Clinical outcomes related to patent foramen ovale in central sleep apnea

This letter evaluates the prognostic significance of patent foramen ovale (PFO) in adults with central sleep apnea (CSA) using a retrospective TriNetX cohort (2010-2024) with 1:1 propensity score matching. In matched analyses (908 CSA with PFO vs 908 CSA without PFO), PFO was associated with higher rates of major adverse cardiac events (HR 1.30), acute heart failure events (HR 1.34), and ischemic stroke (HR 1.31), without significant differences in all-cause mortality or hospitalization. These findings suggest that coexisting PFO identifies a higher-risk CSA phenotype and warrant prospective validation.