Relation of Natriuretic Peptide Concentrations to Central Sleep Apnea in Patients With Heart Failure

Abstract

Background: Central sleep apnea (CSA) is frequent among patients with heart failure (HF) and associated with increased morbidity and mortality. Elevated cardiac fi lling pressures promote CSA and atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) secretion. We hypothesized that circulating natriuretic peptide concentrations predict CSA. Methods: Consecutive patients with HF (n 5 44) with left ventricular ejection fraction (LVEF) Յ 35% underwent polysomnography for detection of CSA. CSA was defi ned as an apnea-hypo pnea index Ն 15 with Ն 50% central apneic events. The relation of natriuretic peptide concentrations to CSA was evaluated by estimation of ORs and receiver operator characteristics (ROCs). Results: Twenty-seven subjects (61%) had CSA, with men more frequently affected than women (73% vs 27%; OR, 7.1; P 5 .01); given that only three women had CSA, further analysis was restricted to men. Subjects with CSA had higher mean ANP (4,336 pg/mL vs 2,510 pg/mL, P 5 .03) and BNP concentrations (746 pg/mL vs 379 pg/mL, P 5 .05). ANP and BNP concentrations were signifi cantly related to CSA (OR, 3.7 per 3,000 pg/mL, P 5 .03 and OR, 1.5 per 200 pg/mL, P 5 .04, respectively), whereas age, LVEF, and New York Heart Association functional class were not. Abbreviations: ANP 5 atrial natriuretic peptide; AUC 5 area under the curve; BNP 5 brain natriuretic peptide; CSA 5 central sleep apnea; eGFR 5 estimated glomerular fi ltration rate; HF 5 heart failure; LVEF 5 left ventricular ejection fraction; NYHA 5 New York Heart Association; OSA 5 obstructive sleep apnea; PSG 5 polysomnography; ROC 5 receiver-operator characteristic; T90% 5 time with arterial oxygen saturation , 90%

Ocena zaburzeń oddychania w czasie snu z wykorzystaniem rejestracji holterowskiej u pacjentów z tętniczym nadciśnieniem płucnym oraz nadciśnieniem płucnym wtórnym do dysfunkcji lewej komory serca

“…In these patients, higher eAHI values indicated a much worse hemodynamic function (lower LVEF and higher NT-proBNP values) and a higher rate of supraventricular arrhythmia. Relations between natriuretic peptide levels, LVEF and SDB in heart failure were documented in the literature [20,21]. Our findings are also consistent with previous reports of SDB promoting supraventricular arrhythmia, including both premature supraventricular beats and atrial fibrillation [22].…”

Leptin Deficiency Promotes Central Sleep Apnea in Patients With Heart Failure

“…The signifi cantly elevated NPs in our subject cohort are also aligned with previous investigations that found ANP and BNP concentrations to be elevated in patients with HF and CSA. 9,10 Subjects with CSA had more severe HF, including evidence of hyperventilation at rest and during exercise, compared with patients with HF without CSA, in agreement with prior report. 34 In addition to the relationship between low leptin and CSA, our data showed that leptin concentration was signifi cantly and inversely correlated with e / co 2 at rest and during exercise and with e and V t during exercise, and was positively correlated with rest and exercise P etco 2 .…”

“…7,8 Natriuretic peptides (NPs) are also increased in proportion to the hemo dynamic severity of HF, and elevated circulating con centrations have been associated with the presence of CSA. 9,10 Leptin is an adipokine that regulates food intake and energy expenditure. 11 Since its discovery, leptin has emerged as a pleiotropic hormone studied extensively in the setting of cardiovascular diseases [12][13][14][15][16] and also appears to be important in the regulation of ventilatory control.…”

The Accuracy of Portable Monitoring in Diagnosing Significant Sleep Disordered Breathing in Hospitalized Patients

“…Although central sleep apnea is less amenable to treatment with CPAP, clinicians must be aware of its prognostic and therapeutic implications in patients with heart failure. [35,36]…”