The Clinical Features In Patients With Hypertrophic Cardiomyopathy Coexsiting With Obstructive Sleep Hypoventilation Syndrome

ObjectivesFew studies of patients with hypertrophic cardiomyopathy?HCM?have found the high prevalence of sleep-disordered breathing in abroad,but have not described and explored its clinical features and pathogenesis involved in possibly.Therefore,we investigated the clinical features in HCM coexisting with obstructive sleep apnea?OSA?.At the same time,we explore the pathogenesis in the special populations.MethodsIn this study,we selected 45 patients with HCM in the second affilated hospital of Nanchang University during the period of January 1 2015 to February 1 2016.All patients had polysomnography.Divided into two groups according to the PSG,the one was 28 cases with HCM coexisting with OSA and the other one was 17 cases with HCM only.At the same,selected 43 cases with pure OSA as the control group.Biochemical indicators,including liver and kidney function,blood glucose,cholesterol,catecholamine,hypersensitive c-reactive protein weretested by collectting the peripheral blood of the three groups patients;Information of echocardiogram,dynamic electrocardiogram and ambulatory blood pressure were collectted;Vascular endothelial function was measured by digital reactive hyperemia peripheral arterial tonometry?RH-PAT?.The urine 8-hydroxy deoxyguanosine?8-OHdG?concentration was detected by ELISA.The self-reported smoking status,age,body mass index,complicating diseases and drug administrations were recorded.Results1.The incidence of HCM coexisting with OSA is 62%.The apnea hypoventilation index?AHI?were higher?7.69±3.75 times/h VS 28.77±8.54 times/h,P=0.000?,the lowest oxygen saturation at night?SPO₂?were lower?87.41±4.98%VS 81.18±6.87%,P=0.000?,body mass index?BMI?were higher?21.46±3.62 kg/m²VS 25.01±3.71kg/m²,P=0.000?,the ascending aorta diameter?AAOd?were wider?29.65±4.21mm VS 32.64±4.25mm,P=0.05?in the HCM coexisting with OSA group when compared with the pure HCM group.2.Conpared with the pure OSA group and the pure HCM group,the serum creatininewerehigher?1.00[0.80,1.39]mg/dlVS0.75[0.67,1.02]mg/dlVS0.80[0.69,1.01]mg/dl,HCM+OSA VS HCM VS OSA,P=0.006?,the estimated glomerular filtration rate?eGFR?were lower?97.81±36.07ml/min/1.73m² VS 116.82±25.34 ml/min/1.73m² VS 123.21±30.82ml/min/1.73m²,P=0.005?,The urine 8-hydroxy deoxyguanosine?8-OHdG?concentration were higher in the HCM coexisting with OSA group?123.57[79.56-167.00]ng/mgCr VS 83.19[52.28-100.20]ng/mgCr VS70.59[44.37-94.49]ng/mg Cr,P=0.000?.3.The eGFR was negatively linear correlated with AHI??=-2.980,P=0.000??LVDd??=-1.744,P=0.022??RAD??=-2.903,P=0.013??HIN??=-33.711,P=0.006??CCB??=-27.508,P=0.037??HR??=-1.665,P=0.001?,and was positively linear correlated with UA??=0.149,P=0.024?.Multivariate linear regression analysis identified that AHI significantly and independently correlated with the decrease in the eGFR.4.Multiariable logistic regression analysis showed thatBMIand urine 8-OHdG levels were independently associated with the recurrence of OSA in HCM.?OR=1.641,[95%CI:1.036,2.598],p=0.043?,?OR=1.024,[95%CI:1.001,1.046],p=0.037?.Conclusions1.The incidence of HCM coexisting with OSA is 62%,Suggesting for clinical screening of OSA in patients with HCM;2.Compared to pute HCM groups,BMI was higher in HCM+OSA group,and independent correlation with HCM coexisting with OSA,which suggesting higer BMI was one of the risk factors in the HCM coexistting with OSA group.3.Compared to pute OSA and HCM groups,urine 8-OHdG was higher in the HCM+OSA group,which suggesting high oxidative stress level may be perform a forewarning function in the HCM coexistting with OSA group.4.Compared to pute OSA and HCM groups,eGFR were significant reduction in the HCM coexisting with OSA group in which the AHI were independent correlation with eGFR.