Desai: Screen HCM Patients for Sleep Apnea Aggressively

In an interview with Pharmacy Times, Milind Desai, MD, MBA, FACC, FAHA, FESC, vice chair of the Heart Vascular Thoracic Institute and director of the Hypertrophic Cardiomyopathy Center at the Cleveland Clinic, discussed why heart failure and arrhythmia outcomes did not differ between groups in his registry analysis, what pharmacists should do for patients with hypertrophic cardiomyopathy (HCM) and obstructive sleep apnea today, and the limitations of the data. The research was published in the Journal of the American College of Cardiology and presented at the European Society of Cardiology 2026 Congress in Munich, Germany.¹

Addressing the unchanged heart failure and arrhythmia outcomes, Desai emphasized that these events are multifactorial and that the analysis was a real-world observational registry. He noted that mortality is straightforward to ascertain—a patient is either alive or dead—while arrhythmias and heart failure admissions are harder to capture reliably as endpoints, which could contribute to the absence of a between-group difference. He added that a broader, global clinical picture often drives outcomes and that survival may be more influenced by that overall picture than by obstructive sleep apnea or HCM alone.

Turning to practice, Desai offered clear guidance: every patient with HCM should be asked whether they snore and whether they feel fatigued the following day, and clinicians should keep a low threshold for ordering a sleep study. Once obstructive sleep apnea is identified, it should be treated aggressively, because it can be a precursor to arrhythmias and poor outcomes. He stressed that obesity and sleep apnea are both major issues and that acting on one can directly or indirectly affect the other—something the arrival of GLP-1 drugs has made more feasible.

Finally, Desai cautioned that the results come from a large national registry with inherent limitations. He described the findings as hypothesis-generating, requiring confirmation in a well-designed, well-conducted prospective study, while noting GLP-1 receptor agonists have improved outcomes across the contexts in which they have been tested.

REFERENCE

Halpern L. GLP-1 agonists tied to lower mortality in HCM with sleep apnea. Pharmacy Times. Published September 3, 2026. Accessed September 4, 2026. https://www.pharmacytimes.com/view/glp-1-agonists-tied-to-lower-mortality-in-hcm-with-sleep-apnea