Department of Cardiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences Beijing People's Republic of China.
J Am Heart Assoc. 2020 Apr 21;9(8):e015013. doi: 10.1161/JAHA.119.015013. Epub 2020 Apr 16.
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 relationship between apnea-hypopnea index (AHI), a measure of OSA severity, and prevalence of AF in a large series of patients with HCM. Methods and Results A total of 555 patients with HCM who underwent sleep evaluations were retrospectively included. Data from polysomnography studies, echocardiography, and baseline clinical characteristics were collected. OSA was present in 327 patients (58.9%). Patients with OSA or higher AHI quartiles were older, more often male, had a higher body mass index, and more clinical comorbidities. The prevalence of AF increased in patients with OSA (23.9% versus 13.6%, =0.003) or across AHI quartiles (9.4%, 17.3%, 26.6%, and 25.2%, respectively; for trend <0.001). After adjustment for age, sex, body mass index, New York Heart Association class, left atrial diameter, hypertension, oxygen desaturation index, and obstructive HCM, highest AHI quartile (odds ratio, 4.42; 95% CI, 1.35-14.52 [=0.014]) or moderate to severe OSA (odds ratio, 3.03; 95% CI, 1.28-7.20 [=0.012]) but not presence of OSA (odds ratio, 1.58; 95% CI, 0.84-2.97 [=0.153]) were significantly associated with AF. Higher AHI levels were also factors associated with persistent or permanent AF (highest AHI quartile with odds ratio, 10.96; 95% CI, 1.07-111.85). Conclusions Severity of AHI level is independently associated with AF in patients with HCM. Clinical trials are required to determine the benefits of OSA treatment on AF in patients with HCM.
阻塞性睡眠呼吸暂停（OSA）在肥厚型心肌病（HCM）患者中较为常见，且与心房颤动（AF）独立相关。本研究旨在调查在一系列 HCM 患者中，呼吸暂停-低通气指数（AHI）这一 OSA 严重程度的衡量指标与 AF 患病率之间的关系。
回顾性纳入了 555 例接受睡眠评估的 HCM 患者。收集了多导睡眠图研究、超声心动图和基线临床特征的数据。327 例（58.9%）患者存在 OSA。OSA 或 AHI 四分位数较高的患者年龄较大，更常为男性，体重指数较高，且合并症更多。OSA 患者（23.9%比 13.6%，=0.003）或 AHI 四分位患者（9.4%、17.3%、26.6%和 25.2%，趋势检验=0.001）的 AF 患病率增加。在校正年龄、性别、体重指数、纽约心脏协会（NYHA）分级、左心房直径、高血压、氧减指数和梗阻性 HCM 后，最高 AHI 四分位数（比值比，4.42；95%置信区间，1.35-14.52[=0.014]）或中重度 OSA（比值比，3.03；95%置信区间，1.28-7.20[=0.012]）而非 OSA 存在（比值比，1.58；95%置信区间，0.84-2.97[=0.153]）与 AF 显著相关。较高的 AHI 水平也是持续性或永久性 AF 的相关因素（最高 AHI 四分位数的比值比为 10.96；95%置信区间，1.07-111.85）。
AHI 水平的严重程度与 HCM 患者的 AF 独立相关。需要开展临床试验以确定 OSA 治疗对 HCM 患者 AF 的益处。
