title: Lack of reliable clinical predictors to identify obstructive sleep apnea in patients with hypertrophic cardiomyopathy.
abstract: OBJECTIVE
  Obstructive sleep apnea is common among patients with hypertrophic cardiomyopathy and may contribute to poor cardiovascular outcomes. However, obstructive sleep apnea is largely unrecognized in this population. We sought to identify the clinical predictors of obstructive sleep apnea among patients with hypertrophic cardiomyopathy.
  
  
  METHODS
  Consecutive patients with hypertrophic cardiomyopathy were recruited from a tertiary University Hospital and were evaluated using validated sleep questionnaires (Berlin and Epworth) and overnight portable monitoring. Ninety patients (males, 51%; age, 46±15 years; body mass index, 26.6±4.9 kg/m2) were included, and obstructive sleep apnea (respiratory disturbance index ≥15 events/h) was present in 37 patients (41%).
  
  
  RESULTS
  Compared with the patients without obstructive sleep apnea, patients with obstructive sleep apnea were older and had higher body mass index, larger waist circumference, larger neck circumference, and higher prevalence of atrial fibrillation. Excessive daytime sleepiness (Epworth scale) was low and similar in the patients with and without obstructive sleep apnea, respectively. The only predictors of obstructive sleep apnea (using a logistic regression analysis) were age ≥45 years (odds ratio [OR], 4.46; 95% confidence interval [CI 95%], 1.47-13.54; p = 0.008) and the presence of atrial fibrillation [OR, 5.37; CI 95%, 1.43-20.12; p = 0.013].
  
  
  CONCLUSIONS
  Consistent clinical predictors of obstructive sleep apnea are lacking for patients with hypertrophic cardiomyopathy, which suggests that objective sleep evaluations should be considered in this population, particularly among elderly patients with atrial fibrillation.
authors.affiliation: Faculdade de Medicina, Heart Institute (InCor), Hospital das Cínicas, Universidade de São Paulo, São Paulo, SP, Brazil. fbnerbass@gmail.com
authors.forename: Flávia B
authors.initials: FB
authors.lastname: Nerbass
authors.forename: Rodrigo P
authors.initials: RP
authors.lastname: Pedrosa
authors.forename: Pedro R
authors.initials: PR
authors.lastname: Genta
authors.forename: Murillo O
authors.initials: MO
authors.lastname: Antunes
authors.forename: Edmundo
authors.initials: E
authors.lastname: Arteaga-Fernández
authors.forename: Luciano F
authors.initials: LF
authors.lastname: Drager
authors.forename: Geraldo
authors.initials: G
authors.lastname: Lorenzi-Filho
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000503:physiopathology; D015992:Body Mass Index; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012016:Reference Values; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013997:Time Factors
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