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Hypertrophic obstructive cardiomyopathy and sleep-disordered breathing: an unfavorable combination

Nature Clinical Practice Cardiovascular Medicine volume 6, pages 14–15 (2009)Cite this article

Despite extraordinary advances in understanding hypertrophic obstructive cardiomyopathy (HOCM) at the molecular and genetic level, the overall clinical management of patients with HOCM remains suboptimum.1 We propose that the presence of obstructive sleep apnea (OSA) in patients with HOCM could be an important contributor to drug-refractory symptoms and worsening left ventricular outflow tract (LVOT) obstruction, as a result of heightened sympathetic activity.

Currently, septal reduction is recommended for patients with HOCM whose septal thickness is 16 mm or more, whose symptoms interfere with lifestyle despite optimum medical therapy, and in whom the LVOT gradient is 30 mmHg or more at rest or 50 mmHg or more on provocation. OSA occurs when inspiratory airflow is either partly (hypopnea) or completely (apnea) occluded during sleep. Approximately 20% of adults in North America and Europe have mild OSA, and another 7% have moderate to severe OSA.2 Although OSA occurs predominantly at night, the combination of sleep-disordered breathing and daytime sleepiness is referred to as OSA syndrome. The hypoxemia and carbon dioxide retention that result from apnea primarily excite peripheral and central chemoreceptors, which increases sympathetic vasoconstrictor activity.3 Furthermore, the repetitive nocturnal stress of hypoxemia, combined with strenuous inspiratory effort because of the occluded upper airway and arousal from sleep, elicit a breadth of neural, humoral, vascular, inflammatory, and metabolic responses that are evident even when the individual is awake. Home-based treatment currently centers on continuous positive airway pressure (CPAP) therapy.

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Authors and Affiliations

  1. B Khandheria is a Consultant and Chair of the Cardiovascular Division, AJ Tajik is a Consultant in the Division of Cardiovascular Diseases, and JM Parisch is a Consultant in the Division of Pulmonary Medicine, PP Sengupta and D Sorajja are Clinical Fellows, MF Eleid is a Resident in Internal Medicine, all at the Mayo Clinic, Scottsdale, AZ.,

    Partho P Sengupta, Dan Sorajja, Mackram F Eleid, James M Parish, Bijoy Khandheria & A Jamil Tajik

  2. VK Somers and SR Ommen are Consultants in the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA,

    Virend K Somers & Steve R Ommen

Authors
  1. Partho P Sengupta
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  2. Dan Sorajja
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  3. Mackram F Eleid
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  4. Virend K Somers
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  8. A Jamil Tajik
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Corresponding author

Correspondence to A Jamil Tajik.

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Sengupta, P., Sorajja, D., Eleid, M. et al. Hypertrophic obstructive cardiomyopathy and sleep-disordered breathing: an unfavorable combination. Nat Rev Cardiol 6, 14–15 (2009). https://doi.org/10.1038/ncpcardio1401

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