Lack of reliable clinical predictors to identify obstructive sleep apnea in patients with hypertrophic cardiomyopathy

Abstract

OBJECTIVE:Obstructive sleep apnea is common among patients with hypertrophic cardiomyopathy and may contribute to poor cardiovascular outcomes. However, obstructive sleep apnea is largely unrecognized in this population. We sought to identify the clinical predictors of obstructive sleep apnea among patients with hypertrophic cardiomyopathy.METHODS:Consecutive patients with hypertrophic cardiomyopathy were recruited from a tertiary University Hospital and were evaluated using validated sleep questionnaires (Berlin and Epworth) and overnight portable monitoring. Ninety patients (males, 51%; age, 46±15 years; body mass index, 26.6±4.9 kg/m2) were included, and obstructive sleep apnea (respiratory disturbance index ≥15 events/h) was present in 37 patients (41%).RESULTS:Compared with the patients without obstructive sleep apnea, patients with obstructive sleep apnea were older and had higher body mass index, larger waist circumference, larger neck circumference, and higher prevalence of atrial fibrillation. Excessive daytime sleepiness (Epworth scale) was low and similar in the patients with and without obstructive sleep apnea, respectively. The only predictors of obstructive sleep apnea (using a logistic regression analysis) were age ≥45 years (odds ratio [OR], 4.46; 95% confidence interval [CI 95%], 1.47–13.54; p = 0.008) and the presence of atrial fibrillation [OR, 5.37; CI 95%, 1.43–20.12; p = 0.013].CONCLUSION:Consistent clinical predictors of obstructive sleep apnea are lacking for patients with hypertrophic cardiomyopathy, which suggests that objective sleep evaluations should be considered in this population, particularly among elderly patients with atrial fibrillation.

Neck circumference in Latin America and the Caribbean: A systematic review and meta-analysis

“…Most of the articles were from Brazil (35) 52 – 57 , 60 , 61 , 63 – 65 , 70 , 71 , 73 – 86 , 88 , 91 – 93 , 95 – 97 , 99 while the others were from Chile (5) 58 , 68 , 87 , 89 , 94 , Mexico (4) 66 , 67 , 90 , 100 , Peru (3) 62 , 69 , 72 and Argentina (2) 59 , 98 . The most frequently studied patients were those with Obstructive Sleep Apnea - Hypopnea Syndrome (OSAHS) (22) 53 , 54 , 58 – 62 , 64 – 69 , 74 , 75 , 79 , 81 , 86 , 87 , 90 , 94 , 97 , 98 and obesity (13) 52 , 71 , 73 , 80 , 82 – 85 , 91 , 92 , 95 , 99 , 100 ; other diseases included HIV/AIDS, sleep disorders, bronchiectasis, depression, stroke, epilepsy, hepatic and cardiovascular pathologies. The instrument or methodology to measure NC was reported in 29 studies 54 – 57 , 60 ,…”

The prevalence of obstructive sleep apnea in patients with atrial fibrillation

“…Several factors may play a role in the under‐recognition of OSA in this specific population. Previous studies showed that patients with cardiac disorders often do not display the usual signs and symptoms of OSA . In addition, there is no formal screening tool for OSA applied as a part of routine management of patients with cardiac arrhythmia.…”

“…Previous studies showed that patients with cardiac disorders often do not display the usual signs and symptoms of OSA. 36 In addition, there is no formal screening tool for OSA applied as a part of routine management of patients with cardiac arrhythmia. Another general factor is the challenges associated with obtaining PSG, the gold-standard method for diagnosis of OSA.…”

Does surgery for obstructive sleep apnea improve depression and sleepiness?

“…Daytime sleepiness is often the primary reason that patients with insomnia, circadian rhythm disorders, and sleep‐related breathing disorders present for treatment. Nonetheless, it is not always a reliable clinical indicator for identifying OSA . Sleepiness has, however, been found to be an independent risk factor associated with depression …”