Obstructive Sleep Apnea and Hypertrophic Cardiomyopathy

The large increase in negative intrathoracic pressures affects 3 pathways in patients with OSA and HCM: 1) increased left ventricular afterload, decreased left ventricular preload with a consequent decrease in left ventricular stroke volume, cardiac output, and increased left ventricular outflow tra...

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Bibliographic Details
Published inJournal of the American College of Cardiology Vol. 64; no. 23; pp. 2560 - 2562
Main Authors Jan, M. Fuad, MBBS, MD, Tajik, A. Jamil, MD
Format Journal Article
LanguageEnglish
Published New York Elsevier Limited 16.12.2014
Subjects
Blood pressure
Cardiology
Cardiomyopathy
Cardiovascular
Cardiovascular disease
Internal Medicine
Mortality
Patients
Sleep
Sleep apnea
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Summary:The large increase in negative intrathoracic pressures affects 3 pathways in patients with OSA and HCM: 1) increased left ventricular afterload, decreased left ventricular preload with a consequent decrease in left ventricular stroke volume, cardiac output, and increased left ventricular outflow tract obstruction; 2) increased left atrial distention/dilation leading to atrial fibrillation, which is the most common arrhythmia in HCM; and 3) increased intrathoracic aortic wall stress, which is a putative mechanism for increased prevalence of aortopathy in patients with HCM (an as yet undetermined field). Mechanistic investigations also stimulate us to propose a true arrhythmogenic role of OSA in HCM in susceptible patients. [...]it can be argued, among others, in obiter dicta that integrating OSA into the risk stratification tool in the "pyramid profile" and arbitration assembly for sudden death in HCM would strengthen the current pyramid profile.
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2014.09.043