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Original Research: Sleep Disorders |

Patent Foramen Ovale in Severe Obstructive Sleep ApneaPatent Foramen Ovale in Obstructive Sleep Apnea: Clinical Features and Effects of Closure

Zarrin F. Shaikh, BMBS, PhD; Jay Jaye, BSc; Neil Ward, MD, PhD; Atul Malhotra, PhD, FCCP; Manuel de Villa, BSc; Michael I. Polkey, PhD; Michael J. Mullen, MD; Mary J. Morrell, PhD
Author and Funding Information

From the National Institute for Health Research Respiratory Biomedical Research Unit (Drs Shaikh and Polkey) and the Echocardiography Department (Mr de Villa) at the Royal Brompton Hospital and Imperial College; the Academic Unit of Sleep and Ventilation (Drs Shaikh, Morrell, and Ward and Ms Jaye), National Heart and Lung Institute, Royal Brompton Hospital, Imperial College, London, England; the Division of Sleep (Dr Malhotra), Department of Medicine, Brigham and Women’s Hospital, Boston, MA; and the Department of Cardiology (Dr Mullen), Heart Hospital, London, England.

Correspondence to: Mary J. Morrell, PhD, Academic Unit of Sleep and Ventilation, 2nd Floor, Fulham Wing, Royal Brompton Hospital, London, SW3 6NP, England; e-mail: m.morrell@imperial.ac.uk


Funding/Support: This study was supported by a grant from NMT Medical Inc.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(1):56-63. doi:10.1378/chest.12-0334
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Background:  Patent foramen ovale (PFO) may contribute to nocturnal desaturation in patients with obstructive sleep apnea (OSA), and the effect of PFO closure in OSA is unknown. Our study tested the hypotheses that: (1) patients with severe OSA have a higher prevalence of PFO compared with healthy control subjects, (2) patients with severe OSA with clinically significant PFO experience more nocturnal desaturation than those without, and (3) PFO closure reduces nocturnal desaturation.

Methods:  Patients with severe OSA and healthy control subjects underwent contrast transthoracic echocardiography and transcranial Doppler to detect PFO and determine shunt size. A subgroup of patients with OSA with large shunts underwent percutaneous PFO closure. Polysomnography was performed at baseline and 1, 6, and 12 months postclosure.

Results:  One hundred patients with OSA (mean [SD] age, 52 [10] years; apnea-hypopnea index [AHI], 54 [18] events/h) and 50 control subjects (age, 52 [11] years; AHI, 2 [2] events/h) were studied. PFO prevalence was 43% in patients with OSA and 30% in control subjects (P = .16). Large shunts were detected in 18% of patients with OSA and 6% of control subjects (P = .049). Patients with OSA with clinically significant shunts had higher oxygen-desaturation index (ODI)/AHI ratios than patients without (ratio, 1.05 [0.27] vs 0.86 [0.26], P = .004). Six patients with OSA underwent PFO closure, which was not associated with a reduction in ODI (baseline, 48 [18]; 12 months, 51 [19] events/h; P = .92) or percentage of the night with arterial oxygen saturation < 90% (baseline, 23% [16%]; 12 months, 20% [22%]; P = .35).

Conclusions:  Patients with severe OSA have a higher prevalence of PFO with large shunts compared with control subjects. The ODI/AHI ratio is increased in patients with OSA with clinically significant shunts. PFO closure does not reduce nocturnal desaturation.

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