Prevalence and clinical characteristics of sleep apnea in hypertrophic cardiomyopathy: A meta-analysis

Objective To investigate the prevalence and clinical characteristics of sleep apnea (SA) in patients with hypertrophic cardiomyopathy (HCM). Methods Eligible studies were screened and selected from four databases. The pooled prevalence of SA in HCM was calculated and presented as proportion with 95% confidence intervals (CI). Comparison of clinical characteristics between HCM patients with or without SA was then assessed and presented as mean difference (MD) or odds ratio (OR) with 95%CI. Sensitivity analyses, subgroup analyses and meta-regression were then applied for heterogeneity assessment. Results Eight studies with 3,922 HCM patients was included, revealing an SA prevalence of 53% (95% CI 39%, 67%). HCM patients with SA were associated with older age (MD 8.91, 95% CI 7.28, 10.54), male (OR 1.59, 95%CI 1.30, 1.95). elevated body mass index (MD 2.59, 95%CI 1.36, 3.81), smoking (OR 1.86, 95%CI 1.39, 2.49), hypertension (OR 2.54, 95%CI 2.06, 3.14), diabetes (OR 2.03, 95%CI 1.31, 3.13) and atrial fibrillation (OR 1.96, 95%CI 1.51, 2.54). Echocardiographic findings revealed that HCM with SA was associated with reduced interventricular septum thickness (MD -1.25, 95%CI -2.44, -0.06), increased left atrial diameter (MD 1.48, 95%CI 0.49, 2.47) and left ventricular end-diastolic diameter (MD 2.81, 95%CI 1.99, 3.62). Additionally, HCM patients with SA showed increased application of hypertensive drugs, and application of calcium channel blockers was identified as source of heterogeneity in meta-regression. Conclusion SA is highly prevalent in HCM, and HCM patients with comorbid SA exhibit distinct baseline characteristics, cardiac structure and drug application.