I've been bitstreaming HDMI for years and have never had these issues, but 90% of my viewing is television shows. Sadly, I have never ripped a bluray in my life, but I do have a handful of full quality 4k HDR 24/23.98fps DTS-HDMA/Atmos mkv Movies, and many HDR Atmos trailers... I can say that I've never had audio dropouts or frame drops watching any of these 4k titles/trailers (or tv either).
nvidia RTX2060 using v536.40 drivers, vsync = ON, power mode = Maximum Performance.
JRVR 4k framerate matching HDMI Bitstream WASAPI out through Atlona Sync AT-ETU-SYNC (EDID emulation/Hot Plug) into Denon 3700 and out to Sony Z9D.
ASUS TUF gaming WiFi z590
i7-11700k @ 3.6GHz - 5GHz
32GB PC4-25600
OS drive: Crucial P5 Plus M.2
Windows 10 64bit 22H2 (installing all windows updates)
Media Storage internal SATA 6TB WD Red Pro
MC32 64bit JRVR