Aortic stenosis and sleep disordered breathing: The effects of interventional management

Sleep disordered breathing (SDB), including obstructive sleep apnea (OSA) and central sleep apnea (CSA), is a common comorbidity of patients with cardiovascular diseases, including heart failure and aortic stenosis (AS). In specific, studies report a high prevalence of SDB among patients with severe AS, ranging from 34% to over 90%. The pathophysiological relationship between SDB and AS is considered to be bidirectional, as both conditions can initiate mechanisms such as circulatory delay, fluid shift theory or inflammation and oxidative stress that further contribute to this interplay. This interaction between SDB and AS raises questions concerning a possible combined therapeutic approach. Indeed, encouraging results have emerged regarding the beneficial effects of transcatheter aortic valve intervention (TAVI) on SDB in patients with AS, with TAVI being associated with a reduction in the prevalence and severity of SDB and improvements of the apnea-hypopnea index (AHI). Thus, the aim of this narrative review is to summarize the evidence linking SDB with AS, emphasizing the combined effects of TAVI on both conditions. The available evidence from observational studies indicates that TAVI is associated with significant reduction in the severity of SDB, particularly central sleep apnea, accompanied by improvements in the AHI and sleep parameters following the intervention, while obstructive events appear less responsive to valvular correction. These findings highlight the close pathophysiological interaction between cardiac hemodynamics and sleep regulation and suggest that treatment of the valvular pathology may provide benefits extending beyond cardiovascular improvement, with important clinical implications for the comprehensive management of these patients.