Olumuyide Emmanuel, Hu Jiun-Ruey, Rahman Ezaz, Wang Yanting, Aneni Ehimen
Department of Medicine, Advocate Illinois Masonic Medical Center, 836 W Wellington Ave, Chicago, 60657, IL, USA.
Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Sleep Breath. 2025 Jul 14;29(4):241. doi: 10.1007/s11325-025-03412-1.
Obstructive Sleep Apnea (OSA), a common yet underdiagnosed condition, is prevalent in 15% of the general population and up to 30% of patients undergoing transcatheter aortic valve replacement (TAVR). OSA contributes to the cardiovascular burden through hypoxia, oxidative stress, and increased sympathetic activity. Despite its prevalence, the impact of OSA on TAVR outcomes remains uncertain.
We stratified patients who underwent TAVR in the national inpatient sample database from 2016 to 2020 by the presence or absence of OSA. Multivariable logistic regression was performed, adjusting for age, gender, race, income, insurance, comorbidity score, hospital location, and bed size. The primary outcome was mortality. Secondary outcomes were atrial fibrillation (AF), pacemaker placement (PPM), cardiogenic shock (CS), acute heart failure (AHF), mechanical circulatory support (MCS), and cerebrovascular Accident (CVA). A Bonferroni correction was applied for multiple comparisons to reduce the risk of false-positive findings, setting statistical significance at p < 0.0033.
Among 296,740 patients undergoing TAVR, 49,005 had OSA. Patients with OSA were less likely to experience CS (1.46% vs. 2.08% p = 0.006) but had higher rates of acute heart failure (31.63% vs. 30.67% p = 0.04), AF (43.54% vs. 37.36%; p < 0.001) and PPM (7.66% vs. 6.86% P = 0.002) with no difference in MCS, CVA, and mortality between groups.
In patients who underwent TAVR, OSA is associated with higher odds of AF and PPM. These findings suggest that OSA influences cardiovascular outcomes and procedural risks. Knowledge of these risks will help inform shared decision-making by physicians and patients with OSA undergoing TAVR.
阻塞性睡眠呼吸暂停（OSA）是一种常见但诊断不足的疾病，在普通人群中的患病率为15%，在接受经导管主动脉瓣置换术（TAVR）的患者中高达30%。OSA通过缺氧、氧化应激和交感神经活动增加加重心血管负担。尽管其患病率较高，但OSA对TAVR结局的影响仍不确定。
我们根据是否存在OSA，对2016年至2020年国家住院患者样本数据库中接受TAVR的患者进行分层。进行多变量逻辑回归分析，并对年龄、性别、种族、收入、保险、合并症评分、医院位置和床位规模进行调整。主要结局是死亡率。次要结局是心房颤动（AF）、起搏器植入（PPM）、心源性休克（CS）、急性心力衰竭（AHF）、机械循环支持（MCS）和脑血管意外（CVA）。采用Bonferroni校正进行多重比较，以降低假阳性结果的风险，设定统计学显著性为p < 0.0033。
在296,740例接受TAVR的患者中，49,005例患有OSA。患有OSA的患者发生CS的可能性较小（1.46%对2.08%，p = 0.006），但急性心力衰竭、AF和PPM的发生率较高（31.63%对30.67%，p = 0.04；43.54%对37.36%，p < 0.001；7.66%对6.86%，P = 0.002），两组之间的MCS、CVA和死亡率无差异。
在接受TAVR的患者中，OSA与AF和PPM的较高几率相关。这些发现表明OSA会影响心血管结局和手术风险。了解这些风险将有助于为接受TAVR的OSA患者和医生的共同决策提供信息。
