Advanced heart failure and nocturnal hypoxaemia due to central sleep apnoea are associated with increased serum erythropoietin

Abstract

AimsCentral sleep apnoea (CSA) and increased serum erythropoietin (EPO) concentration have each been associated with adverse prognosis in heart failure (HF) patients. The aim of this study was to examine the relationship between nocturnal hypoxaemia due to CSA and the serum EPO concentration in patients with HF. Methods and resultsHeart failure subjects (n ¼ 33) and healthy controls (n ¼ 18) underwent polysomnography (PSG) for diagnosis of CSA and identification and quantification of hypoxaemia. Blood collection for measurement of EPO was performed immediately post-PSG. For the analysis, HF subjects were dichotomized into subgroups defined by the presence or absence of CSA and by HF severity. Multivariate analyses were performed to evaluate the relationships of hypoxaemia and advanced HF to EPO concentration. Mean EPO concentration was 62% higher for HF subjects with CSA than for healthy controls (P ¼ 0.004). The magnitude of nocturnal hypoxaemia was significantly and positively related to EPO concentration (r ¼ 0.45, P ¼ 0.02). Advanced HF was also significantly and positively related to EPO concentration (r ¼ 0.43, P ¼ 0.02). On multivariate analysis, the presence of combined nocturnal hypoxaemia and advanced HF yielded greater correlation to EPO concentration than either factor alone (r ¼ 0.57, P ¼ 0.04 and P ¼ 0.05, respectively). Linear regression demonstrated that the combination of New York Heart Association Class and CSA was strongly associated with EPO concentration (P , 0.0001). ConclusionIn non-anaemic HF patients, advanced HF and hypoxaemia due to CSA may each be independently associated with increased serum EPO concentration.--

Clinical predictors of sleep apnoea in heart failure outpatients

“…The reason for this is unclear. Repetitive desaturation in patients with sleep apnoea has been shown to be a stimulus for erythropoietin (EPO) production , potentially leading to higher haemoglobin levels. Patients with CSA may also have a higher use of diuretics compared with patients with OSA which can contribute to further increase the haemoglobin.…”

Erythropoietin does not have effects on the ventilatory and pulmonary vascular response to acute hypoxia in men and women

“…In disease states, however, the situation could be different. It is known that, depending on the severity of the disease, patients with obstructive sleep apnoea or those suffering from heart failure combined with central sleep apnoea show elevated serum EPO concentrations, and this is thought to be triggered by the nocturnal exposures to intermittent hypoxia (for references see Calvin et al 2010;Brugniaux et al 2011). Apart from having neuroand cardioprotective effects (Lipsic et al 2006;Calvin et al 2010), it would be of interest to see whether these increased EPO concentrations, possibly in an interaction with upregulated EPOR and the common β-receptor, may contribute to the augmented O 2 and CO 2 sensitivities in patients exposed to intermittent hypoxia, resulting in a destabilizing effect on respiratory control and in a worsening of sleep-disordered breathing (Dempsey et al 2010).…”

Sleep apnoea and stroke

“…Nocturnal hypoxia leads to red cell proliferation [33] and increases blood viscosity which affects cerebral blood flow. Results from observational studies suggest that there is an association between sleep apnoea and increases in fibrinogen concentration [34,35] and platelet aggregation [36] with concomitant increased stroke risk.…”