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 analyzed their HR as recorded by a 24-h Holter monitor. We compared mean, minimum, maximum HR between those with vs without SDB. In a pilot subanalysis of HCM patients with SDB who also underwent subsequent diagnostic polysomnography (PSG), we analyzed RR interval changes coinciding with obstructive sleep apnea and hypopnea episodes. RESULTS: Of the 230 HCM patients included in this study (age 54 ± 16 years; 138 male; LVOT pressure gradient at rest 45 ± 39 mmHg), 115 (50%) patients had SDB. HCM patients with SDB were recorded to have higher mean HR (71 vs. 67 bpm; p = .002, adjusted p = .001), and this difference was most pronounced during night hours of 10 PM to 5 AM (61 vs. 67 bpm; p < .001). In the pilot analysis of the available PSG data, the release of obstructive sleep apneas and hypopneas coincided with fluctuation of HR. CONCLUSIONS: SDB is independently associated with higher mean HR in patients with HCM, and this difference is most significant during sleep. Treatment of SDB, which is readily available, should be tested as a complementary modality to the currently recommended pharmacotherapy aimed at lowering HR in patients with symptomatic HCM.

Comenius University and NUSCH Bratislava Slovakia

Institute for Clinical and Experimental Medicine Prague Czech Republic

Mayo Clinic Rochester MN United States of America

Mayo Clinic Rochester MN United States of America; Masaryk University Hospital Brno Czech Republic

University of Southern California Los Angeles California United States of America

University of Southern California Los Angeles California United States of America; Mayo Clinic Rochester MN United States of America

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Maron BJ, Gardin JM, Flack JM, Gidding SS, Kurosaki TT, Bild DE. Prevalence of hypertrophic cardiomyopathy in a general population of young adults. Echocardiographic analysis of 4111 subjects in the CARDIA Study. Coronary Artery Risk Development in (Young) Adults. Circulation 1995;92:785–9. PubMed

Gersh BJ, Maron BJ, Bonow RO et al. 2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Journal of the American College of Cardiology 2011;58:e212–60. PubMed

Frank S, Braunwald E. Idiopathic hypertrophic subaortic stenosis. Clinical analysis of 126 patients with emphasis on the natural history. Circulation 1968;37:759–88. PubMed

Maron BJ, Bonow RO, Cannon RO 3rd, Leon MB, Epstein SE. Hypertrophic cardiomyopathy. Interrelations of clinical manifestations, pathophysiology, and therapy (2). The New England journal of medicine 1987;316:844–52. PubMed

Maron BJ, Bonow RO, Cannon RO 3rd, Leon MB, Epstein SE. Hypertrophic cardiomyopathy. Interrelations of clinical manifestations, pathophysiology, and therapy (1). The New England journal of medicine 1987;316:780–9. PubMed

Ruzek L, Konecny T, Soucek F et al. Phosphodiesterase 5 Inhibitor Use in Men With Hypertrophic Cardiomyopathy. Am J Cardiol 2015;116:618–21. PubMed

Eleid MF, Konecny T, Orban M et al. High prevalence of abnormal nocturnal oximetry in patients with hypertrophic cardiomyopathy. Journal of the American College of Cardiology 2009;54:1805–9. PubMed

Konecny T, Kuniyoshi FH, Orban M et al. Under-diagnosis of sleep apnea in patients after acute myocardial infarction. Journal of the American College of Cardiology 2010;56:742–3. PubMed PMC

Kawano Y, Tamura A, Watanabe T, Kadota J. Influence of the severity of obstructive sleep apnea on heart rate. J Cardiol 2010;56:27–34. PubMed

Cicek D, Lakadamyali H, Gokay S, Sapmaz I, Muderrisoglu H. Effect of obstructive sleep apnea on heart rate, heart rate recovery and QTc and P-wave dispersion in newly diagnosed untreated patients. Am J Med Sci 2012;344:180–5. PubMed

Konecny T, Brady PA, Park JY et al. Usefulness of Heart Rate Control in Atrial Fibrillation Patients With Obstructive Sleep Apnea. Am J Cardiol 2018;122:1482–1488. PubMed

Ziegler MG, Mills PJ, Loredo JS, Ancoli-Israel S, Dimsdale JE. Effect of continuous positive airway pressure and placebo treatment on sympathetic nervous activity in patients with obstructive sleep apnea. Chest 2001;120:887–93. PubMed

Sumi K, Chin K, Takahashi K et al. Effect of nCPAP therapy on heart rate in patients with obstructive sleep apnoea-hypopnoea. QJM 2006;99:545–53. PubMed

Richardson P, McKenna W, Bristow M et al. Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of cardiomyopathies. Circulation 1996;93:841–2. PubMed

Maron BJ, Epstein SE. Hypertrophic cardiomyopathy: a discussion of nomenclature. The American journal of cardiology 1979;43:1242–4. PubMed

Loube DI, Andrada TF. Comparison of respiratory polysomnographic parameters in matched cohorts of upper airway resistance and obstructive sleep apnea syndrome patients. Chest 1999;115:1519–24. PubMed

Levy P, Pepin JL, Deschaux-Blanc C, Paramelle B, Brambilla C. Accuracy of oximetry for detection of respiratory disturbances in sleep apnea syndrome. Chest 1996;109:395–9. PubMed

Crawford MH, Bernstein SJ, Deedwania PC et al. ACC/AHA Guidelines for Ambulatory Electrocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the Guidelines for Ambulatory Electrocardiography). Developed in collaboration with the North American Society for Pacing and Electrophysiology. Journal of the American College of Cardiology 1999;34:912–48. PubMed

Conrad Iber on behalf of American Academy of Sleep Medicine. The AASM manual for the scoring of sleep and associated events : rules, terminology and technical specifications. Westchester, IL: : American Academy of Sleep Medicine, 2007.

Cook S, Togni M, Schaub MC, Wenaweser P, Hess OM. High heart rate: a cardiovascular risk factor? European heart journal 2006;27:2387–93. PubMed

Levine HJ. Rest heart rate and life expectancy. Journal of the American College of Cardiology 1997;30:1104–6. PubMed

Castagno D, Skali H, Takeuchi M et al. Association of heart rate and outcomes in a broad spectrum of patients with chronic heart failure: results from the CHARM (Candesartan in Heart Failure: Assessment of Reduction in Mortality and morbidity) program. Journal of the American College of Cardiology 2012;59:1785–95. PubMed

Palatini P Elevated heart rate in cardiovascular diseases: a target for treatment? Prog Cardiovasc Dis 2009;52:46–60. PubMed

Li J, Becker R, Rauch B et al. Usefulness of Heart Rate to Predict One-Year Mortality in Patients With Atrial Fibrillation and Acute Myocardial Infarction (from the OMEGA Trial). The American journal of cardiology 2012. PubMed

Fox K, Borer JS, Camm AJ et al. Resting heart rate in cardiovascular disease. Journal of the American College of Cardiology 2007;50:823–30. PubMed

Wyse DG, Waldo AL, DiMarco JP et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. The New England journal of medicine 2002;347:1825–33. PubMed

Namtvedt SK, Randby A, Einvik G et al. Cardiac arrhythmias in obstructive sleep apnea (from the Akershus Sleep Apnea Project). Am J Cardiol 2011;108:1141–6. PubMed

Shivalkar B, Van de Heyning C, Kerremans M et al. Obstructive sleep apnea syndrome: more insights on structural and functional cardiac alterations, and the effects of treatment with continuous positive airway pressure. Journal of the American College of Cardiology 2006;47:1433–9. PubMed

Harrison DC, Braunwald E, Glick G, Mason DT, Chidsey CA, Ross J Jr. Effects of Beta Adrenergic Blockade on the Circulation with Particular Reference to Observations in Patients with Hypertrophic Subaortic Stenosis. Circulation 1964;29:84–98. PubMed

Cohen LS, Braunwald E. Amelioration of angina pectoris in idiopathic hypertrophic subaortic stenosis with beta-adrenergic blockade. Circulation 1967;35:847–51. PubMed

Sengupta PP, Sorajja D, Eleid MF et al. Hypertrophic obstructive cardiomyopathy and sleep-disordered breathing: an unfavorable combination. Nature clinical practice 2009;6:14–5. PubMed

Bradley TD, Logan AG, Kimoff RJ et al. Continuous positive airway pressure for central sleep apnea and heart failure. N Engl J Med 2005;353:2025–33. PubMed

Alonso-Fernandez A, Garcia-Rio F, Racionero MA et al. Cardiac rhythm disturbances and ST-segment depression episodes in patients with obstructive sleep apnea-hypopnea syndrome and its mechanisms. Chest 2005;127:15–22. PubMed

Ludka O, Konecny T, Somers V. Sleep apnea, cardiac arrhythmias, and sudden death. Tex Heart Inst J 2011;38:340–3. PubMed PMC

Netzer N, Eliasson AH, Netzer C, Kristo DA. Overnight pulse oximetry for sleep-disordered breathing in adults: a review. Chest 2001;120:625–33. PubMed

Oeverland B, Skatvedt O, Kvaerner KJ, Akre H. Pulseoximetry: sufficient to diagnose severe sleep apnea. Sleep medicine 2002;3:133–8. PubMed

Sleep-disordered breathing in hypertrophic cardiomyopathy: challenges and opportunities