Prevalence and Prognostic Implications of Sleep Disordered Breathing in Hypertrophic Cardiomyopathy
Abstract Body (Do not enter title and authors here): Background Sleep disordered breathing (SDB) is frequently observed in patients with cardiovascular disease, and is associated with intermittent hypoxia, sympathetic activation, oxidative stress, and endothelial dysfunction, all of which may facilitate the development and progression of cardiovascular disease.
Objectives We sought to determine the prevalence, subtypes, and clinical implications of comorbid SDB in patients with hypertrophic cardiomyopathy (HCM).
Methods In this prospective observational study, patients with HCM without prior diagnosis of SDB were recruited to undergo inpatient polysomnography between May 1st 2018 and October 31st 2022. Electrocardiographic and echocardiographic parameters, cardiac biomarkers, and symptoms were comparatively assessed in patients with and without comorbid SDB. Patients were assessed for the development of major adverse cardiovascular events (MACE) during follow-up (median 29, range 3-57 months).
Results Among 154 participants, 91 (59.1%) were diagnosed with SDB of whom 38 (41.8%) had mild, 22 (24.2%) moderate, 18 (19.8%) severe obstructive sleep apnea, and 13 (14.3%) had central sleep apnea. SDB was associated with greater left ventricular mass (median [IQR]) (128 [107, 161] vs. 109 [96, 134] g/m2, p=0.034) and E/e’ ratio (12.5 [10, 15] vs. 10.0 [8.3, 14.5], p=0.039). Patients with HCM over the age of 50 years, with body mass index ≥ 30kg/m2, who described their sleep as “poor” were at particularly high risk of having comorbid SDB, as were those who were diabetic, hypertensive, or described greater exertional limitation (NYHA Class ≥II 53% vs. 27%, p=0.005).
Importantly, subjects with SDB had elevated baseline Troponin T levels (14 ng/L vs 11 ng/L, p=0.030), and further substantial overnight troponin increases following untreated apneic sleep (2.1ng/L vs 0.2ng/L, p=0.009). Finally, patients with comorbid SDB experienced a significantly higher proportion of incident adverse cardiovascular events (MACE hazard ratio 5.3, 95% CI, 1.6, 17.2, p=0.006) than those without SDB.
Conclusions We report a particularly high burden of previously undiagnosed SDB in patients with HCM, particularly in older, heavier, male patients. Undiagnosed SDB in HCM is not benign and is associated with symptom progression, comorbidity, and a poorer prognosis, particularly in the case of central sleep apnea. These important new findings provide rationale for heightened vigilance and routine screening for SDB in patients with HCM.
Karim, Shahid
( Mayo Clinic, Rochester, MN
, Rochester
, Minnesota
, United States
)
Geske, Jeffrey
( MAYO CLINIC
, Rochester
, Minnesota
, United States
)
Somers, Virend
( MAYO CLINIC
, Rochester
, Minnesota
, United States
)
Chahal, Anwar
( WellSpan Health
, Lancaster County
, Pennsylvania
, United States
)
Venkataraman, Shreyas
( Mayo Clinic
, Rochester
, Minnesota
, United States
)
Deshmukh, Abhishek
( Mayo Clinic
, Rochester
, Minnesota
, United States
)
Siontis, Konstantinos
( Mayo Clinic
, Rochester
, Minnesota
, United States
)
Mansukhani, Meghna
( Mayo Clinic
, Rochester
, Minnesota
, United States
)
Konecny, Thomas
( University of Florida and NFSG VA
, Gainesville
, Florida
, United States
)
Khanji, Mohammed
( Barts Health NHS Trust
, London
, United Kingdom
)
Petersen, Steffen
( Queen Mary University London
, London
, United Kingdom
)
Author Disclosures:
Shahid Karim:DO NOT have relevant financial relationships
| Jeffrey Geske:No Answer
| Virend Somers:DO have relevant financial relationships
;
Consultant:Jazz Pharmaceutical:Active (exists now)
; Other (please indicate in the box next to the company name):Sleep Number / Advisory Board:Active (exists now)
; Consultant:Zoll:Past (completed)
; Consultant:Know Labs:Active (exists now)
; Consultant:Axome:Active (exists now)
; Consultant:Lilly:Past (completed)
| Anwar Chahal:DO NOT have relevant financial relationships
| Shreyas Venkataraman:No Answer
| Abhishek Deshmukh:DO NOT have relevant financial relationships
| Konstantinos Siontis:No Answer
| meghna mansukhani:No Answer
| Thomas Konecny:No Answer
| Mohammed Khanji:DO NOT have relevant financial relationships
| Steffen Petersen:DO have relevant financial relationships
;
Consultant:Circle Cardiovascular imaging:Active (exists now)
