Sleep Disordered Breathing and Mortality in Patients With Hypertrophic Obstructive Cardiomyopathy Undergoing Septal Myectomy.

Published on Sep 1, 2021
· DOI :10.1016/J.MAYOCP.2021.03.036
Hao Cui4
Estimated H-index: 4
(Mayo Clinic),
Hartzell V. Schaff131
Estimated H-index: 131
(Mayo Clinic)
+ 5 AuthorsSteve R. Ommen78
Estimated H-index: 78
(Mayo Clinic)
Sources
Abstract
Abstract null null Objective null To determine the impact of sleep-disordered breathing (SDB) on survival in patients with hypertrophic cardiomyopathy (HCM) following septal myectomy. null null null Patients and Methods null Patients with obstructive HCM undergoing septal myectomy from 2007 to 2016 were reviewed. Those who had an overnight oximetry test within 6 months before myectomy were included in analysis. Oxygen desaturation index was examined continuously and also categorically (SDB [>5/h] and severe SDB [>15/h]). null null null Results null A total of 619 of 1500 patients undergoing septal myectomy had overnight oximetry tests. Sleep-disordered breathing (oxygen desaturation index >5/h) was identified in 338 (54.6%) patients, and among those patients, 117 (18.9%) were classified as severe. Patients with SDB were older, had greater body mass index and body surface area, were more likely to have arterial hypertension and atrial fibrillation, and had an increased E/e’ ratio on Doppler echocardiography. Notably, there was no difference in preoperative resting left ventricular outflow tract pressure gradient between patients with SDB and those with normal overnight oximetry (55 (interquartile range: 25 to 86) mm Hg versus 52 (interquartile range: 21 to 85) mm Hg; P=.29). There was no difference in age-adjusted survival among patients with normal oximetry compared with those with mild SDB (hazard ratio: 0.98; 95% CI: 0.45 to 2.17), and severe SDB (hazard ratio: 1.06, 95% CI 0.42 - 2.71). null null null Conclusion null Sleep-disordered breathing is present in more than half of patients with obstructive HCM in whom septal myectomy is indicated, and is mainly associated with aging, overweight, and male sex. However, SDB does not alter survival following septal myectomy.
References18
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#3Qingjun Meng (First Affiliated Hospital of Xinjiang Medical University)
Last. Baopeng Tang (First Affiliated Hospital of Xinjiang Medical University)H-Index: 10
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Background Previous studies have proved that low-level vagus nerve stimulation (LLVS) could suppressed acute obstructive sleep apnea (OSA) associated atrial fibrillation (AF). Objective This study mainly investigates the underlying electrophysiological, neural and cardiomyocyte injury mechanisms on acute OSA-induced AF, and testify whether LLVS can attenuate or reverse these remodeling. Methods and results Eighteen mongrel dogs received endotracheal intubation under general anesthesia and random...
1 CitationsSource
#1Tomas Konecny (SC: University of Southern California)H-Index: 16
#2Michael Khoo (SC: University of Southern California)H-Index: 1
Last. Virend K. Somers (Mayo Clinic)H-Index: 117
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Abstract Background 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. Method We diagnosed uncontrolled SDB (oxygen desaturation index ≥5) in consecutive echocardiographically confirmed HCM patients seen at Mayo Clinic, Rochester, and a...
3 CitationsSource
#1Shengwei Wang (Capital Medical University)H-Index: 2
#2Hao Cui (Mayo Clinic)H-Index: 4
Last. Shuiyun Wang (Peking Union Medical College)H-Index: 8
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Background The prevalence of obstructive sleep apnoea (OSA) is high in patients with hypertrophic cardiomyopathy. The effect of septal myectomy on OSA is not clear. This study aimed to examine the association between hypertrophic obstructive cardiomyopathy and OSA before and after septal myectomy. Method We included 85 consecutive patents with a confirmed diagnosis of hypertrophic obstructive cardiomyopathy who underwent septal myectomy. Polysomnography was performed in all patients before and 3...
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#1Madalina Macrea (VCU: Virginia Commonwealth University)H-Index: 7
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Background: Noninvasive ventilation (NIV) is used for patients with chronic obstructive pulmonary disease (COPD) and chronic hypercapnia. However, evidence for clinical efficacy and optimal management of therapy is limited.Target Audience: Patients with COPD, clinicians who care for them, and policy makers.Methods: We summarized evidence addressing five PICO (patients, intervention, comparator, and outcome) questions. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation...
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#1Haobo Xu (Academy of Medical Sciences, United Kingdom)H-Index: 2
#2Juan Wang (Academy of Medical Sciences, United Kingdom)H-Index: 4
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Background Obstructive sleep apnea (OSA) is common and independently associated with atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM). This study aimed to investigate the...
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#1Daniel J. Gottlieb (Harvard University)H-Index: 87
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Importance: Obstructive sleep apnea (OSA) affects 17% of women and 34% of men in the US and has a similar prevalence in other countries. This review provides an update on the diagnosis and treatment of OSA. Observations: The most common presenting symptom of OSA is excessive sleepiness, although this symptom is reported by as few as 15% to 50% of people with OSA in the general population. OSA is associated with a 2- to 3-fold increased risk of cardiovascular and metabolic disease. In many patien...
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Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiomyopathy and sleep disordered breathing (SDB) is a treatable risk factor that has been seen to occur concurrently, and is known to propagate mortality and morbidity in a number of cardiovascular disease states including heart failure, and indeed hypertrophic cardiomyopathy. In this review, we summarize past studies that explored the simultaneous occurrence of HCM and SDB, and the pathophysiology of SDB in relation to heart fail...
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Importance Unrecognized obstructive sleep apnea increases cardiovascular risks in the general population, but whether obstructive sleep apnea poses a similar risk in the perioperative period remains uncertain. Objectives To determine the association between obstructive sleep apnea and 30-day risk of cardiovascular complications after major noncardiac surgery. Design, Setting, and Participants Prospective cohort study involving adult at-risk patients without prior diagnosis of sleep apnea and und...
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#2Zien Zhou (SJTU: Shanghai Jiao Tong University)H-Index: 11
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Importance Sleep apnea (obstructive and central) is associated with adverse cardiovascular risk factors and increased risks of cardiovascular disease. Positive airway pressure (PAP) provides symptomatic relief, whether delivered continuously (CPAP) or as adaptive servo-ventilation (ASV), but the associations with cardiovascular outcomes and death are unclear. Objective To assess the association of PAP vs control with cardiovascular events and death in patients with sleep apnea. Data Sources and ...
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#1Keitaro Akita (Keio: Keio University)H-Index: 8
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The coexistence of sleep-disordered breathing (SDB) and hypertrophic obstructive cardiomyopathy (HOCM) has widely been recognized; however, the impact of percutaneous transluminal septal myocardial ablation (PTSMA) for HOCM on SDB remains unknown. Herein, we examine cardiorespiratory polygraph parameters in patients with drug-refractory HOCM before and after PTSMA. Forty consecutive drug-refractory HOCM patients, admitted to Keio University Hospital, and who underwent cardiorespiratory polygraph...
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Cited By1
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#1Jan Konecny (Masaryk University)
#2Thomas Konecny (UF: University of Florida)
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