Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.
Sleep Med. 2024 Apr;116:115-122. doi: 10.1016/j.sleep.2024.02.040. Epub 2024 Mar 1.
Cardiac remodeling is a life-long process in hypertrophic cardiomyopathy (HCM), and if uncontrolled, would cause substantial morbidity and mortality. Sleep apnea (SA) is a common comorbidity in HCM. This study aimed to investigate the relationship between SA and cardiac remodeling in a large series of patients with HCM.
A total of 606 patients with HCM who underwent sleep evaluations at Fuwai Hospital were included. Parameters of cardiac remodeling were evaluated by echocardiographic studies.
SA was present in 363 (59.9%) patients. Left ventricular (LV) end-diastolic diameter (P < 0.001), left atrial (LA) diameter (P = 0.024), ascending aortic diameter (P < 0.001) all increased and maximal end-diastolic wall thickness (P < 0.001) decreased with the severity of SA. After adjustment for sex, age, body mass index, hypertension, hyperlipidemia, diabetes, coronary artery disease and cigarette use, log (apnea-hypopnea index+1) was independently correlated with increasing LV end-diastolic diameter (β = 0.729, P = 0.003) and deceasing maximal end-diastolic wall thickness (β = -0.503, P = 0.009). Log (percentage of total sleep time spent with oxygen saturation<90% + 1) was independently correlated with increasing LV end-diastolic diameter (β = 0.609, P = 0.004) and LA diameter (β = 0.695, P = 0.006). Severity of SA (severe SA with odds ratio, 2.38; 95% CI, 1.20-4.70; P = 0.013), log (apnea-hypopnea index+1) (OR, 1.28; 95% CI, 1.01-1.63; P = 0.045) and log (percentage of total sleep time spent with oxygen saturation<90% + 1) (OR, 1.31; 95% CI, 1.08-1.59; P = 0.006) were also independently associated with LV enlargement.
Severity of SA is independently associated with cardiac remodeling indicating a trend toward enlarged chamber size and thinned wall. Clinical trials are required to determine whether treatment of SA improves cardiac remodeling and long-term outcomes in patients with HCM.
心脏重构是肥厚型心肌病（HCM）的一个终身过程，如果得不到控制，会导致大量的发病率和死亡率。睡眠呼吸暂停（SA）是 HCM 的常见合并症。本研究旨在调查大量 HCM 患者中 SA 与心脏重构之间的关系。
共纳入 606 例在阜外医院接受睡眠评估的 HCM 患者。通过超声心动图研究评估心脏重构参数。
363 例（59.9%）患者存在 SA。左心室（LV）舒张末期直径（P<0.001）、左心房（LA）直径（P=0.024）、升主动脉直径（P<0.001）随 SA 严重程度增加而增加，最大舒张末期壁厚度（P<0.001）减少。调整性别、年龄、体重指数、高血压、高血脂、糖尿病、冠心病和吸烟因素后，log（呼吸暂停-低通气指数+1）与 LV 舒张末期直径增加独立相关（β=0.729，P=0.003），与最大舒张末期壁厚度减少独立相关（β=-0.503，P=0.009）。log（总睡眠时间中血氧饱和度<90%+1）与 LV 舒张末期直径增加（β=0.609，P=0.004）和 LA 直径增加（β=0.695，P=0.006）独立相关。SA 严重程度（严重 SA 的优势比为 2.38；95%CI，1.20-4.70；P=0.013）、log（呼吸暂停-低通气指数+1）（OR，1.28；95%CI，1.01-1.63；P=0.045）和 log（总睡眠时间中血氧饱和度<90%+1）（OR，1.31；95%CI，1.08-1.59；P=0.006）也与 LV 扩大独立相关。
SA 的严重程度与心脏重构独立相关，表明心室大小增大和壁变薄的趋势。需要临床试验来确定治疗 SA 是否能改善 HCM 患者的心脏重构和长期预后。
