A national analysis of obstructive sleep apnea in patients undergoing transcatheter aortic valve replacement

Background: 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.

Methods: 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.

Result: 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.

Conclusion: 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.