Sleep Quality in patients with rheumatic mitral stenosis and the effect of percutaneous mitral balloon valvuloplasty on Sleep Quality

Background: Impaired sleep quality is common in patients with heart disease. However, data on the effects of mitral stenosis severity and percutaneous mitral balloon valvuloplasty on sleep quality are scarce. Materials and methods: 205 patients included in the study were divided into two groups as severe and non-severe (mild to moderate MS) rheumatic MS. 123 patients with mild to moderate MS and 82 patients with severe MS were analyzed. 82 patients with severe rheumatic MS who underwent percutaneous mitral balloon valvuloplasty were prospectively enrolled. Sleep quality was prospectively investigated immediately before and approximately six months after the percutaneous mitral balloon valvuloplasty procedure. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality. Results: The PSQI score was considerably higher in patients with severe MS compared to mild to moderate MS (3.7 ± 2.0 vs. 7.7 ± 2.9, p<0.001, respectively). A significant correlation was demonstrated between total PSQI scores and echocardiographic parameters [ Left atrial diameter (r= 0.599, p=0.003), Mitral valve area (r= 0.837, p<0.001), Transmitral mean gradient (r=0.773, p<0.001), TR max velocity (r=0.593, p=0.004), Estimated PAP (r=0.530, p=0.01), TAPSE (r=-0.510, p=0.013)]. In addition, mitral valve area (QR=0.73; 95% CI: 0.54-0.92; p=0.011) and transmitral mean gradient (QR=1.78; 95% CI: 1.44-2.18; p <0.001) were found to be statistically significant in the multivariate regression analysis performed between echocardiographic parameters and total PSQI scores. Total PSQI scores at 6 months after the PMBV procedure were significantly lower than before the PMBV procedure (7.1 ± 2.7 vs. 3.9 ± 2.5; p < 0.001). There was an improvement in the PSQI score, a subjective measure of sleep quality. Conclusions: A correlation was found between the PSQI score, which can subjectively assess sleep quality, and the severity of mitral valve stenosis. Sleep quality may deteriorate as the severity of mitral stenosis increases. An additional benefit of PMBV may be that it can ameliorate the underlying sleep disorder. Percutaneous mitral balloon valvuloplasty may be beneficial in improving sleep quality in adult patients with MS.