Prevalence of Sleep-Disordered Breathing in a Cohort of Adult Fontan Patients

Abstract

Sleep-disordered breathing (SDB) is described in patients with acquired heart failure but its prevalence in adults with congenital heart disease is not well documented. It is likely that single-ventricle patients who have undergone Fontan palliation poorly tolerate the additional stress of SDB on their fragile cardiac physiology. This study sought to determine the prevalence of SDB in a population of adult Fontan patients. We performed a retrospective chart review of adult Fontan patients followed in our program (n = 55). All charts were evaluated for documentation of polysomnography (PSG). SDB was characterized as nocturnal hypoxemia without apnea or obstructive sleep apnea (OSA). Baseline demographics and clinical characteristics were documented, as were PSG findings including Apnea Hypopnea Index (AHI, events/hour) and desaturation events of > 5% from baseline saturation. Twenty-two of our 55 patients (40%) had undergone PSG (45% male, mean age 29 years). Of these patients, 17 had a PSG positive for SDB (77%). Nine patients (41%) had nocturnal hypoxemia without apnea, while 8 patients (36%) had a PSG positive for OSA. Lower baseline oxygen saturations, but not BMI or age, were statistically significantly correlated with higher AHI. SDB was present in the majority of our Fontan cohort who had undergone PSG, occurring at a higher prevalence than what is described in the general population, suggesting that screening should be considered for all Fontan patients. However, further study is needed to confirm this prevalence in a larger population, and if therapy has an impact on clinical outcomes.

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Data Availability

Data available on request from the authors.

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Acknowledgements

We thank Dominik Wiktor, MD for his dedication and service to our program and patients. He was unable to participate in the final development of this manuscript secondary to his untimely death, but he helped care for many of these included patients during his time as a fellow and faculty in our program.

Funding

Not applicable, as the study was not funded.

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Affiliations

Authors

Contributions

All authors contributed to the study design. Data collection and analysis were performed by Christina Stevens, Joseph Kay, MD, and Roni Jacobsen, MD. The first draft of the manuscript was written by Christina Stevens, Joseph Kay, MD and Roni Jacobsen, MD and all authors edited and commented on subsequent drafts. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Stevens CG.

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The authors declare that they have no conflict of interest.

Ethical Approval

This research study was conducted retrospectively from data obtained for clinical purposes. The Colorado Multiple Institutions Review Board determined that our study did not need ethical approval. An IRB official waiver of ethical approval was granted from the IRB.

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Cite this article

CG, S., RM, J., AD, K. et al. Prevalence of Sleep-Disordered Breathing in a Cohort of Adult Fontan Patients. Pediatr Cardiol (2020). https://doi.org/10.1007/s00246-020-02403-1

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Keywords

  • Fontan
  • Single ventricle
  • Sleep-disordered breathing
  • Congenital heart defect