Sleep Apnea and Hypertrophic Cardiomyopathy - Implications for Arrhythmia and Sudden Death

项目描述 肥厚型心肌病（HCM）是最常见的遗传性心脏病。伴随着衰弱 难治性症状、心房颤动（AF）、心力衰竭（HF）和室性心律失常（VA），HCM是 是年轻人和儿童心脏性猝死（SCD）的主要原因。睡眠呼吸障碍（SDB）， 包括中枢性和阻塞性睡眠呼吸暂停（OSA），在心血管疾病中具有高患病率。 我们和其他研究者已经证明OSA是AF、HF、夜间心肌梗死的独立危险因素 和SCD。我们的初步数据表明SDB在HCM患者中的患病率很高， 虽然我们已经证明OSA是SCD的危险因素， 在一般人群中，其在HCM相关SCD中的作用从未被研究过。除了我们的试点数据， HCM患者的金标准多导睡眠图（PSG）显示OSA的患病率更高， 在60%以上，没有研究使用PSG在HCM中。我们建议通过以下方式研究OSA在HCM中的作用： 1)确定HCM患者中SDB的患病率、类型和严重程度，并与年龄和性别进行比较- 匹配的，正常对照使用全面参加PSG。 2)评估OSA与心血管风险生物标志物（包括内皮功能障碍）的相关性， 结构和功能性心脏变化、心率变异性受损和压力反射功能障碍。 3)估计HCM伴和不伴OSA时AF的患病率，并确定 在一项前瞻性纵向队列研究中，HCM背景下新诊断的AF发生率。 4)描述OSA与VA和猝死的频率和昼夜变化的关系。 我们假设阻塞性睡眠呼吸暂停在肥厚型心肌病患者中有很高的患病率， 有难治性症状房颤VA和SCD这一建议的科学前提建立在几个方面 几十年来，我们在OSA的心血管后果方面的开创性工作，以及我们发表的探索性研究， 研究表明，未诊断的SDB在HCM中非常普遍，并与运动减少有关 我们为该提案生成的未发表的试点数据支持我们的 中心假设：60%以上的HCM患者有OSA，经PSG证实。马约 HCM注册中心是世界上最大的单中心HCM数据库，拥有3，673项研究授权 患者，支持我们的建议的可行性。我们的研究结果将使人们更好地理解 OSA的症状、发病机制、心律失常和SCD，这是OSA的基本治疗目标， HCM。这一创新的建议作为一种优雅和快速翻译的途径，具有重大的前景， 改善HCM的结果，并将在确定一个新的，有效的管理策略的关键。这些 目标直接针对NHLBI的使命声明：促进心脏、肺和心血管疾病的预防和治疗， 血液疾病和增强所有人的健康，使他们能够活得更长。

Project Description Hypertrophic cardiomyopathy (HCM) is the commonest inherited heart condition. Associated with debilitating refractory symptoms, atrial fibrillation (AF), heart failure (HF) and ventricular arrhythmia (VA), HCM is the leading cause of sudden cardiac death (SCD) in young adults and children. Sleep disordered breathing (SDB), which includes central and obstructive sleep apnea (OSA), has a high prevalence in cardiovascular disease. We and others have shown OSA to be an independent risk factor for AF, HF, nocturnal myocardial infarction and SCD. Our preliminary data suggest that SDB has a high prevalence in patients with HCM and is associated with decreased exercise capacity and AF. While we have shown that OSA is a risk factor for SCD in the general population, its role in HCM-related SCD has never been studied. Apart from our pilot data using gold-standard attended polysomnography (PSG) in patients with HCM, showing a prevalence of OSA greater than 60%, there are no studies using PSG in HCM. We propose to investigate the role of OSA in HCM by: 1) Determining the prevalence, types and severity of SDB in patients with HCM compared with age and sex- matched, normal controls using comprehensive attended PSG. 2) Evaluating the association of OSA and biomarkers of cardiovascular risk including endothelial dysfunction, structural and functional cardiac changes, impaired heart rate variability, and baroreflex dysfunction. 3) Estimating the prevalence ratio for AF in the setting of HCM with and without OSA, and determining the incidence ratio of newly diagnosed AF in the setting of HCM in a prospective longitudinal cohort study. 4) Characterizing the association of OSA with the frequency and day-night variation of VA and sudden death. We hypothesize that OSA has a high prevalence amongst patients with HCM, and is independently associated with refractory symptoms, AF, VA, and SCD. The scientific premise for this proposal builds on several decades of our pioneering work on the cardiovascular consequences of OSA, and our published exploratory studies suggesting undiagnosed SDB is highly prevalent in HCM, and is associated with decreased exercise capacity and increased frequency of AF. Our unpublished pilot data generated for this proposal support our central hypothesis: over 60% of unselected patients with HCM have OSA documented by PSG. The Mayo HCM registry is the largest single-center HCM database in the world with research authorization from 3,673 patients, supporting feasibility of our proposal. Our findings will lead to increased understanding of the role of OSA in symptoms, disease mechanisms, arrhythmia, and SCD, which are the fundamental treatment goals in HCM. This innovative proposal holds significant promise as an elegant and rapidly translatable avenue for improving outcomes in HCM, and will be pivotal in identifying a novel, effective management strategy. These goals directly address the NHLBI mission statement: to promote prevention and treatment of heart, lung, and blood diseases and enhance the health of all individuals so that they can live longer.