Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), Av. Enéas Carvalho de Aguiar, 44, São Paulo, Brazil.
Chest. 2010 May;137(5):1078-84. doi: 10.1378/chest.09-2335. Epub 2010 Feb 12.
Hypertrophic cardiomyopathy (HCM) is associated with arrhythmias and cardiovascular death. Left atrial enlargement and atrial fibrillation (AF) are considered markers for death due to heart failure in patients with HCM. Obstructive sleep apnea (OSA) is independently associated with heart remodeling and arrhythmias in other populations. We hypothesized that OSA is common and is associated with heart remodeling and AF in patients with HCM.
We evaluated 80 consecutive stable patients with a confirmed diagnosis of HCM by sleep questionnaire, blood tests, echocardiography, and sleep study (overnight respiratory monitoring).
OSA (apnea-hypopnea index [AHI] > 15 events/h) was present in 32 patients (40%). Patients with OSA were significantly older (56 [41-64] vs 38.5 [30-53] years, P < .001) and presented higher BMI (28.2 +/- 3.5 vs 25.2 +/- 5.2 kg/m(2), P < .01) and increased left atrial diameter (45 [42-52.8] vs 41 [39-47] mm, P = .01) and aorta diameter (34 [30-37] vs 29 [28-32] mm, P < .001), compared with patients without OSA. Stepwise multiple linear regression showed that the AHI (P = .05) and BMI (P = .06) were associated with left atrial diameter. The AHI was the only variable associated with aorta diameter (P = .01). AF was present in 31% vs 6% of patients with and without OSA, respectively (P < .01). OSA (P = .03) and left atrial diameter (P = .03) were the only factors independently associated with AF.
OSA is highly prevalent in patients with HCM and it is associated with left atrial and aortic enlargement. OSA is independently associated with AF, a risk factor for cardiovascular death in this population.
肥厚型心肌病（HCM）与心律失常和心血管死亡相关。左心房扩大和心房颤动（AF）被认为是 HCM 患者心力衰竭死亡的标志物。阻塞性睡眠呼吸暂停（OSA）与其他人群的心脏重构和心律失常独立相关。我们假设 OSA 在 HCM 患者中很常见，并与心脏重构和 AF 相关。
我们通过睡眠问卷、血液检查、超声心动图和睡眠研究（整夜呼吸监测）评估了 80 例确诊为 HCM 的连续稳定患者。
32 例（40%）患者存在 OSA（呼吸暂停-低通气指数[AHI]＞15 次/小时）。OSA 患者年龄明显较大（56[41-64]岁 vs 38.5[30-53]岁，P＜0.001），BMI 较高（28.2±3.5kg/m² vs 25.2±5.2kg/m²，P＜0.01），左心房直径较大（45[42-52.8]mm vs 41[39-47]mm，P=0.01）和主动脉直径较大（34[30-37]mm vs 29[28-32]mm，P＜0.001）。逐步多元线性回归显示，AHI（P=0.05）和 BMI（P=0.06）与左心房直径相关。AHI 是唯一与主动脉直径相关的变量（P=0.01）。OSA 组和无 OSA 组分别有 31%和 6%的患者存在 AF（P＜0.01）。OSA（P=0.03）和左心房直径（P=0.03）是 AF 的唯一独立相关因素。
OSA 在 HCM 患者中很常见，与左心房和主动脉扩大有关。OSA 与 AF 独立相关，AF 是该人群心血管死亡的危险因素。
