Oxygen stabilized sleep disordered breathing and reduced sympathetic activity in patients with heart failure and Cheyne-Stokes respiration. We were unable to demonstrate an effect on either patient symptoms or cognitive function.

Objective-To characterise the central and regional haemodynamic eVects of insulin in patients with chronic heart failure. Design-Single blind, placebo controlled study. Setting-University teaching hospital. Patients-Ten patients with stable chronic heart failure. Interventions-Hyperinsulinaemic euglycaemic clamp and non-invasive haemodynamic measurements. Main outcome measures-Change in resting heart rate, blood pressure, cardiac output, and regional splanchnic and skeletal muscle blood flow. Results-Insulin infusion led to a dose dependent increase in skeletal muscle blood flow of 0.36 (0.13) and 0.73 (0.14) ml/dl/min during low and high dose insulin infusions (p < 0.05 and p < 0.005 v placebo, respectively). Low and high dose insulin infusions led to a fall in heart rate of 4.6 (1.4) and 5.1 (1.3) beats/min (p < 0.05 and p < 0.005 v placebo, respectively) and a modest increase in cardiac output. There was no significant change in superior mesenteric artery blood flow. Conclusion-In patients with chronic heart failure insulin is a selective skeletal muscle vasodilator that leads to increased muscle perfusion primarily through redistribution of regional blood flow rather than by increased cardiac output. These results provide a rational haemodynamic explanation for the apparent beneficial eVects of insulin infusion in the setting of heart failure. (Heart 2001;85:508-513)

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Summary. Matched maternal venous (MV), umbilical artery (UA) and umbilical vein (UV) concentrations of atrial natriuretic peptide [ANP] were measured in 36 normotensive women at term delivery (23 vaginal, 13 caesarean) and 17 non‐pregnant women in the first half of the menstrual cycle. MV [ANP] at caesarean section was similar to that in nonpregnant women, but UA and UV [ANP] were higher (P<0.01 for both). UA, but not UV, [ANP] was markedly raised after vaginal delivery. Plasma concentrations of aldosteronce[ALD] were measured in 16 of the matched sets of samples. No statistically significant association was found between [ANP] and [ALD] in either maternal or fetal samples. Neither maternal nor fetal [ANP] correlated with serum Na+ or osmolality, haematoerit, blood pressure or heart rate.