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Original Research: Sleep Disorders |

Decreased Exercise Capacity and Sleep-Disordered Breathing in Patients With Hypertrophic CardiomyopathyExercise Capacity in Hypertrophic Cardiomyopathy

Tomas Konecny, MD, PhD; Jeffrey B. Geske, MD; Ondrej Ludka, MD, PhD; Marek Orban, MD; Peter A. Brady, MD; Muaz M. Abudiab, MD; Felipe N. Albuquerque, MD; Alexander Placek, BSc; Tomas Kara, MD, PhD; Karine R. Sahakyan, MD, PhD; Bernard J. Gersh, MD, DPhil; A. Jamil Tajik, MD; Thomas G. Allison, PhD; Steve R. Ommen, MD; Virend K. Somers, MD, DPhil, FCCP
Author and Funding Information

From the Mayo Clinic (Drs Konecny, Geske, Brady, Abudiab, Albuquerque, Kara, Sahakyan, Gersh, Tajik, Allison, Ommen, and Somers and Mr Placek), Rochester, MN; St. Anne’s University Hospital (Drs Konecny, Ludka, Orban, and Somers), International Clinical Research Center (ICRC), Brno, Czech Republic; the Department of Internal Medicine and Cardiology (Drs Ludka and Kara), University Hospital Brno, Brno, Czech Republic; the Faculty of Medicine (Drs Ludka and Kara), Masaryk University, Brno, Czech Republic; the Center for Cardiovascular and Transplant Surgery (CKTCH) (Dr Orban), Brno, Czech Republic; Yale University (Dr Albuquerque), New Haven, CT; Georgetown University Medical Center (Mr Placek), Washington, DC; and Department of Cardiology, University Hospital Olomouc (Dr Kara), Olomouc, Czech Republic.

CORRESPONDENCE TO: Virend K. Somers, MD, DPhil, FCCP, Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905; e-mail: somers.virend@mayo.edu


FUNDING/SUPPORT: This study was supported in part by grants from the Mayo Foundation, the National Institutes of Health [NIH HL65176], the European Regional Development Fund - Project FNUSA-ICRC [No. CZ.1.05/1.1.00/02.0123], and the National Center for Advancing Translational Sciences [NCATS UL1 TR000135].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(6):1574-1581. doi:10.1378/chest.14-1498
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BACKGROUND:  Mechanisms of decreased exercise capacity in patients with hypertrophic cardiomyopathy (HCM) are not well understood. Sleep-disordered breathing (SDB) is a highly prevalent but treatable disorder in patients with HCM. The role of comorbid SDB in the attenuated exercise capacity in HCM has not been studied previously.

METHODS:  Overnight oximetry, cardiopulmonary exercise testing, and echocardiographic studies were performed in consecutive patients with HCM seen at the Mayo Clinic. SDB was considered present if the oxygen desaturation index (number of ≥ 4% desaturations/h) was ≥ 10. Peak oxygen consumption (V. o2peak) (the most reproducible and prognostic measure of cardiovascular fitness) was then correlated with the presence and severity of SDB.

RESULTS:  A total of 198 patients with HCM were studied (age, 53 ± 16 years; 122 men), of whom 32% met the criteria for the SDB diagnosis. Patients with SDB had decreased V. o2peak compared with those without SDB (16 mL O2/kg/min vs 21 mL O2/kg/min, P < .001). SDB remained significantly associated with V. o2peak after accounting for confounding clinical variables (P < .001) including age, sex, BMI, atrial fibrillation, and coronary artery disease.

CONCLUSIONS:  In patients with HCM, the presence of SDB is associated with decreased V. o2peak. SDB may represent an important and potentially modifiable contributor to impaired exercise tolerance in this unique population.

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