Increased heart rate with sleep disordered breathing in hypertrophic cardiomyopathy
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...
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| Veröffentlicht in: | International journal of cardiology 2021-01, Vol.323, p.155-160 |
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| creator | Konecny, Tomas Khoo, Michael Covassin, Naima Edelhofer, Paul Bukartyk, Jan Park, Jae Yoon Venkataraman, Shreyas Karim, Shahid Chahal, Anwar Kara, Tomas Orban, Marek Ludka, Ondrej Kautzner, Josef Ommen, Steve R. Somers, Virend K. |
| description | 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.
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.
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 |
| doi_str_mv | 10.1016/j.ijcard.2020.08.020 |
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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.
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.
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.
•Hypertrophic cardiomyopathy patients with sleep apnea have higher mean heart rate•This difference is most pronounced during night-time hours.•Further studies could explore whether sleep apnea treatment could complement rate-control medications in symptomatic patients.</description><identifier>ISSN: 0167-5273</identifier><identifier>EISSN: 1874-1754</identifier><identifier>DOI: 10.1016/j.ijcard.2020.08.020</identifier><identifier>PMID: 32798627</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Adult ; Aged ; Autonomic nervous system ; Cardiomyopathy, Hypertrophic - complications ; Cardiomyopathy, Hypertrophic - diagnostic imaging ; Heart Rate ; Humans ; Hypertrophic cardiomyopathy ; Male ; Middle Aged ; Polysomnography ; Sleep apnea ; Sleep Apnea Syndromes - diagnosis ; Sleep Apnea Syndromes - epidemiology ; Sleep Apnea, Obstructive - diagnosis ; Sleep Apnea, Obstructive - epidemiology ; Sleep disordered breathing</subject><ispartof>International journal of cardiology, 2021-01, Vol.323, p.155-160</ispartof><rights>2020</rights><rights>Copyright © 2020. Published by Elsevier B.V.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c464t-9cc7e8d101844982c3361304c8c45e26abfdc67f8dde366d8e366693c7b429fe3</citedby><cites>FETCH-LOGICAL-c464t-9cc7e8d101844982c3361304c8c45e26abfdc67f8dde366d8e366693c7b429fe3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ijcard.2020.08.020$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3536,27903,27904,45974</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32798627$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Konecny, Tomas</creatorcontrib><creatorcontrib>Khoo, Michael</creatorcontrib><creatorcontrib>Covassin, Naima</creatorcontrib><creatorcontrib>Edelhofer, Paul</creatorcontrib><creatorcontrib>Bukartyk, Jan</creatorcontrib><creatorcontrib>Park, Jae Yoon</creatorcontrib><creatorcontrib>Venkataraman, Shreyas</creatorcontrib><creatorcontrib>Karim, Shahid</creatorcontrib><creatorcontrib>Chahal, Anwar</creatorcontrib><creatorcontrib>Kara, Tomas</creatorcontrib><creatorcontrib>Orban, Marek</creatorcontrib><creatorcontrib>Ludka, Ondrej</creatorcontrib><creatorcontrib>Kautzner, Josef</creatorcontrib><creatorcontrib>Ommen, Steve R.</creatorcontrib><creatorcontrib>Somers, Virend K.</creatorcontrib><title>Increased heart rate with sleep disordered breathing in hypertrophic cardiomyopathy</title><title>International journal of cardiology</title><addtitle>Int J Cardiol</addtitle><description>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.
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.
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.
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.
•Hypertrophic cardiomyopathy patients with sleep apnea have higher mean heart rate•This difference is most pronounced during night-time hours.•Further studies could explore whether sleep apnea treatment could complement rate-control medications in symptomatic patients.</description><subject>Adult</subject><subject>Aged</subject><subject>Autonomic nervous system</subject><subject>Cardiomyopathy, Hypertrophic - complications</subject><subject>Cardiomyopathy, Hypertrophic - diagnostic imaging</subject><subject>Heart Rate</subject><subject>Humans</subject><subject>Hypertrophic cardiomyopathy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Polysomnography</subject><subject>Sleep apnea</subject><subject>Sleep Apnea Syndromes - diagnosis</subject><subject>Sleep Apnea Syndromes - epidemiology</subject><subject>Sleep Apnea, Obstructive - diagnosis</subject><subject>Sleep Apnea, Obstructive - epidemiology</subject><subject>Sleep disordered breathing</subject><issn>0167-5273</issn><issn>1874-1754</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUFP3DAQha0KVLa0_6CqcuSS4Nhe27lQVahQJKQegLPlHU-IV9k4tb2g_ff1aimCSy_zDvPNm7EfIV9b2rS0lefrxq_BRtcwymhDdVPkA1m0Wom6VUtxRBYFU_WSKX5CPqW0ppSKrtMfyQlnqtOSqQW5u5kgok3oqgFtzFW0Gatnn4cqjYhz5XwK0WEswKqAefDTY-WnatjNGHMM8-Ch2t_hw2YX5gLsPpPj3o4Jv7zoKXm4-nl_-au-_X19c_njtgYhRa47AIXalcdoITrNgHPZcipAg1gik3bVO5Cq184hl9LpfZUdB7USrOuRn5LvB995u9qgA5xytKOZo9_YuDPBevO-M_nBPIYn01LBpKa6OJy9OMTwZ4spm41PgONoJwzbZJjgQi0VlbSg4oBCDClF7F_3tNTsAzFrcwjE7AMxVJsiZezb2xtfh_4lUICLA4Dlp548RpPA4wTofETIxgX__w1_AYpXoIg</recordid><startdate>20210115</startdate><enddate>20210115</enddate><creator>Konecny, Tomas</creator><creator>Khoo, Michael</creator><creator>Covassin, Naima</creator><creator>Edelhofer, Paul</creator><creator>Bukartyk, Jan</creator><creator>Park, Jae Yoon</creator><creator>Venkataraman, Shreyas</creator><creator>Karim, Shahid</creator><creator>Chahal, Anwar</creator><creator>Kara, Tomas</creator><creator>Orban, Marek</creator><creator>Ludka, Ondrej</creator><creator>Kautzner, Josef</creator><creator>Ommen, Steve R.</creator><creator>Somers, Virend K.</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20210115</creationdate><title>Increased heart rate with sleep disordered breathing in hypertrophic cardiomyopathy</title><author>Konecny, Tomas ; Khoo, Michael ; Covassin, Naima ; Edelhofer, Paul ; Bukartyk, Jan ; Park, Jae Yoon ; Venkataraman, Shreyas ; Karim, Shahid ; Chahal, Anwar ; Kara, Tomas ; Orban, Marek ; Ludka, Ondrej ; Kautzner, Josef ; Ommen, Steve R. ; Somers, Virend K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c464t-9cc7e8d101844982c3361304c8c45e26abfdc67f8dde366d8e366693c7b429fe3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Autonomic nervous system</topic><topic>Cardiomyopathy, Hypertrophic - complications</topic><topic>Cardiomyopathy, Hypertrophic - diagnostic imaging</topic><topic>Heart Rate</topic><topic>Humans</topic><topic>Hypertrophic cardiomyopathy</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Polysomnography</topic><topic>Sleep apnea</topic><topic>Sleep Apnea Syndromes - diagnosis</topic><topic>Sleep Apnea Syndromes - epidemiology</topic><topic>Sleep Apnea, Obstructive - diagnosis</topic><topic>Sleep Apnea, Obstructive - epidemiology</topic><topic>Sleep disordered breathing</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Konecny, Tomas</creatorcontrib><creatorcontrib>Khoo, Michael</creatorcontrib><creatorcontrib>Covassin, Naima</creatorcontrib><creatorcontrib>Edelhofer, Paul</creatorcontrib><creatorcontrib>Bukartyk, Jan</creatorcontrib><creatorcontrib>Park, Jae Yoon</creatorcontrib><creatorcontrib>Venkataraman, Shreyas</creatorcontrib><creatorcontrib>Karim, Shahid</creatorcontrib><creatorcontrib>Chahal, Anwar</creatorcontrib><creatorcontrib>Kara, Tomas</creatorcontrib><creatorcontrib>Orban, Marek</creatorcontrib><creatorcontrib>Ludka, Ondrej</creatorcontrib><creatorcontrib>Kautzner, Josef</creatorcontrib><creatorcontrib>Ommen, Steve R.</creatorcontrib><creatorcontrib>Somers, Virend K.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Konecny, Tomas</au><au>Khoo, Michael</au><au>Covassin, Naima</au><au>Edelhofer, Paul</au><au>Bukartyk, Jan</au><au>Park, Jae Yoon</au><au>Venkataraman, Shreyas</au><au>Karim, Shahid</au><au>Chahal, Anwar</au><au>Kara, Tomas</au><au>Orban, Marek</au><au>Ludka, Ondrej</au><au>Kautzner, Josef</au><au>Ommen, Steve R.</au><au>Somers, Virend K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Increased heart rate with sleep disordered breathing in hypertrophic cardiomyopathy</atitle><jtitle>International journal of cardiology</jtitle><addtitle>Int J Cardiol</addtitle><date>2021-01-15</date><risdate>2021</risdate><volume>323</volume><spage>155</spage><epage>160</epage><pages>155-160</pages><issn>0167-5273</issn><eissn>1874-1754</eissn><abstract>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.
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.
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.
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.
•Hypertrophic cardiomyopathy patients with sleep apnea have higher mean heart rate•This difference is most pronounced during night-time hours.•Further studies could explore whether sleep apnea treatment could complement rate-control medications in symptomatic patients.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>32798627</pmid><doi>10.1016/j.ijcard.2020.08.020</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adult Aged Autonomic nervous system Cardiomyopathy, Hypertrophic - complications Cardiomyopathy, Hypertrophic - diagnostic imaging Heart Rate Humans Hypertrophic cardiomyopathy Male Middle Aged Polysomnography Sleep apnea Sleep Apnea Syndromes - diagnosis Sleep Apnea Syndromes - epidemiology Sleep Apnea, Obstructive - diagnosis Sleep Apnea, Obstructive - epidemiology Sleep disordered breathing |
| title | Increased heart rate with sleep disordered breathing in hypertrophic cardiomyopathy |
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