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Original Research: SLEEP MEDICINE |

Obstructive Sleep Apnea Is Common and Independently Associated With Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy

Rodrigo P. Pedrosa, MD; Luciano F. Drager, MD, PhD; Pedro R. Genta, MD; Aline C. S. Amaro, RpT; Murillo O. Antunes, MD; Afonso Y. Matsumoto, MD, PhD; Edmundo Arteaga, MD, PhD; Charles Mady, MD, PhD; Geraldo Lorenzi-Filho, MD, PhD
Author and Funding Information

From the Sleep Laboratory, Pulmonary Division (Drs Pedrosa, Drager, Genta, and Lorenzi-Filho and Ms Amaro) and the Cardiomyopathy Medical Unit (Clinical Unit of Cardiomyopathies) (Drs Antunes, Matsumoto, Arteaga, and Mady), Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.

Correspondence to: Geraldo Lorenzi-Filho, MD, PhD, Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), Av. Enéas Carvalho de Aguiar, 44, São Paulo, Brazil; e-mail: geraldo.lorenzi@incor.usp.br


Funding/Support: This study was supported by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) and the Fundação Zerbini.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(5):1078-1084. doi:10.1378/chest.09-2335
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Background:  Hypertrophic cardiomyopathy (HCM) is associated with arrhythmias and cardiovascular death. Left atrial enlargement and atrial fibrillation (AF) are considered markers for death due to heart failure in patients with HCM. Obstructive sleep apnea (OSA) is independently associated with heart remodeling and arrhythmias in other populations. We hypothesized that OSA is common and is associated with heart remodeling and AF in patients with HCM.

Methods:  We evaluated 80 consecutive stable patients with a confirmed diagnosis of HCM by sleep questionnaire, blood tests, echocardiography, and sleep study (overnight respiratory monitoring).

Results:  OSA (apnea-hypopnea index [AHI] > 15 events/h) was present in 32 patients (40%). Patients with OSA were significantly older (56 [41-64] vs 38.5 [30-53] years, P < .001) and presented higher BMI (28.2 ± 3.5 vs 25.2 ± 5.2 kg/m2, P < .01) and increased left atrial diameter (45 [42-52.8] vs 41 [39-47] mm, P = .01) and aorta diameter (34 [30-37] vs 29 [28-32] mm, P < .001), compared with patients without OSA. Stepwise multiple linear regression showed that the AHI (P = .05) and BMI (P = .06) were associated with left atrial diameter. The AHI was the only variable associated with aorta diameter (P = .01). AF was present in 31% vs 6% of patients with and without OSA, respectively (P < .01). OSA (P = .03) and left atrial diameter (P = .03) were the only factors independently associated with AF.

Conclusions:  OSA is highly prevalent in patients with HCM and it is associated with left atrial and aortic enlargement. OSA is independently associated with AF, a risk factor for cardiovascular death in this population.

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