CardioVascular Center Frankfurt, Sankt Katharinen, Frankfurt, Germany.
J Clin Sleep Med. 2012 Aug 15;8(4):375-80. doi: 10.5664/jcsm.2026.
Patent foramen ovale (PFO) with right-to-left shunt has a prevalence of 10% to 34% in the general population. It can cause an ischemic stroke, transient ischemic attack, and paradoxical peripheral or coronary embolization. Its influence on migraine and several other diseases and conditions is currently under debate. Attention has recently been turned to the correlation between PFO and obstructive sleep apnea. Thus far, studies on the prevalence of right-to-left shunts as a surrogate for PFO in these patients were limited by small sample sizes and the results have been conflicting. Here, we evaluate the prevalence of right-to-left shunting (RLS) through transcranial Doppler ultrasound (TCD) in a large patient group with obstructive sleep apnea (OSA).
One hundred consecutive patients (mean age 59.5 y) with OSA underwent TCD with intravenous injection of agitated saline. The grading of right-to-left-shunts was in accordance with the Spencer PFO Grading Scale.
RLS was detected in 72 of 100 patients (72%). Thirty-four out of these 72 patients (47%) had a shunt grade I or II; 15 (21%) had a shunt Grade III or IV; and 23 (32%) had a large shunt (Grade V or V+). In 47 of 72 patients (65%), a right-to-left shunt was detectable at rest without Valsalva maneuver.
The prevalence of a RLS in patients with OSA is high. Provided other intracardiac or pulmonary shunts were absent, the high prevalence of a RLS suggests a high prevalence of PFO in patients with OSA.
卵圆孔未闭（PFO）伴右向左分流在普通人群中的发生率为 10%至 34%。它可引起缺血性卒、短暂性脑缺血发作和反常性外周或冠状动脉栓塞。其对偏头痛和其他几种疾病和状况的影响目前仍存在争议。最近人们开始关注 PFO 与阻塞性睡眠呼吸暂停之间的相关性。迄今为止，关于这些患者中 PFO 的右向左分流（RLS）作为替代指标的患病率的研究受到样本量小的限制，结果也存在争议。在此，我们通过经颅多普勒超声（TCD）评估了阻塞性睡眠呼吸暂停（OSA）大患者组中右向左分流（RLS）的患病率。
100 例 OSA 患者（平均年龄 59.5 岁）接受 TCD 检查，并静脉注射搅动盐水。右向左分流的分级符合 Spencer PFO 分级量表。
在 100 例患者中，有 72 例（72%）检测到 RLS。在这 72 例患者中，有 34 例（47%）为 I 或 II 级分流；15 例（21%）为 III 或 IV 级分流；23 例（32%）为大分流（V 级或 V+级）。在 72 例患者中的 47 例（65%）中，无需瓦尔萨尔瓦动作即可在休息时检测到右向左分流。
OSA 患者 RLS 的患病率较高。如果不存在其他心内或肺内分流，那么 RLS 的高患病率表明 OSA 患者中 PFO 的高患病率。
