Sleep Disordered-Breathing and Aortic Valve Stenosis: A Systematic Review and Meta-Analysis

Background and Objective Sleep-disordered breathing (SDB), including obstructive sleep apnea (OSA) and central sleep apnea (CSA), is common in older adults and linked to cardiovascular disease. Aortic stenosis (AS), is another prevalent condition in this population. The interaction between SDB and AS remains unclear, particularly regarding outcomes after surgical aortic valve replacement or transcatheter aortic valve implantation. This review systematically examines the prevalence, clinical impact, and potential bidirectional relationship between SDB and AS.Methods Following PRISMA guidelines, multiple databases were searched. Eligible observational studies included adults with both AS and SDB, reporting prevalence or comparative outcomes. Data extraction included study characteristics, diagnostic methods, interventions, and prevalence estimates. Quality assessment employed JBI and Newcastle-Ottawa tools. Metaanalyses were performed using odds ratios (OR), standardized mean differences, and prevalence estimates with random or fixed effects models based on heterogeneity.Results A total of 11 studies met inclusion criteria (9 prevalence-focused, 2 comparative). Pooled prevalence of SDB in AS patients was 76% (95% confidence interval [CI]: 63%–89%). Both OSA (49%) and CSA (51%) were observed. Male sex was more common among patients with SDB (OR=1.68, 95% CI: 1.07–2.62). Body mass index (BMI) tended to be higher in OSA than CSA, though not consistently significant. In comparative analyses, patients with SDB showed higher odds of AS (OR=1.16, 95% CI: 1.14–1.17).Conclusions SDB is highly prevalent in AS and may contribute to disease progression. Findings suggest a possible bidirectional association influenced by sex and BMI. Larger wellmatched cohorts with long-term follow-up before and after valve interventions are needed to clarify causality and treatment effects.