15	40±13	0.97
AVA/catheter (cm^2)	0.73±0.23	0.64±0.21	0.71±0.25	0.59
Systolic PA pressure (mmHg)	35±21	51±17	50±14	0.13
Mean PA pressure (mmHg)	25±6	31±10	31±9	0.33
PCWP (mmHg)	17±5	21±7	21±8	0.60
LVEDP (mmHg)	24±9	23±8	23±7	0.94
Cardiac index (L/min*m^2)	2.87±0.52	2.55±0.43	2.56±0.63	0.26

Abbreviations: AHI, apnea–hypopnea index; AVA, aortic valve area; PA, pulmonary artery; PCWP, pulmonary capillary wedge pressure; LVEDP, left ventricular end diastolic pressure; SRBD, sleep-related breathing disorders; dP_max, maximal systolic pressure gradient between left ventricle and aorta ascendens; dp_mean, mean systolic pressure gradient between left ventricle and aorta ascendens.

Table 3 Univariate correlations between the apnea-hypopnea index, the mean minimal oxygen saturation and clinical characteristics or measurements

	AHI		Mean minimal SO2
	r	P-value	r	P-value
Age	−0.07	0.66	−0.1	0.56
Body mass index	−0.03	0.82	0.18	0.29
Glomerular filtration rate	−0.39	0.007	−0.22	0.31
Mean arterial pressure	−0.2	0.2	0.26	0.14
ES log	−0.09	0.53	−0.08	0.63
NTproBNP	0.53	0.003	−0.22	0.31
Ejection fraction	−0.09	0.55	0.06	0.74
AVA/echocardiography	−0.15	0.31	0.04	0.82
dPmax	−0.19	0.22	0.05	0.82
dPmean	−0.16	0.28	−0.01	0.1
Systolic PA pressure	0.13	0.45	0.17	0.38
Cardiac index	0.05	0.75	0.18	0.3

Notes: Data in bold indicates statistical significance.

Abbreviations: AHI, apnea–hypopnea index; AVA, aortic valve area; ES log, logarithmic EuroSCORE; PA, pulmonary artery; EuroSCORE, European System for Cardiac Operative Risk Evaluation; NTproBNP, N-terminal of the prohormone brain natriuretic peptide; SO₂, arterial oxygen saturation; dP_max, maximal systolic pressure gradient between left ventricle and aorta ascendens; dp_mean, mean systolic pressure gradient between left ventricle and aorta ascendens.

Figure 2 Determinants of the AHI.

Notes: (A) The AHI showed a significant inverse correlation with GFR. (B) A correlation was found for AHI and NTproBNP.
Abbreviations: NTproBNP, N-terminal of the prohormone brain natriuretic peptide; AHI, apnea–hypopnea index; GFR, glomerular filtration rate.