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Interatrial pressure gradients during simulated obstructive sleep apnea: a catheter-based study.

Tomas Konecny1, Amber D Khanna, Jan Novak

  • 1Department of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota; Department of Cardiology International Clinical Research Center (ICRC), St. Anne's Hospital, Brno, Czech Republic.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|March 29, 2014
PubMed
Summary

Simulated obstructive sleep apnea (OSA) using the Mueller maneuver (MM) significantly increased the right-to-left atrial pressure gradient. This finding reveals the hemodynamic basis for right-to-left shunting during OSA events.

Keywords:
foramen ovalegradientmueller maneuverpressuresleep apneavalsalva maneuver

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Area of Science:

  • Cardiology
  • Pulmonary Medicine
  • Physiology

Background:

  • Obstructive sleep apnea (OSA) involves inspiratory effort against an obstructed airway.
  • The impact of OSA on the interatrial pressure gradient is not well-defined.
  • A right-to-left atrial pressure gradient could facilitate shunting.

Purpose of the Study:

  • To measure the interatrial pressure gradient during simulated obstructive sleep apnea (OSA).
  • To investigate the hemodynamic changes associated with the Mueller maneuver (MM).

Main Methods:

  • Simultaneous measurement of airway and atrial pressures (right atrium [RA] and left atrium [LA]) using high-fidelity micromanometry.
  • Measurements were taken at rest, during MM, and during Valsalva maneuver (VM) in patients undergoing right heart catheterization.

Main Results:

  • The Mueller maneuver (MM) consistently and transiently increased right atrial pressure over left atrial pressure.
  • The maximum right-to-left atrial pressure gradient rose significantly from 0.1 ± 1.4 mm Hg at baseline to 7.0 ± 4.3 mm Hg during MM (P < 0.001).
  • The pressure gradient during MM was greater than that observed during VM release (P < 0.007).

Conclusions:

  • The onset of the Mueller maneuver (MM) increases the right-to-left atrial pressure gradient.
  • This gradient increase is likely due to enhanced venous return to the right atrium (RA).
  • These findings establish the hemodynamic substrate for right-to-left shunting during OSA.