AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Association of Patent Foramen Ovale with Cardiovascular Outcomes and Mortality in Patients with Obstructive Sleep Apnea
By Razaghi M, Farina J, Scalia IG et al.
Background: Patent foramen ovale (PFO) may worsen the adverse hemodynamic and hypoxemic consequences of obstructive sleep apnea (OSA), thus potentially increasing the risk of cardiovascular and cerebrovascular events. However, the long-term clinical implications of PFO in patients with OSA are not fully understood. Hypothesis: We hypothesized that patients with OSA and concomitant PFO would have a higher risk of adverse cardiovascular and cerebrovascular outcomes and all-cause mortality compared with those without PFO. Methods: This was a retrospective multicenter cohort study of adults with OSA across three Mayo Clinic sites (Arizona, Florida, and Minnesota) between March 2004 and July 2025. PFO was identified using transthoracic echocardiography with agitated saline contrast or transesophageal echocardiography. Outcomes included major adverse cardiovascular events (MACE) defined as a composite of myocardial infarction (MI), stroke/transient ischemic attack (TIA), and heart failure (HF) hospitalization, as well as individual cardiovascular outcomes and all-cause mortality. Associations between PFO and outcomes were evaluated using Kaplan-Meier analyses and multivariable Cox regression models adjusted for demographic characteristics, cardiovascular risk factors, and medication use. Results: Among 5,963 patients with OSA (mean age 63.8 ± 11.5 years; 70.5% male), 1,116 (18.7%) had a PFO. Over five years of follow-up, PFO was independently associated with an increased risk of stroke/TIA (adjusted hazard ratio [aHR] 1.31, 95% confidence interval [CI] 1.05-1.63; p=0.02), Figure 1, and all-cause mortality (aHR 1.32, 95% CI 1.01-1.71; p=0.04), Figure 2. No significant associations were observed between PFO and MACE (aHR 1.07, 95% CI 0.95-1.22; p=0.27), MI (aHR 0.90, 95% CI 0.68-1.18; p=0.46), or HF hospitalization (aHR 0.97, 95% CI 0.83-1.14; p=0.72) Conclusions: Among patients with OSA, PFO was independently associated with increased risks of stroke/TIA and all-cause mortality but not with MI, HF hospitalization, or composite MACE. These findings suggest that PFO can help to identify a subgroup of patients with OSA at increased cerebrovascular and mortality risk and may have implications for future risk stratification and preventive management strategies.