Increased heart rate with sleep disordered breathing in hypertrophic cardiomyopathy

Current guidelines recommend medications with rate control properties for symptomatic patients with hypertrophic cardiomyopathy (HCM) based on the rationale that lowering heart rate (HR) improves their symptoms. Whether sleep disordered breathing (SDB) is associated with increased HR in HCM patients...

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Bibliographic Details
Published in:International journal of cardiology 2021-01, Vol.323, p.155-160
Main Authors: Konecny, Tomas, Khoo, Michael, Covassin, Naima, Edelhofer, Paul, Bukartyk, Jan, Park, Jae Yoon, Venkataraman, Shreyas, Karim, Shahid, Chahal, Anwar, Kara, Tomas, Orban, Marek, Ludka, Ondrej, Kautzner, Josef, Ommen, Steve R., Somers, Virend K.
Format: Article
Language:English
Subjects:
Adult
Aged
Autonomic nervous system
Cardiomyopathy, Hypertrophic - complications
Cardiomyopathy, Hypertrophic - diagnostic imaging
Heart Rate
Humans
Hypertrophic cardiomyopathy
Male
Middle Aged
Polysomnography
Sleep apnea
Sleep Apnea Syndromes - diagnosis
Sleep Apnea Syndromes - epidemiology
Sleep Apnea, Obstructive - diagnosis
Sleep Apnea, Obstructive - epidemiology
Sleep disordered breathing
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Summary:Current guidelines recommend medications with rate control properties for symptomatic patients with hypertrophic cardiomyopathy (HCM) based on the rationale that lowering heart rate (HR) improves their symptoms. Whether sleep disordered breathing (SDB) is associated with increased HR in HCM patients is not known. We diagnosed uncontrolled SDB (oxygen desaturation index ≥5) in consecutive echocardiographically confirmed HCM patients seen at Mayo Clinic, Rochester, and analyzed their HR as recorded by a 24-h Holter monitor. We compared mean, minimum, maximum HR between those with vs without SDB. In a pilot subanalysis of HCM patients with SDB who also underwent subsequent diagnostic polysomnography (PSG), we analyzed RR interval changes coinciding with obstructive sleep apnea and hypopnea episodes. Of the 230 HCM patients included in this study (age 54 ± 16 years; 138 male; LVOT pressure gradient at rest 45 ± 39 mmHg), 115 (50%) patients had SDB. HCM patients with SDB were recorded to have higher mean HR (71 vs. 67 bpm; p = .002, adjusted p = .001), and this difference was most pronounced during night hours of 10 PM to 5 AM (61 vs. 67 bpm; p 
ISSN:0167-5273
1874-1754
DOI:10.1016/j.ijcard.2020.08.020