0748 Cardiovascular Findings in Patients with Central Disorders of Hypersomnolence: Preliminary Results of the Cleveland Clinic Hypersomnia Carepath

Abstract Introduction Patients with CNS disorders of hypersomnolence (CDH) are at risk of cardiovascular comorbidities that require monitoring. In 2024, we launched a Hypersomnia Carepath (HSCP) that standardizes access and incorporates cardiovascular quality and safety monitoring. Methods HSCP patients on stable pharmacotherapy were enrolled into Q3: 3-month visits for traditional stimulants or Q6: 6-month visits for all other medication groups. Annual EKG was performed in Q3 patients and by provider request in Q6. A board-certified cardiologist classified EKG abnormalities. QTc was calculated using the Framingham equation. Office blood pressure was acquired during the annual in-person visit. Statistics presented as N (%) and mean (SD). Two-sample t-test, chi square, Fisher’s exact test, or Kruskal-Wallis test were used, as appropriate. Results A total of 119 patients with completed EKG after HSCP enrollment were included: mean age 41.5±12.7 yr, 79.8% female, 84% Caucasian. Of these, 79(66.4) were taking monotherapy. Traditional stimulants were used by 78(65.5), solriamfetol 6(5), modafinil/armodafinil 72(60.5), oxybates 24(20.2), and pitolisant 5(4.2) patients. Monotherapies included: traditional stimulants in 44(55.7), solriamfetol 1(1.3%), modafinil/armodafinil 27(34.2), and oxybates 7(8.9) patients. Ventricular rate was higher (83±15 vs 73±9 bpm, p=0.005) and QT interval shorter (372±26 vs 385 ± 22 ms, p=0.0115) with traditional stimulants versus others. QTc (411±17 vs 411 ± 17 ms) and abnormal EKGs (24.4 vs 34.1%) were similar between groups. Among monotherapy users, ventricular rate was greater with traditional stimulants/solriamfetol versus oxybates and modafinil/armodafinil (84±15 vs 68±6 and 75±10 bpm, respectively, p=0.018) and no differences were observed in QT, QTc or abnormal EKGs. Office BP was similar between traditional stimulant users and others (systolic: 122±14 vs 121±13, p=0.15; diastolic: 74±14 vs 74 ±8, p=0.29, respectively). EKGs were classified as abnormal in 33(27.1), including >1 abnormality in 16(48.5%). Most common were T wave abnormalities (22.6%) and QRS axis deviation and abnormal distal conduction (15.1% each). Conclusion In this CDH cohort, traditional stimulant use relative to all other pharmacotherapies was associated with higher ventricular rate and shorter QT interval but not higher BP or abnormal EKG interpretation. EKGs were classified as abnormal in over one quarter of CDH patients, underscoring the value of proactive cardiovascular monitoring. Support (if any)