Link between nocturnal hypoventilation and hypoxia on arrhythmias/CV morbidity in neuromuscular disorders

Background: Sleep disorder breathing, particularly obstructive sleep apnea (OSA), has been identified as an independent risk factor for cardiovascular disease. Patients with cardiac disease and OSA have increased morbidity and mortality. Neuromuscular disorders are characterized by respiratory muscle weakness that frequently leads to sleep disorder breathing, and respiratory failure. Also, many neuromuscular conditions present with cardiac pathology. However, the relationship between respiratory morbidity and cardiovascular outcomes has been understudied in the neuromuscular population. Aim of review: This review aims to describe the relationship between respiratory pathology and cardiac disease in patients with neuromuscular disorders. We will review the available literature on the two most common types of cardiac disease, cardiomyopathy and arrhythmias, and their relationship with sleep disorder breathing. Key scientific concepts of review: • Sleep disorder breathing has been identified as an independent risk factor for cardiovascular disease in the general population; however, the relationship between SBD and neuromuscular disease is not well studied. • The two most common types of cardiac disorders in the neuromuscular population are cardiomyopathy and heart rhythm problems, which can be disease and age-specific. • Ventilatory support improves symptoms and clinical outcomes of patients with neuromuscular disorders. However, the literature is not clear regarding improvement in cardiac function and heart rhythm in patients treated with positive pressure ventilation.