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Updated: May 19, 2026

Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence
10:52

Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence

Published on: December 23, 2022

PFO and right-to-left shunting in patients with obstructive sleep apnea

Marina Guchlerner1, Peter Kardos, Eva Liss-Koch

  • 1CardioVascular Center Frankfurt, Sankt Katharinen, Frankfurt, Germany.

Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine
|August 16, 2012
PubMed
Abstract

Insights

A high prevalence of right-to-left shunting (RLS), indicating a patent foramen ovale (PFO), was found in patients with obstructive sleep apnea (OSA). This suggests a strong correlation between PFO and OSA, warranting further investigation.

Area of Science:

  • Cardiology
  • Neurology
  • Sleep Medicine

Background:

  • Patent foramen ovale (PFO) with right-to-left shunt (RLS) affects 10-34% of the population and is linked to stroke and embolization.
  • The association between PFO and obstructive sleep apnea (OSA) is under investigation, with prior studies yielding conflicting results due to small sample sizes.

Purpose of the Study:

  • To evaluate the prevalence of RLS as a surrogate for PFO in a large cohort of patients diagnosed with OSA.
  • To investigate the correlation between PFO and OSA using transcranial Doppler ultrasound (TCD).

Main Methods:

  • One hundred consecutive patients with OSA underwent TCD with intravenous agitated saline injection.
  • Right-to-left shunts were graded using the Spencer PFO Grading Scale, with detection at rest and during Valsalva maneuver.

Main Results:

  • Right-to-left shunting (RLS) was detected in 72% of OSA patients (72 out of 100).
  • Of those with RLS, 47% had Grade I or II shunts, 21% had Grade III or IV, and 32% had large shunts (Grade V or V+).
  • A shunt was detectable at rest in 65% of patients with RLS, without requiring a Valsalva maneuver.

Conclusions:

  • The prevalence of RLS in patients with OSA is significantly high.
  • This high prevalence suggests a substantial occurrence of PFO in individuals with OSA, assuming no other intracardiac or pulmonary shunts are present.
Keywords:
Obstructive sleep apneapatent foramen ovaleright-to-left-shunttranscranial doppler

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