natriuretic-peptide--brain and Sleep-Apnea--Obstructive

Nocturnal enuresis is usually diagnosed and treated by a primary paediatrician or family practitioner; if there is any doubt, the children may be referred to a paediatric urologist. Obstructive sleep-disordered breathing is a complex, multifactorial disorder. Adenotonsillar hypertrophy is considered an important factor associated with obstructive sleep apnoea syndrome. Enuresis and obstructive sleep-disordered breathing are both frequent problems of sleep in childhood. We conducted an electronic search in Medline, Scopus and the ISI Web of Science to look for published material and identify a putative link between nocturnal enuresis and obstructive sleep-disordered breathing. A total number of 98 documents were found, but 24 of these had to be excluded after an attentive reading of the title, abstract or full text because the information therein was not suitable for the aims of our search. Studies have found that children with obstructive sleep apnoea syndrome frequently also have nocturnal enuresis. Both disorders have an underlying sleep disturbance characterised by an altered arousal response and sleep fragmentation. The pathophysiology of enuretic events is seemingly linked to nocturnal obstructive events, causing increased intra-abdominal pressure and altered systemic blood pressure that induces natriuresis and polyuria by altering levels of antidiuretic hormone, and atrial and brain natriuretic peptides. We found 17 studies regarding the urological outcome of treatment for obstructive sleep-disordered breathing in children with enuresis. Although a vast amount of information is now available regarding the relationship between nocturnal enuresis and obstructive sleep-disordered breathing, many of the published studies were uncontrolled, retrospective or prospective cohort studies (grade C recommendation). Resolution of enuresis after medical or surgical treatment for obstructive sleep-disordered breathing has been emphasised. Consequently, symptoms such as snoring, sleep apnoeas and restless sleep should be sought for all children with enuresis. Confirmed obstructive sleep-disordered breathing should be treated promptly; subsequently, the persistence of enuresis requires treatment following the standard protocol.

Topics: Child; Humans; Natriuretic Peptide, Brain; Nocturnal Enuresis; Sleep Apnea, Obstructive; Snoring

Obstructive sleep apnea syndrome (OSAS) leads to cardiovascular complications such as coronary artery disease, left/right ventricular hypertrophy and dysfunction, heart failure, systemic and pulmonary hypertension, arrhythmias and stroke; and these all cardiovascular complications increase morbidity and mortality of OSAS. However, Cheyne-Stokes respiration, central and obstructive apneas may occur in the patient with heart failure. Increased sympathetic activity by hypoxemia and endothelial dysfunction play a role in cardiovascular complications. Some cardiovascular biomarkers have a role in early diagnosis, treatment and prognosis. In the present review, some cardiovascular biomarkers such as serum C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukins, adiponectin, heart-type fatty acid binding protein (hFABP) and brain (B-type) natriuretic peptide (BNP), and their clinical importance were reviewed.

Topics: Adiponectin; Biomarkers; C-Reactive Protein; Cardiovascular Diseases; Early Diagnosis; Humans; Interleukins; Natriuretic Peptide, Brain; Prognosis; Sleep Apnea, Obstructive; Tumor Necrosis Factor-alpha

Topics: Atrial Natriuretic Factor; Cost-Benefit Analysis; Disease Progression; Humans; Kidney Failure, Chronic; Kidney Transplantation; Natriuretic Peptide, Brain; Oximetry; Polysomnography; Positive-Pressure Respiration; Sleep Apnea, Obstructive; Sleep Stages; Treatment Outcome

The aim of this study was to assess the clinical characteristics of patients with heart failure and preserved ejection fraction (HFpEF) and atrial fibrillation (AF) and compare them with those of HFpEF patients without AF.. This study was a sub-group analysis of a multicenter, observational, and cross-sectional registry conducted in Turkey (ClinicalTrials.gov identifier: NCT03026114). Patients with HFpEF were divided into 2 groups: HFpEF with AF and HFpEF with sinus rhythm (SR), and the clinical characteristics of the groups were compared.. In a total of 819 HFpEF patients (median age: 67 years; 58% women), 313 (38.2%) had AF. Compared to the patients with SR, those with AF were older (70 years vs 66 years; p<0.001) and more symptomatic, with a higher rate of classification as New York Heart Association functional class III-IV, paroxysmal nocturnal dyspnea, orthopnea, palpitations, fatigue, pulmonary crepitations, and peripheral edema. The hospitalization rate for heart failure was higher (28.4% vs 12.6%; p<0.001) in patients with AF, and participants with AF had higher level of N-terminal pro-B-type natriuretic peptide (887 pg/mL vs 394.8 pg/mL; p<0.001) and higher left atrial volume index level. Patients without AF had a higher burden of diabetes mellitus, obstructive sleep apnea, and coronary artery disease. The prescription rate of nondihydropyridine calcium blockers, digoxin, loop diuretics, and anticoagulant drugs was higher in the AF group.. The results of this study revealed that in a large Turkish cohort with HFpEF, significant clinical differences were present between those with and without AF and. Further prospective studies are needed to clarify the prognostic implications of AF in this growing heart failure population in our country.

Topics: Aged; Atrial Fibrillation; Cardiac Electrophysiology; Case-Control Studies; Coronary Artery Disease; Cross-Sectional Studies; Diabetes Mellitus; Female; Heart Atria; Heart Failure; Hospitalization; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prevalence; Registries; Sleep Apnea, Obstructive; Stroke Volume; Turkey; Ventricular Dysfunction, Left

We evaluated the effects of sleep-study guided multidisciplinary therapy (SGMT) of obstructive sleep apnoea (OSA) in patients presenting with acute coronary syndrome.. Eligible patients were randomized into (1) SGMT, comprised a sleep study during the index admission and continuous positive airway pressure and behavioral therapy for those with at least mild OSA or (2) standard therapy. The primary end point was the change in the plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) level from baseline to the 7-month follow-up.. A total of 159 patients completed the trial. Of the 70 patients randomized to SGMT, 21 (30%), 15 (22%) and 27 (39%) were diagnosed with mild, moderate and severe OSA, respectively. Continuous positive airway pressure and a positional pillow were prescribed to 57 (91%) and 6 (9%) patients with OSA. Although plasma NT-proBNP levels were lower after 7 months compared to the baseline, the levels did not differ significantly between the SGMT and standard therapy groups at baseline (579 ± 1117 vs. 611 ± 899 pg/dL, p = .851) or at 7 months (90 ± 167 vs. 93 ± 174 pg/dL, p = .996). The changes in NT-proBNP levels from baseline to 7 months were similar with SGMT and standard therapy (-489 vs. -518 pg/dL, p = .726). Similar findings were observed for the plasma ST2 and hs-CRP levels.. OSA screening and multifaceted treatment during the sub-acute phase of acute coronary syndrome did not further reduce the levels of cardiovascular biomarkers when compared with standard therapy.. clinicaltrial.gov NCT02599298.

Topics: Acute Coronary Syndrome; Aftercare; Biomarkers; C-Reactive Protein; Cognitive Behavioral Therapy; Combined Modality Therapy; Continuous Positive Airway Pressure; Female; Humans; Male; Mass Screening; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Polysomnography; Sleep Apnea, Obstructive; Treatment Outcome

Pulmonary hypertension (PH) is extremely common in acute decompensated heart failure (ADHF) patients and predicts increased mortality. Obstructive sleep apnea (OSA), highly prevalent in congestive heart failure patients, may contribute to further elevated pulmonary pressures. This study evaluates the impact of positive airway pressure (PAP) therapy on PH in patients admitted for ADHF with OSA.. A two-center randomized control trial comparing standard of care (SOC) therapy for ADHF versus addition of PAP therapy in patients with concomitant OSA.. Twenty-one consecutive patients were enrolled with 1:1 randomization to SOC versus SOC plus 48-hour PAP therapy protocol. In the intervention arm, the mean pulmonary artery systolic pressure (PASP) difference before therapy and after 48 hours of PAP therapy was -15.8 ± 3.2 (58.6 ± 2.5 mm Hg to 42.8 ± 2.7) versus the SOC arm where the mean PASP difference was -5.2 ± 2.6 (62.7 ± 3.3 mm Hg reduced to 57.5 ± 3.9) (p = 0.025). In addition, ejection fraction in the intervention arm improved (3.4 ± 1.5% versus -0.5 ± 0.5 %) (p = 0.01). Significant improvement was also noted in tricuspid annular plane systolic excursion (TAPSE) and right ventricular systolic area in the intervention arm but not in NT-pro-BNP or 6-minute walk distance.. In patients with ADHF and OSA, addition of 48 hours of PAP therapy to SOC treatment significantly reduced PH. In addition, PAP therapy was able to improve right and left ventricular function. ClinicalTrials.gov identifier: NCT02963597.

Topics: Aged; Aged, 80 and over; Continuous Positive Airway Pressure; Female; Heart Failure; Heart Ventricles; Humans; Hypertension, Pulmonary; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Pilot Projects; Sleep Apnea, Obstructive; Ventricular Function, Left

Obstructive sleep apnea (OSA) is an emerging risk marker for acute coronary syndrome (ACS). This randomized trial aims to determine the effects of sleep study-guided multidisciplinary therapy (SGMT) comprising overnight sleep study, continuous positive airway pressure, and behavioral therapy for OSA during the subacute phase of ACS. We hypothesize that SGMT will reduce (1) the plasma levels of N-terminal pro brain natriuretic peptide and suppression of tumorigenicity 2; (2) the estimated 10-year risk of cardiovascular mortality as measured by the European Systematic Coronary Risk Evaluation (SCORE) algorithm; and (3) the cardiovascular event rate during a 3-year follow-up, compared with standard therapy. In the SGMT trial, 180 patients presenting with ACS will be randomly assigned to SGMT (n = 90) and standard therapy (n = 90) groups. Both groups will receive guideline-mandated treatment for ACS. Those assigned to SGMT will additionally undergo a sleep study and, if OSA is diagnosed, attend a multidisciplinary OSA clinic where they will receive personalized treatment including continuous positive airway pressure and behavioral/lifestyle counseling. The primary endpoint is the plasma N-terminal pro brain natriuretic peptide concentration at 7-month follow-up. This report presents the baseline characteristics of 117 patients (SGMT group: n =54; standard therapy group: n =63) who had been enrolled into the study as of August 31, 2017. The results of this trial will help us to understand whether active OSA diagnosis and treatment will improve the physiologic and clinical cardiovascular outcomes of this group of patients.

Topics: Acute Coronary Syndrome; Behavior Therapy; Biomarkers; Clinical Protocols; Combined Modality Therapy; Continuous Positive Airway Pressure; Female; Humans; Interleukin-1 Receptor-Like 1 Protein; Male; Middle Aged; Natriuretic Peptide, Brain; Patient Care Team; Peptide Fragments; Research Design; Risk Factors; Singapore; Sleep; Sleep Apnea, Obstructive; Time Factors; Treatment Outcome

Untreated obstructive sleep apnoea (OSA) is associated with increased risk of coronary artery disease (CAD) and heart failure. High-sensitivity cardiac troponin (hs Trop-T) and B-type natriuretic peptide (NT-pro-BNP) are sensitive biomarkers for myocardial injury and heart failure respectively. No randomised controlled trials have examined the treatment effect of continuous positive airway pressure (CPAP) in patients with OSA on these biomarkers.. Patients >21 years old with apnoea-hypopnoea index (AHI) ≥25/h by overnight polysomnography were recruited. Main exclusion criteria were previous CPAP use and any significant comorbidities including CAD and heart failure. Eligible subjects were randomised to receive CPAP or sham CPAP for eight weeks each in a crossover design with a wash out period of one month between the treatments. Blood samples were collected at 8pm, 3am, and 8am during sleep studies conducted at the end of each eight-week treatment period.. Of the 37 patients who were randomised, 28 patients had stored frozen samples available for analysis. In comparison to sham treatment, CPAP significantly lowered the NT-pro-BNP level by 0.91 pmol/L (p = 0.0002). The reduction of 0.235 ng/L in hs Trop-T on CPAP therapy was not statistically significant (p = 0.052). There were no overnight changes, across the three time points, in either biomarker with either treatment.. Our study confirms CPAP therapy in patients with moderate-severe OSA reduces NT-pro-BNP, but we did not confirm a significant effect on hs Trop-T. Future larger studies of longer duration incorporating biomarkers and cardiac functional measures are needed to better establish the benefit of OSA treatment.

Topics: Biomarkers; Continuous Positive Airway Pressure; Coronary Artery Disease; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Polysomnography; Sleep Apnea, Obstructive; Troponin T

Recent studies have suggested a strong association between obstructive sleep apnoea (OSA) and atrial fibrillation (AF). However, the impact of continuous positive airway pressure (CPAP) therapy on reverse atrial remodelling in patients with OSA is poorly understood. We aimed to determine the impact of CPAP therapy on total atrial conduction time measured by PA tissue Doppler imaging (TDI) interval in patients without history of AF.. Thirty-five patients with first diagnosed OSA (group 1) and 20 reference patients without OSA (group 2) were prospectively enrolled. Group 1 was divided into 25 patients with starting CPAP therapy (intervention group) and 10 patients without CPAP therapy (control group). PA-TDI interval, measured by tissue Doppler imaging, and B-type natriuretic-peptide (BNP) were determined at baseline and repeated after 30 days in group 1. Patients with OSA had a significantly longer PA-TDI interval (131.4±16.0 ms vs. 120.1±6.4 ms, p<0.001) compared to reference patients. PA-TDI interval shortened significantly after 30 days of CPAP therapy (131±17.1 ms vs. 124.6±15.7 ms, p<0.001), whereas no significant change was found in the control group (132.6±13.6 ms vs. 133.2±13.1 ms, p=0.31) and BNP-levels decreased significantly (39.1±50.7 pg/ml vs. 28.2±42.4 pg/ml, p<0.01), while BNP-levels remained unaffected after 30 days in control group (31.5±20 pg/ml vs. 34.4±20.5 pg/ml, p=0.41).. Change in PA-TDI interval, as an indirect surrogate marker of atrial remodelling, suggests reverse atrial remodelling in patients with OSA and treated by CPAP. This effect may ensue from decreased atrial pressure or volume overload, as indicated by significantly reduced BNP levels. These observations suggest that the substrate pre-disposing to AF may be reversible and moreover can be measured by PA-TDI interval and BNP.

Topics: Atrial Fibrillation; Atrial Remodeling; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Prospective Studies; Sleep Apnea, Obstructive

The impact of obstructive sleep apnoea on heart failure with preserved ejection fraction is unknown.. Fifty-eight patients who had heart failure with a left ventricular ejection fraction; ≥50% underwent a sleep study. Brain natriuretic peptide (BNP) levels were determined at enrolment and at one, six, 12 and 36 months after enrolment.. Obstructive sleep apnoea was found in 39 patients (67%), and they were all subsequently treated with continuous positive airway pressure. Echocardiography at admission showed that E/E' tended to be higher in the 39 patients with, than in the 19 patients without, obstructive sleep apnoea (15.0±3.6 vs 12.1±1.9, respectively, P=0.05). The median BNP levels at enrolment were similar in patients with and without obstructive sleep apnoea [median (interquartile range): 444 (233-752) vs 316 (218-703) pg/ml]. Although BNP levels decreased over time in both groups, the reduction was less pronounced in patients with obstructive sleep apnoea (P<0.05). Consequently, BNP levels were higher in patients with sleep apnoea at six months, [221 (137-324) vs 76 (38-96) pg/ml, P<0.05], 12 months [123 (98-197) vs 52 (38-76) pg/ml, P<0.05] and 36 months [115 (64-174) vs 56 (25-74) pg/ml, P<0.05].. Obstructive sleep apnoea, even when treated appropriately, may worsen long-term cardiac function and outcomes in patients who have heart failure with preserved ejection fraction.

Topics: Aged; Aged, 80 and over; Echocardiography; Heart Failure; Humans; Middle Aged; Natriuretic Peptide, Brain; Sleep Apnea, Obstructive; Stroke Volume

Obesity is a major risk factor for obstructive sleep apnea, impaired pulmonary function and heart failure, but obesity is also associated with paradoxically low levels of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP). In subjects with severe obesity undergoing weight loss treatment, we assessed the associations between changes in severity of obstructive sleep apnea, pulmonary function and serum NT-proBNP levels.. One-year non-randomized controlled clinical trial. Participants, 69.6 % women, mean (SD) age 44.6 (10.8) years and body mass index (BMI) 45.1 (5.6) kg/m(2), underwent gastric bypass surgery (n = 76) or intensive lifestyle intervention (n = 63), resulting in 30 (8) % and 8 (9) % weight loss, respectively. The reference group included 30 normal weight, healthy, gender and age matched controls. Sleep recordings, arterial blood gases, pulmonary function and blood tests were assessed before and 1 year after the interventions.. NT-proBNP concentrations increased significantly more after surgery than after lifestyle intervention. The post intervention values in both groups were significantly higher than in a normal weight healthy reference group. In the whole study population changes (∆) in NT-proBNP correlated significantly with changes in both BMI (r = -0.213) and apnea hypopnea index (AHI, r = -0.354). ∆NT-proBNP was, independent of age, gender and ∆BMI, associated with ∆AHI (beta -0.216, p = 0.021). ∆AHI was, independent of ∆BMI, significantly associated with changes in pO2 (beta -0.204), pCO2 (beta 0.199), forced vital capacity (beta -0.168) and forced expiratory volume first second (beta -0.160).. Gastric bypass surgery was associated with a greater increase in NT-proBNP concentrations than non-surgical weight loss treatment. Reduced AHI was, independent of weight loss, associated with increased NT-proBNP levels and improved dynamic lung volumes and daytime blood gases. Clinical Trial Registration ClinicalTrials.gov NCT00273104, retrospectively registered Jan 5, 2006 (study start Dec 2005).

Topics: Adult; Body Mass Index; Female; Gastric Bypass; Humans; Life Style; Lung; Male; Natriuretic Peptide, Brain; Peptide Fragments; Respiratory Function Tests; Sleep Apnea, Obstructive; Weight Loss

Diastolic dysfunction is common in patients with coronary artery disease (CAD). We hypothesize that patients with CAD and preserved left ventricular ejection fraction (LVEF) and obstructive sleep apnea (OSA) will have worse diastolic function than similar patients without OSA.. We analyzed sleep-study recordings and echocardiographic measurements obtained at baseline in a randomized controlled trial (RICCADSA) of revascularized patients with CAD who had LVEF of at least 50%. OSA was defined as an apnea-hypopnea-index (AHI) ≥15 events/h, and, no OSA, as an AHI <5. Worse diastolic function was defined as assumed elevated left ventricular filling pressure based on peak flow velocity in early diastole/Tissue Doppler of early diastolic ventricular filling (E/é) of >13 (or >9 in patients with an enlarged left atrial diameter [≥39 mm for women and ≥40 mm for men]).. Data from 431 patients were evaluated (mean age: 63.7 ± 8.8 y; men: 82.5%; OSA: n = 331). Worse diastolic function was more common among the patients with OSA than those without (54.4% vs 41.0%, p = 0.019). In multivariate analysis, OSA was associated with worse diastolic function (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.13; 3.18) adjusted for female sex (OR 2.28, 95% CI 1.28; 4.07), hypertension (OR 1.84, 95% CI 1.20; 2.82), and diabetes mellitus (OR 2.45, 95% CI 1.42; 4.23). Age ≥60 years, obesity, and current smoking were nonsignificant.. In this cohort with CAD and preserved LVEF, OSA was associated with worse diastolic function independent of the traditionally recognized risk indicators.

Topics: Aged; Continuous Positive Airway Pressure; Coronary Artery Disease; Cross-Sectional Studies; Diastole; Female; Humans; Male; Middle Aged; Myocardial Revascularization; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Sleep Apnea, Obstructive; Stroke Volume; Ventricular Function, Left

The aim of this study was to investigate the effects of a noninvasive positive pressure ventilation therapy on cardiac structure and function in patients with coronary heart disease combined with obstructive sleep apnea/hypopnea syndrome (OSAHS).. Eighty patients with coronary heart disease OSAHS were divided randomly into treatment (n=40) and control (n=40) groups. Both groups received standard medications. The treatment group received additional noninvasive mechanical ventilation support for at least 3 h (3-6 h) every night. On the first day after selection and 3 months afterwards, participants were examined with echocardiograms, 24-h ambulatory blood pressure monitoring, and blood analyses. Primary endpoints were left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left ventricular ejection fraction, left atrial diameter as well as serum concentrations of N-terminal prohormone of brain natriuretic peptide, and high-sensitive C-reactive protein. Secondary endpoints included cardiac death, nonfatal myocardial infarction, and hospitalization.. After the 3-month study period, patients in the treatment group showed significantly improved left ventricular end-diastolic diameter (P=0.02), left ventricular end-systolic diameter (P=0.035), left ventricular ejection fraction (P=0.05), and left atrial diameter (P=0.02) values, and their serum N-terminal prohormone of brain natriuretic peptide (P=0.01) and high-sensitive C-reactive protein (P=0.04) concentrations were significantly improved compared with the control group. During the 3 months, three cardiovascular complications occurred in the treatment group versus nine in the control group (P<0.05).. For patients with coronary heart disease combined with OSAHS, noninvasive mechanical ventilation therapy can significantly improve heart functions and reduce the occurrence of cardiovascular complications.

Topics: Aged; Atrial Remodeling; Biomarkers; C-Reactive Protein; Cardiovascular Agents; China; Combined Modality Therapy; Coronary Artery Disease; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Noninvasive Ventilation; Peptide Fragments; Positive-Pressure Respiration; Prospective Studies; Recovery of Function; Sleep Apnea, Obstructive; Stroke Volume; Time Factors; Treatment Outcome; Ventricular Function, Left

Heart failure (HF) is a major public health problem associated with high rates of morbidity and mortality. Patients with HF exhibit a high prevalence of sleep-disordered breathing (SDB). We have investigated the long-term impact of positive airway pressure (PAP) therapy on heart function and clinical outcomes in patients with advanced HF and concomitant SDB.. We assessed 18 patients with advanced HF (New York Heart Association (NYHA) functional classification III-IV) and concomitant SDB (diagnosed with polysomnography) either of obstructive or central type. Eleven patients who received PAP therapy (auto-titrating PAP or adaptive servo-ventilation) for 12 months were compared with seven patients who refused this therapy. All participants were assessed at both baseline and end of follow-up for NYHA functional status, left and right ventricular function, neurohormonal activation, and exercise tolerance. The rates of hospitalization, deaths, and the combination of both were also recorded.. Patients treated with PAP achieved better functional status, higher left ventricular ejection fraction, improved longitudinal right ventricular contractile function, lower levels of b-type natriuretic peptide, and greater exercise performance compared to those who remained untreated. PAP-treated group had a significantly lower incidence of the prespecified combined end-point (i.e., hospital admissions and death) than the control group (87.5 vs. 18.2%, p = 0.013). Interestingly, the mortality rate was 28% (two out of seven patients) in the control group, while no deaths were recorded in the PAP-treated group.. In this preliminary study, we found that treatment of SDB, irrespective of type, in stable patients with advanced HF receiving optimal medical therapy was associated with improvement in cardiac functional status, ventricular contraction, physical performance, and neurohormonal status, leading to better clinical outcomes.

Topics: Aged; Comorbidity; Continuous Positive Airway Pressure; Equipment Design; Exercise Tolerance; Female; Follow-Up Studies; Heart Failure; Hemodynamics; Humans; Male; Middle Aged; Myocardial Contraction; Natriuretic Peptide, Brain; Prospective Studies; Sleep Apnea, Central; Sleep Apnea, Obstructive; Stroke Volume; Ventricular Function, Left; Ventricular Function, Right

In patients without cardiac disease, obstructive sleep apnea-hypopnea syndrome (OSAHS) is associated with systolic and diastolic dysfunction and left ventricular hypertrophy. Although continuous positive airway pressure (CPAP) therapy has been demonstrated to improve left ventricular structure and function in these patients, the effects of oral-appliance therapy on cardiac function are largely unknown. The aims of this study were to determine the left ventricular structure and function and natriuretic peptides in untreated OSAHS patients without cardiovascular disease, and to compare the effects of oral-appliance with CPAP therapy.. In 28 moderate to severe OSAHS patients echocardiography and measurements of concentrations of the amino-terminal fragment of pro-brain natriuretic peptide (NT-pro-BNP) were performed. Fifteen patients were randomized to oral-appliance and 13 to CPAP therapy. After 2 to 3 months of treatment echocardiography and NT-pro-BNP measurements were repeated.. Of the 28 patients, 7 had left ventricular hypertrophy, 6 had left ventricular dilatation, and 3 had elevated NT-pro-BNP values. No significant improvements in echocardiographic outcomes were observed following treatment. The median NT-pro-BNP values improved significantly following oral-appliance therapy (52 pg/ml to 22 pg/ml) whereas not following CPAP therapy (31 pg/ml to 37 pg/ml).. This study demonstrates that 50% of patients with moderate to severe OSASH, without cardiovascular disease, have left ventricular hypertrophy, left ventricular dilatation or elevated natriuretic peptides. Significant changes in NT-pro-BNP values indicate an improvement of cardiac function following effective oral-appliance therapy.

Topics: Cardiovascular Diseases; Continuous Positive Airway Pressure; Echocardiography; Female; Humans; Hypertrophy, Left Ventricular; Male; Mandibular Advancement; Middle Aged; Natriuretic Peptide, Brain; Orthodontic Appliances, Removable; Peptide Fragments; Polysomnography; Sleep Apnea, Obstructive; Ventricular Dysfunction, Left; Ventricular Function, Left

The aim of this study was to evaluate the impact of obstructive sleep apnea syndrome (OSAS) on B-type natriuretic peptide (BNP) and to determine the effect of nasal continuous positive airway pressure (nCPAP) treatment on BNP levels.. Increased sympathetic activity, repetitive rises in blood pressure, and apnea-induced wall stress may contribute as a trigger to release BNP in OSAS. However, there is uncertainty about whether OSAS affects BNP and whether application of nasal continuous positive airway pressure (nCPAP) ventilation affects release of BNP.. A prospective study in 69 consecutive patients with suspected sleep disordered breathing referred to our sleep laboratory was conducted. OSAS was confirmed in 26 normotensive and 34 hypertensive patients and ruled out in nine normotensive patients (controls) by polysomnography (PSG).. Baseline N-terminal fragment of BNP prohormone (NT-pro-BNP) did not differ significantly between OSAS patients (hypertensive: mean +/-SEM 60.8+/-9.9 pg/ml, normotensive: 43.2+/-6.8 pg/ml) and controls (36.5+/-8.5 pg/ml). Application of CPAP resulted in a significant decrease of NT-pro-BNP in hypertensive (60.8+/-9.9 pg/ml to 47.6+/-7.4 pg/ml, p=0.023) and normotensive OSAS (43.2+/-6.8 pg/ml to 29.6+/-5.3 pg/ml, p=0.0002). In contrast, controls showed no significant differences in NT-pro-BNP after a second PSG (36.5+/-8.5 pg/ml to 40.7+/-12.3 pg/ml, p=0.597).. Normotensive and hypertensive OSAS was not associated with a significant elevation of NT-pro-BNP. Application of nCPAP decreased NT-pro-BNP levels significantly in normotensive and, in particular, hypertensive OSAS. These findings may provide further evidence of the potential for nCPAP to improve cardiovascular comorbidity and co-mortality in OSAS and sleep disordered breathing, in general.

Topics: Continuous Positive Airway Pressure; Female; Humans; Hypertension; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies; Sleep Apnea, Obstructive; Treatment Outcome

Obstructive sleep apnoea (OSA) is associated with oxygen desaturation, blood pressure increase, and neurohumoral activation, resulting in possible detrimental effects on the cardiovascular system. Continuous positive airway pressure (CPAP) is the therapy of choice for OSA. In a recent study, nocturnal atrial overdrive pacing (pacing) reduced the severity of sleep apnoea in pacemaker patients. We compared the effects of CPAP with those of pacing in patients with OSA but without pacemaker indication or clinical signs of heart failure.. Ten patients with OSA on CPAP therapy were studied for three nights by polysomnography. During the nights that followed a night without any treatment (baseline), the patients were treated with CPAP or pacing in a random order. Pacing was performed with a temporary pacing lead. The pacing frequency was 15 b.p.m. higher than the baseline heart rate. The apnoea-hypopnoea index was 41.0 h(-1) (12.0-66.6) at baseline and was significantly lower during CPAP [2.2 h(-1) (0.3-12.4)] compared with pacing [39.1 h(-1) (8.2-78.5)]. Furthermore, duration and quality of sleep were significantly improved during CPAP when compared with pacing.. Nocturnal atrial overdrive pacing is no alternative therapeutic strategy to CPAP for the treatment of OSA in patients without clinical signs of heart failure and without conventional indication for anti-bradycardia pacing.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cardiac Pacing, Artificial; Continuous Positive Airway Pressure; Cross-Over Studies; Electrocardiography, Ambulatory; Female; Heart Rate; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Norepinephrine; Peptide Fragments; Polysomnography; Sleep Apnea, Obstructive

BNP elevation in patients with AF is observed in the absence of heart failure; however, prior mechanistic studies have not included direct left atrial pressure measurements. This study sought to understand how emptying function of the left atrial appendage (LAA) and LAA dimension contributes to brain-natriuretic peptide elevations (BNP) in atrial fibrillation (AF) accounting for left atrial pressure (LAP).. 132 patients referredfor left atrial appendage occlusion (LAAO) were prospectively enrolled in this study. BNP levels and LAP were measured just before LAAO. Statistical analysis considered BNP, rhythm at time of procedure, LAP, LAA morphology, LAA size (ostial diameter, depth, volume), LAA emptying velocity, CHADS2-VASc score, body mass index (BMI), left ventricular ejection fraction (LVEF), estimated glomerular filtration rate (eGFR), and obstructive sleep apnea (OSA) diagnosis as covariates.. Bivariate statistical analysis demonstrated positive associations with age, LAA ostial diameter, depth, and volume, LAP, AF status at time of measurement, OSA, and CHADS2-VASc score. BNP was negatively associated with LVEF, eGFR, LAA emptying velocity and BMI. With multivariate logistic regression including LAP as covariate, significant relationships between BNP and AF/AFL(OR 1.99 [1.03, 3.85]), LAP (OR 1.13 [1.06, 1.20]), LAA diameter (OR 1.14 [1.03, 1.27]), LAA depth (OR 1.14 [1.07, 1.22]), and LAA emptying velocity (OR 0.97 [0.96,0.99]) were observed; however, no significant associations were seen with LAA morphology or CHADS2-VASc score.. BNP elevations in AF are associated with LAA size and function, but not CHADS2-VASc score or appendage morphology after accounting for changes in LAP.

Topics: Atrial Appendage; Atrial Fibrillation; Echocardiography, Transesophageal; Humans; Natriuretic Peptide, Brain; Sleep Apnea, Obstructive; Stroke Volume; Ventricular Function, Left

Aim      To study the role of soluble ST2 (sST2), N-terminal pro-brain natriuretic peptide (NT-proBNP), and С-reactive protein (CRP) in patients with chronic heart failure and preserved left ventricular ejection fraction (CHF with pLVEF) and syndrome of obstructive sleep apnea (SOSA) in stratification of the risk for development of cardiovascular complications (CVC) during one month of a prospective observation.Material and methods  The study included 71 men with SOSA with an apnea/hypopnea index (AHI) >15 per hour, abdominal obesity, and arterial hypertension. Polysomnographic study and echocardiography according to a standard protocol with additional evaluation of left ventricular myocardial fractional changes and work index were performed for all patients at baseline and after 12 months of observation. Serum concentrations of sST2 , NT-proBNP, and CRP were measured at baseline by enzyme-linked immunoassay (ELISA).Results The ROC analysis showed that the cutoff point characterizing the development of CVC were sST2 concentrations ≥29.67 ng/l (area under the curve, AUC, 0.773, sensitivity 65.71 %, specificity 86.11 %; p<0.0001) while concentrations of NT-proBNP (AUC 0.619; p=0.081) and CRP (AUC 0.511; р=0.869) were not prognostic markers for the risk of CVC. According to data of the ROC analysis, all patients were divided into 2 groups based on the sST2 cutoff point: group 1 included 29 patients with ST2 ≥29.67 ng/l and group 2 included 42 patients with ST2 <29.67 ng/l. The Kaplan-Meyer analysis showed that the incidence of CVC was higher in group 1 than in group 2 (79.3 and 28.6 %, respectively, p<0.001). The regression analysis showed that adding values of AHI and left ventricular myocardial mass index (LVMMI) to sST2 in the model increased the analysis predictive significance.Conclusion      Measuring sST2 concentration may be used as a noninvasive marker for assessment of the risk of CVC development in patients with CHF with pLVEF and SOSA within 12 months of observation. Adding AHI and LVMMI values to the model increases the predictive significance of the analysis.

Topics: Biomarkers; Heart Failure; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Prospective Studies; Sleep Apnea, Obstructive; Stroke Volume; Ventricular Function, Left

Topics: Aged; Blood Gas Analysis; Cardiac Catheterization; Female; Guideline Adherence; Humans; Hypertension, Pulmonary; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Polysomnography; Prospective Studies; Sleep Apnea, Obstructive; Unnecessary Procedures; Walk Test

Natriuretic peptides have been identified as biomarkers of increased myocardial wall stress in the context of obstructive sleep apnea (OSA) in the general population. However, the relationship between N-terminal pro B-type natriuretic peptide (NT-proBNP) and OSA remains unclear in patients with coronary artery disease (CAD). Hence, we aimed to investigate the clinical value of NT-proBNP in evaluating OSA in a large population of patients with CAD.. Consecutive patients with CAD were prospectively enrolled between February 2015 and March 2018. Portable respiratory monitoring was applied to facilitate the diagnosis of sleep apnea. Patients were as assigned to the non-OSA (when the respiratory events index [REI] or 3% oxygen desaturation index [ODI] < 15 events/h) and OSA (when the REI or 3% ODI ≥ 15 events/h) groups. Multivariate analyses were used to explore the independent association between NT-proBNP levels and OSA.. A total of 1,292 consecutive patients were included with a mean NT-proBNP value of 826.57 μg/L. Patients with high levels of NT-proBNP experienced increasing severity of OSA in those with CAD (P = .0004). Univariate analysis demonstrated that NT-proBNP was a risk factor for OSA (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.03-1.18, P = .005). In addition, multivariate analysis revealed that NT-proBNP was independently associated with the presence of OSA (OR 1.11, 95% CI 1.02-1.20, P = .012) even after adjusting for other cofounding factors.. Elevated levels of NT-proBNP were independently associated with a higher likelihood of OSA in patients with CAD. Periodically screening for NT-proBNP levels may provide early identification of OSA.

Topics: Biomarkers; China; Coronary Artery Disease; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies; Sleep Apnea, Obstructive

Marfan syndrome (MFS) is an inherited connective tissue disorder characterized by ectopia lentis, aortic root dilation and dissection and specific skeletal features. Obstructive sleep apnea (OSA) in MFS has been described earlier but the prevalence and its relation with the cardiovascular risk is still controversial. This study aimed to further investigate these aspects.. In this prospective longitudinal study, we performed an attended polysomnography in 40 MFS patients (60% women, 37 ± 12.8 years) and evaluated several cardiovascular parameters through echocardiography, resting electrocardiogram, 24 hr-Holter monitoring and serum NT-ProBNP measurements.. We found that OSA was present in 42.5% of the patients and that higher body mass index was the most important factor associated with the presence of OSA. We observed that overweight was present in 27.5% of the patients in the whole cohort and in 55.6% if >40 years. Furthermore, when evaluating the impact of OSA on the cardiovascular system, we observed that patients with OSA tended to have higher systolic blood pressure, larger distal aortic diameters and a higher prevalence of ventricular arrhythmia. These differences were, however, not significant after adjusting for confounders.. Our study shows a high prevalence of OSA and a high prevalence of overweight in MFS patients. We found some trends between OSA and cardiovascular features but we could not establish a solid association. Our study, however might be underpowered, and a multicenter collaborative study could be very useful to answer some important open questions.

Topics: Adult; Aortic Aneurysm; Aortic Dissection; Arrhythmias, Cardiac; Blood Pressure; Body Mass Index; Cardiovascular Diseases; Electrocardiography; Female; Fibrillin-1; Genetic Association Studies; Humans; Male; Marfan Syndrome; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Polysomnography; Prevalence; Prospective Studies; Risk Factors; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Young Adult

Obstructive sleep apnea (OSA) and left ventricular (LV) hypertrophy are considered to be closely associated. However, the relationship has not yet been fully demonstrated and is hence still controversial. The purpose of this study was to assess in hypertensive male patients the relationship between OSA and cardiac structure using a new index, namely, integrated area of desaturation (IAD), in addition to the apnea-hypopnea index (AHI) that is currently the most frequently used index of sleep-disordered breathing.. In our cross-sectional study, 223 hypertensive men younger than 65 years with sleep apnea and normal cardiac function were enrolled. All subjects were evaluated by fully attended polysomnography. Cardiac structure and function were evaluated by echocardiography.. LV mass index significantly correlated with IAD (r = 0.203, P < 0.05), but not with AHI. Multivariate linear regression analyses showed that IAD, brain natriuretic peptide (BNP), and age are independent variables affecting the LV mass index (β = 0.262, 0.237, and 0.173, respectively, P < 0.05). IAD was the one and only determinant among the indices of sleep-disordered breathing.. Nocturnal intermittent hypoxia defined by IAD may be associated with LV hypertrophy in men with well-controlled hypertension and obstructive sleep apnea.

Topics: Adult; Age Factors; Cross-Sectional Studies; Echocardiography; Humans; Hypertension; Hypertrophy, Left Ventricular; Hypoxia; Linear Models; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Sleep Apnea, Obstructive

Topics: Continuous Positive Airway Pressure; Heart Failure; Humans; Natriuretic Peptide, Brain; Polysomnography; Sleep Apnea Syndromes; Sleep Apnea, Obstructive

Insulin resistance, glucose dyshomeostasis and oxidative stress are associated to the cardiovascular consequences of obstructive sleep apnea (OSA). The effects of a long-term continuous positive airway pressure (LT-CPAP) treatment on such mechanisms still remain conflicting.. To investigate the effect of LT-CPAP on glucose tolerance, insulin sensitivity, oxidative stress and cardiovascular biomarkers in non-obese non-diabetic OSA patients.. Twenty-eight apneic, otherwise healthy, men suffering from OSA (mean age = 48.9 ± 9.4 years; apnea-hypopnea index = 41.1 ± 16.1 events/h; BMI = 26.6 ± 2.8 kg/m(2); fasting glucose = 4.98 ± 0.37 mmol/L) were evaluated before and after LT-CPAP by an oral glucose tolerance test (OGTT), measuring plasma glucose, insulin and proinsulin. Glycated hemoglobin, homeostasis model assessment resistance insulin, blood lipids, oxidative stress, homocysteine and NT-pro-brain natriuretic peptide (NT-proBNP) were also measured.. LT-CPAP treatment lasted 13.9 ± 6.5 months. At baseline, the time spent at SaO2<90%, minimal and mean SaO2 were associated with insulin area under the curve during OGTT (r = 0.448, P = 0.011; r = -0.382; P = 0.047 and r = -0.424; P = 0.028, respectively) and most other glucose/insulin homeostasis biomarkers, as well as with homocysteine (r = 0.531, P = 0.006; r = -0.487; P = 0.011 and r = -0.409; P = 0.034, respectively). LT-CPAP had no effect on all the OGTT-related measurements, but increased plasma total antioxidant status (+7.74%; P = 0.035) in a duration-dependent manner (r = 0.607; P < 0.001), and decreased both homocysteine (-15.2%; P = 0.002) and NT-proBNP levels (-39.3%; P = 0.002).. In non-obese non-diabetic OSA patients, nocturnal oxygen desaturation is strongly associated to insulin resistance. LT-CPAP does not improve glucose homeostasis nor insulin sensitivity but has a favorable effect on antioxidant capacity and cardiovascular risk biomarkers.

Topics: Adult; Biomarkers; Blood Glucose; Cardiovascular Diseases; Carotid Intima-Media Thickness; Case-Control Studies; Cholesterol; Cholesterol, HDL; Cholesterol, LDL; Continuous Positive Airway Pressure; Glucose Tolerance Test; Glycated Hemoglobin; Homocysteine; Humans; Insulin; Insulin Resistance; Male; Middle Aged; Natriuretic Peptide, Brain; Oxidative Stress; Peptide Fragments; Polysomnography; Proinsulin; Risk Factors; Sleep Apnea, Obstructive; Treatment Outcome; Triglycerides

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is associated with cardiovascular morbidity and mortality, which can be improved by using continuous positive airway pressure (CPAP) therapy. However, the pathophysiological links between the two kinds of disease and the mechanism of the CPAP effect remain incompletely understood. We aimed to inquire into the myocardial involvement in this relationship. We suggested that serum brain natriuretic peptide (BNP) is sensitive enough to detect myocardial stress caused by OSAHS.. Sixty-four subjects without cardiovascular disease (21 controls, 24 normotensive OSAHS patients, and 19 hypertensive OSAHS patients) were analyzed for serum BNP at baseline and serially over 6 months. CPAP was applied to 23 patients with severe OSAHS.. At baseline, the serum BNP levels were significantly higher (p=0.0001) in the OSAHS group (22.3±14.79 pg/ml) than in the control group (9.2±6.75 pg/ml). Increased serum BNP levels were significantly associated with mean transcutaneous oxygen saturation (SpO2) (p<0.0001), minimal SpO2 (p=0.002), oxygen desaturation index (p=0.001), and total sleep time spent with SpO2 lower than 90% (p=0.002). All patients with elevated BNP levels (≥37 pg/ml) had moderate or severe OSAHS (11/43 OSAHS patients). The more severe the OSAHS, the higher the BNP levels were. However, only the difference between severe and mild OSAHS was statistically significant (p=0.029). Hypertensive OSAHS patients had the highest baseline BNP levels (27.7±16.74 pg/ml). They were significantly higher (p=0.001) than in normotensive OSAHS patients (18±11.72 pg/ml) (p=0.039) and the controls (9.2±6.75 pg/ml). As compared with baseline, treatment with CPAP significantly decreased BNP levels in both hypertensive and normotensive OSAHS patients (respectively, from 36±16.10 to 29.7±14.29 pg/ml, p<0.001, and from 20±10.09 to 16±8.98 pg/ml, p<0.001). In contrast, the BNP levels slightly increased in the controls (from 9.2±6.75 to 9.5±7.02 pg/ml, p=0.029), but there was no statistically significant difference in comparison with the baseline value. The effect of CPAP on BNP levels was more marked in patients with higher baseline BNP levels and those with the most prolonged nocturnal desaturation (p=0.001, r=0.65). It was also more marked in hypertensive OSHAS patients (p=0.015, r=0.72) in comparison with normotensive OSAHS patients (p=0.03, r=0.62).. BNP seems to be sensitive enough to detect myocardial stress caused by OSAHS. As such, it is a potential marker for screening of preclinical cardiovascular damage in patients with untreated OSAHS. Application of CPAP decreases levels significantly in normotensive and particularly in hypertensive OSAHS. These findings are consistent with previous results suggesting the potential benefits of CPAP on cardiovascular outcome in OSAHS patients.

Topics: Adult; Cardiovascular Diseases; Continuous Positive Airway Pressure; Cross-Sectional Studies; Early Diagnosis; Female; Humans; Hypertension; Male; Middle Aged; Natriuretic Peptide, Brain; Prospective Studies; Risk Factors; Sleep Apnea, Obstructive

Obstructive sleep apnea (OSA) is characterized by intermittent hypoxia during sleep. We tested the hypothesis that nocturnal myocardial ischemia is detectable by ST segment depression and elevation of high sensitive troponin T (hsTrop T) and B-type natriuretic peptide (NT-proBNP) in patients with OSA and coexisting coronary artery disease (CAD). Twenty-one patients with OSA and CAD and 20 patients with OSA alone underwent in-hospital polysomnography. Blood samples for hsTrop T and NT-proBNP measurements were drawn before and after sleep. ST segment depression was measured at the time of maximum oxygen desaturation during sleep. The apnea-hypopnea-index (AHI), oxygen saturation nadir, and time in bed with oxygen saturation of ≤80% were similar in both groups. Levels of hsTrop T and NT-proBNP did not differ significantly before and after sleep but NT-proBNP levels were significantly higher in patients suffering from OSA and CAD compared to patients with OSA alone. No significant ST depression was found at the time of oxygen saturation nadir in either group. Despite the fact that patients with untreated OSA and coexisting CAD experienced severe nocturnal hypoxemia, we were unable to detect myocardial ischemia or myocyte necrosis based on significant ST segment depression or elevation of hsTrop T and NT-proBNP, respectively.

Topics: Aged; Biomarkers; Coronary Artery Disease; Electrocardiography; Female; Germany; Humans; Male; Middle Aged; Myocardial Ischemia; Natriuretic Peptide, Brain; Peptide Fragments; Polysomnography; Prospective Studies; Sleep Apnea, Obstructive; Troponin T

Obstructive sleep apnea (OSA) is associated with an increased risk of cardiovascular complications. OSA and coronary artery disease (CAD) share the same risk factors and coexist in many patients. In previous studies, repeated nocturnal cardiac ischemic events in OSA patients with CAD have been reported.. We hypothesized that OSA may precipitate myocardial ischemia, evidenced by ST-segment depression and elevated N-terminal brain natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (hs-TropT) levels in patients with severe OSA and concomitant CAD. We also aimed to evaluate if the effects could be reversed by continuous positive airway pressure (CPAP) therapy.. Twenty-one patients with severe OSA (apnea-hypopnea index >15/h, nadir oxygen desaturation ≤ 80%), and coexisting CAD underwent in-hospital polysomnography at baseline and under CPAP. Blood samples for hs-TropT and NT-proBNP measurements were drawn prior and immediately after sleep. ST-segment depression was measured at the time of maximum oxygen desaturation during sleep.. CPAP significantly decreased elevated NT-proBNP levels from 475 ± 654 pg/mL before sleep to 353 ± 573 pg/mL after sleep and attenuated ST-segment depression during sleep. hs-TropT was not elevated and did not differ after nocturnal oxygen desaturation at baseline and after CPAP.. CPAP significantly reduced NT-proBNP in patients suffering from severe OSA and coexisting CAD. Repeated nocturnal myocardial ischemia did not cause myocyte necrosis evidenced by elevated hs-TropT or ST-segment depression.

Topics: Aged; Biomarkers; Continuous Positive Airway Pressure; Coronary Artery Disease; Electrocardiography; Female; Germany; Humans; Male; Middle Aged; Myocardial Ischemia; Natriuretic Peptide, Brain; Peptide Fragments; Polysomnography; Prospective Studies; Sleep Apnea, Obstructive; Troponin T

Topics: Humans; Male; Natriuretic Peptide, Brain; Nocturia; Polyuria; Sleep Apnea, Obstructive; Vasopressins

Risk factors for obstructive sleep apnea (OSA) and the development of subsequent cardiovascular (CV) complications differ by sex. We hypothesize that the relationship between OSA and high-sensitivity troponin T (hs-TnT), cardiac structure, and CV outcomes differs by sex.. Seven hundred fifty-two men and 893 women free of CV disease participating in both the Atherosclerosis Risk in the Communities and the Sleep Heart Health Studies were included. All participants (mean age, 62.5 ± 5.5 years) underwent polysomnography and measurement of hs-TnT. OSA severity was defined by using established clinical categories. Subjects were followed for 13.6 ± 3.2 years for incident coronary disease, heart failure, and CV and all-cause mortality. Surviving subjects underwent echocardiography after 15.2 ± 0.8 years. OSA was independently associated with hs-TnT among women (P=0.03) but not in men (P=0.94). Similarly, OSA was associated with incident heart failure or death in women (P=0.01) but not men (P=0.10). This association was no longer significant after adjusting for hs-TnT (P=0.09). Among surviving participants without an incident CV event, OSA assessed in midlife was independently associated with higher left ventricle mass index only among women (P=0.001).. Sex-specific differences exist in the relationship between OSA and CV disease. OSA, assessed in midlife, is independently associated with higher levels of concomitantly measured hs-TnT among women but not men, in whom other comorbidities associated with OSA may play a more important role. During 13-year follow-up, OSA was associated with incident heart failure or death only among women, and, among those without an incident event, it was independently associated with left ventricular hypertrophy only in women.

Topics: Aged; Biomarkers; C-Reactive Protein; Comorbidity; Coronary Disease; Death Certificates; Female; Follow-Up Studies; Heart Failure; Hospitalization; Humans; Hypertrophy, Left Ventricular; Hypertrophy, Right Ventricular; Male; Middle Aged; Mortality; Natriuretic Peptide, Brain; Peptide Fragments; Polysomnography; Prospective Studies; Severity of Illness Index; Sex Factors; Sleep Apnea, Obstructive; Troponin T; Ultrasonography; United States

We analyzed the outcome of nocturnal enuresis after adenotonsillectomy in children with sleep disordered breathing. We also evaluated differences in demographic, clinical, laboratory and polysomnography parameters between responders and nonresponders after adenotonsillectomy.. We prospectively evaluated children 5 to 18 years old diagnosed with sleep disordered breathing (snoring or obstructive sleep apnea syndrome) on polysomnography and monosymptomatic primary nocturnal enuresis requiring adenotonsillectomy to release upper airway obstruction. Plasma antidiuretic hormone and brain natriuretic peptide were measured preoperatively and 1 month postoperatively.. Sleep studies were done in 46 children and 32 also underwent blood testing preoperatively and postoperatively. Mean ± SD patient age was 8.79 ± 2.41 years and the mean number of wet nights weekly was 6.39 ± 1.26. Polysomnography revealed obstructive sleep apnea syndrome in 71.7% of patients and snoring in 28.3%. After adenotonsillectomy 43.5% of patients became dry. Preoperative polysomnography findings indicated that responders, who were dry, had significantly more arousals and obstructive apnea episodes but fewer awakenings than nonresponders, who were wet. Significant increases in plasma antidiuretic hormone and significant decreases in plasma brain natriuretic peptide were seen in all children with no difference between responders and nonresponders. No difference between the groups was noted in age, gender, race, body mass index, constipation, preoperative number of wet nights weekly or type of sleep disordered breathing.. Nocturnal enuresis resolved after adenotonsillectomy in almost half of the children with sleep disordered breathing. Those who became dry had more frequent arousal episodes caused by apnea events than those who remained wet.

Topics: Adolescent; Child; Child, Preschool; Comorbidity; Female; Humans; Hypertrophy; Male; Natriuretic Peptide, Brain; Nocturnal Enuresis; Palatine Tonsil; Polysomnography; Prospective Studies; Sleep Apnea, Obstructive; Snoring; Tonsillectomy; Vasopressins

Topics: Cardiomyopathies; Female; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Sleep Apnea, Obstructive; Troponin T

Topics: Cardiomyopathies; Female; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Sleep Apnea, Obstructive; Troponin T

Topics: Cardiomyopathies; Female; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Sleep Apnea, Obstructive; Troponin T

To investigate the impact of obstructive sleep apnea syndrome (OSAS) on night-time secretion of brain natriuretic peptide (BNP) and antidiuretic hormone (ADH) in older men with nocturia accompanied by nocturnal polyuria.. One hundred six men with nocturia aged ≥ 60 years underwent full-night polysomnography to determine whether they had OSAS. Blood count, standard chemistry panel, BNP, urinary ADH, urinary creatinine (u-Cre), and urinary osmolarity were measured at 6:00 AM, and a frequency volume chart was recorded on the same day that polysomnography was performed.. We evaluated 83 patients after excluding 18 with mild OSAS and 5 with nocturnal polyuria index <0.35. Participants with OSAS had higher apnea-hypopnea index (P < .0001) than those without OSAS. Body mass index and systolic blood pressure were higher in OSAS patients than those in the control group. BNP was higher in the OSAS patients than in the control patients (48.6 ± 41.4 vs 30.7 ± 31.5; P = .0006). On urinalysis, OSAS patients showed higher urinary sodium and u-Cre secretion than controls (24.7 ± 11.3 vs 16.2 ± 5.1; P <.0001). Urine osmolarity was also higher in OSAS patients than in the control patients (616 ± 172 vs 516 ± 174; P = .0285). There was no significant difference in urinary ADH and u-Cre (6.7 ± 10.4 vs 6.8 ± 7.8; P = .3617) between the 2 groups.. Our results indicated that older men with nocturnal polyuria and OSAS did not compensate their fluid imbalance presented with decreased secretion of ADH but increased BNP level.

Topics: Aged; Aged, 80 and over; Circadian Rhythm; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Nocturia; Polyuria; Sleep Apnea, Obstructive; Vasopressins

Topics: Humans; Male; Natriuretic Peptide, Brain; Nocturia; Polyuria; Sleep Apnea, Obstructive; Vasopressins

Topics: Humans; Male; Natriuretic Peptide, Brain; Nocturia; Polyuria; Sleep Apnea, Obstructive; Vasopressins

Right cardiac pathologies develop in patients with obstructive sleep apnea syndrome (OSAS) and in most patients there are no symptoms in the early stages of right cardiac disorders. We aimed to evaluate a possible relationship between B-type natriuretic peptide (BNP), blood uric acid, C-reactive protein (CRP), and the right cardiac pathologies in patients with OSAS, and the role of these parameters in the management of patients with OSAS.. A total of 98 subjects, 31 (31.6%) controls and 67 (68.4%) with OSAS, were included in the study. All the subjects underwent polysomnography, and standard and tissue Doppler echocardiography (ECHO) examinations. BNP, CRP, and blood uric acid levels were measured in all patients.. Upon evaluating the relationship between BNP and ECHO parameters, BNP levels were found to positively correlate with such ECHO parameters as pulmonary artery pressure. As for the association between CRP and ECHO findings, RV diameter exhibited a statistically significant positive correlation with them. Moreover, uric acid was found to statistically correlate positively with right atrium dimensions.. BNP, CRP, and blood uric acid levels can be used as adjunctive parameters in the early diagnosis and follow-up of right heart pathologies in patients with OSAS.

Topics: Adult; Comorbidity; Echocardiography, Doppler; Female; Heart Diseases; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; ROC Curve; Sensitivity and Specificity; Sleep Apnea, Obstructive; Uric Acid

Sleep disordered breathing (SDB) has important clinical implications in patients with congestive heart failure (CHF). We performed portable recording in unselected CHF patients on contemporary therapy. Data on the interactions of SDB in patients supervised at heart failure clinics are rare and we illustrate diversities of obstructive sleep apnoea (OSA) and central sleep apnoea (CSA).. We studied 176 consecutive subjects on contemporary medical therapy with a median left ventricular ejection fraction of 25.0 % (range 7-35%) and median NT-pro BNP levels of 3,413.0 pg/ml (range 305.1-35,000.0 pg/ml). Participants underwent prospective overnight portable recording.. 50% presented with an at least moderate form of nocturnal breathing disorder [apnoea-hypopnoea index (AHI) ≥15/h]. Only 15 patients (17.1%) with AHI ≥15/h reported excessive daytime sleepiness. Irrespective of left ventricular ejection fraction, patients with CSA had higher levels of NT-pro BNP compared to patients with OSA (differences in medians = 2,639.0 pg/ml, p = 0.016), and compared to patients with an AHI <15/h (differences in medians = 2,710.0 pg/ml, p < 0.001). OSA affected 26 patients (14.8%).. Patients with severe stable CHF on contemporary therapy have a prevalence of 50.0% of moderate to severe SDB. The natural cascade of the failing heart is initially characterised by absent SDB or OSA, whereas end-stage CHF is associated with CSA.

Topics: Adult; Aged; Aged, 80 and over; Disorders of Excessive Somnolence; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prevalence; Prospective Studies; Severity of Illness Index; Sleep Apnea Syndromes; Sleep Apnea, Central; Sleep Apnea, Obstructive; Ventricular Function, Left

Obstructive sleep apnea (OSA) is associated with cardiovascular morbidity and mortality, although the underlying mechanisms are not well understood.. We aimed to determine whether more severe OSA, measured by the Respiratory Disturbance Index (RDI), is associated with subclinical myocardial injury and increased myocardial wall stress.. A total of 1,645 participants (62.5 ± 5.5 yr and 54% women) free of coronary heart disease and heart failure and participating in both the Atherosclerosis Risk in the Communities and the Sleep Heart Health Studies underwent overnight polysomnography and measurement of high-sensitivity troponin T (hs-TnT) and N-terminal pro B-type natriuretic peptide (NT-proBNP).. OSA severity was defined using conventional clinical categories: none (RDI ≤ 5), mild (RDI 5-15), moderate (RDI 15-30), and severe (RDI > 30). Hs-TnT, but not NT-proBNP, was associated with OSA after adjusting for 17 potential confounders (P = 0.02). Over a median of 12.4 (interquartile range, 11.6-13.1) years follow-up, hs-TnT was related to risk of death or incident heart failure in all OSA categories (P ≤ 0.05 in each category).. In middle-aged to older individuals, OSA severity is independently associated with higher levels of hs-TnT, suggesting that subclinical myocardial injury may play a role in the association between OSA and risk of heart failure. OSA was not associated with NT-proBNP levels after adjusting for multiple possible confounders.

Topics: Aged; Asymptomatic Diseases; Biomarkers; Cardiomyopathies; Cross-Sectional Studies; Female; Humans; Linear Models; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Polysomnography; Proportional Hazards Models; Risk Factors; Severity of Illness Index; Sleep Apnea, Obstructive; Troponin T

Topics: Cardiomyopathies; Female; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Sleep Apnea, Obstructive; Troponin T

This study investigated the effect of heart failure on respiratory patterns in patients with obstructive sleep apnoea (OSA). 39 patients with established OSA (apnoea/hypopnoea index (AHI) >10 events·h(-1)) and either with heart failure (New York Heart Association (NYHA) class II and III, left ventricular-ejection fraction (LVEF) ≤40%; n=26, age mean ± SD 67 ± 9 years) or without heart failure (LVEF ≥50%, N-terminal pro-brain naturic peptide <400 pg·mL(-1); n=13, age 73 ± 6 years) underwent simultaneous right- and left-heart catheterisation within 12 h of cardiorespiratory polygraphy recording. Respiratory patterns of OSA were significantly longer in OSA patients with heart failure versus without heart failure, including mean ± SD cycle length (46.0 ± 10.0 versus 37.8 ± 10.6 s; p=0.024), ventilation length (25.4 ± 6.3 versus 21.3 ± 7.1 s; p=0.044), apnoea length (20.5 ± 4.9 versus 16.5 ± 3.9 s; p=0.013), time-to-peak ventilation (10.6 ± 3.0 versus 8.3 ± 2.5 sc; p=0.021) and circulatory delay (28.5 ± 7.5 versus 22.6 ± 3.7 s; p=0.005). Positive and robust correlations were found between some of these parameters and the degree of congestion in heart failure: cycle length (r=0.53; p=0.006), ventilation length (r=0.55; p=0.004) and time-to-peak ventilation (r=0.47; p=0.015) all increased with a rise in pulmonary capillary wedge pressure. Respiratory patterns in OSA appear to be dependent on cardiac function, with an increase in event lengths as cardiac function decreases. In patients with heart failure, some of these events correlate with the degree of pulmonary congestion.

Topics: Aged; Cardiac Catheterization; Female; Heart Failure; Hemodynamics; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Polysomnography; Respiration; Risk Factors; Sex Factors; Sleep Apnea, Obstructive; Ventricular Function, Left

Obstructive sleep apnea (OSA) is associated with an increased risk of cardiovascular morbidity and mortality. Although previous echocardiographic studies have demonstrated short-term improvement in cardiovascular remodeling in patients with OSA receiving continuous positive airway pressure (CPAP) therapy, a long-term study incorporating cardiac biomarkers, echocardiography, and cardiac MRI (CMR) has not been performed to date.. A prospective study of 47 patients with OSA was performed between 2007 and 2010. Cardiac biomarkers, including C-reactive protein (CRP), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and troponin T (TnT), were measured at baseline and serially over 1 year. All patients underwent baseline and serial transthoracic echocardiography (TTE) and CMR to assess cardiac remodeling.. Following 12 months of CPAP therapy, levels of CRP, NT-proBNP, and TnT did not change significantly from normal baseline values. As early as 3 months after initiation of CPAP, TTE revealed an improvement in right ventricular end-diastolic diameter, left atrial volume index, right atrial volume index, and degree of pulmonary hypertension, which continued to improve over 1 year of follow-up. Finally, left ventricular mass, as determined by CMR, decreased from 159 ± 12 g/m(2) to 141 ± 8 g/m(2) as early as 6 months into CPAP therapy and continued to improve until completion of the study at 1 year.. Both systolic and diastolic abnormalities in patients with OSA can be reversed as early as 3 months into CPAP therapy, with progressive improvement in cardiovascular remodeling over 1 year as assessed by both TTE and CMR.

Topics: Adult; Biomarkers; Blood Pressure; C-Reactive Protein; Cardiovascular Diseases; Continuous Positive Airway Pressure; Echocardiography; Female; Follow-Up Studies; Heart; Heart Ventricles; Humans; Longitudinal Studies; Magnetic Resonance Imaging; Male; Middle Aged; Myocardium; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies; Retrospective Studies; Risk Factors; Sleep Apnea, Obstructive; Troponin T; Ventricular Remodeling

Obstructive sleep apnea (OSA) is associated with an increased risk of cardiovascular disease. One contributory factor may be hemodynamic stress due to the negative intrathoracic pressure during each episode of apnea. Type B natriuretic peptide (BNP) is secreted by the cardiac ventricles in response to volume expansion and pressure load and the authors hypothesized that there would be an association between indices of OSA during the night and levels of BNP in the morning.. Community-based in Uppsala, Sweden.. There were 349 women who participated.. Participants underwent full-night polysomnography and anthropometric measurements, and answered questionnaires about medical conditions and current medication. The morning after the polysomnography, blood samples were drawn for analysis of plasma BNP, C-reactive protein, creatinine, and hemoglobin. There was an increase in mean BNP as the severity of sleep apnea increased, increasing from a mean value of 8.5 ng/L among women with an apnea-hypopnea index (AHI) < 5 to 18.0 ng/L in women with an AHI ≥ 30. Elevated BNP levels (≥ 20 ng/L) were found in 29.8% of the women, whereas 70.2% had normal levels. The odds ratio was 2.2 for elevated BNP levels for women with an AHI of 5-14.9 in relation to women with an AHI < 5, 3.1 for women with an AHI of 15-29.9, and 4.6 for women with an AHI ≥ 30 after adjustment for age, body mass index, systolic blood pressure, antihypertensive drugs, and creatinine.. There is a dose-response relationship in women between the severity of sleep apnea during the night and the levels of BNP in the morning.

Topics: Adult; Aged; Female; Follow-Up Studies; Humans; Natriuretic Peptide, Brain; Polysomnography; Risk Factors; Sleep Apnea, Obstructive; Surveys and Questionnaires; Sweden; Young Adult

To investigate the urodynamic changes in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and nocturnal polyuria.. From Sept. 2002 to Jun. 2008, 23 patients with nocturnal polyuria were diagnosed as having OSAHS by polysomnography (PSG). The number and output of nocturia, the osmotic pressure and the excretion of Na(+) were recorded during both the PSG night and CPAP titrating night. Plasma levels of brain natriuretic peptide (BNP) and atrial natriuretic peptides (ANP) were also measured at 11PM in the 2 nights and 7AM in the next mornings. Urodynamic studies including urine flow, bladder pressure during filling, pressure-flow study during voiding and urethral pressure were carried out in these patients. Urodynamic studies were performed again after treatment with CPAP for 3 months.. PSG showed that the patients with nocturnal polyuria had moderate to severe OSAHS, in which the apnea-hypopnea index (AHI) being 48 ± 15 events per hour. The number of nocturnal voiding during the PSG night was more than that during the CPAP titrating night. During the PSG night, the output of nocturia, the nocturia excretion of Na(+), ANP levels (at 7am in the next morning after PSG night) increased and the osmotic pressure of nocturia decreased. CPAP therapy could reverse these abnormalities. The main characteristics of urodynamics in these patients included weak detrusor contraction, hypoesthesia in filling cystometry, and decreased bladder compliance, and detrusor external sphincter dyssynergia. After 3 months of CPAP treatment, both the motility of the detrusor of bladder and the bladder compliance improved.. CPAP therapy can effectively reverse the nocturnal polyuria in OSAHS patients. In OSAHS patients, the features of nocturia, including the changes of output, osmotic pressure and the excretion of Na(+), may be related to the secretion of high-level of ANP. During the course of chronic progressively OSAHS pathophysiology, detrusor function of bladder may be damaged. CPAP therapy could decrease the nocturnal excretion of ANP, and improve the motility of the detrusor of bladder.

Topics: Adult; Aged; Aged, 80 and over; Atrial Natriuretic Factor; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Nocturia; Polyuria; Sleep Apnea, Obstructive; Urinary Bladder; Urodynamics

This study, in optimally treated CAD patients with newly diagnosed OSA, focused on (1) The relationships between OSA and serum biomarkers of four potential pathways of cardiovascular injury in OSA: high-sensitivity C-reactive protein (hs-CRP), endothelin-1 (ET-1), N terminal pro B type natriuretic peptide (NT-proBNP) and fibrinogen; and (2) The effect of continuous positive airway pressure (CPAP) therapy on these markers. 151 Chinese patients with proven CAD and standard medication were enrolled. After polysomnography, patients were classified into four groups according to apnea-hypopnea index (AHI): no OSA (n = 25); mild OSA (n = 50); moderate OSA (n = 43); severe OSA (n = 33). Morning levels of hs-CRP, ET-1, NT-proBNP and fibrinogen were assayed and repeated in severe OSA patients after 3-months CPAP treatment. Hs-CRP was greater in patients with severe OSA than those with no OSA or mild OSA (P = 0.001, P = 0.003; respectively). After adjustment for confounders, the hs-CRP levels correlated most strongly with AHI and oxygen desturation index (ODI) (r = 0.439, P < 0.001; r = 0.445, P < 0.001; respectively). In stepwise multiple linear regressions, the strongest predictor of hs-CRP levels was ODI (P < 0.001). After 3 months of CPAP treatment, the hs-CRP levels deceased (P = 0.005) in CAD patients with severe OSA. In CAD patients on current optimal medications, hs-CRP is significantly correlated with the severity of OSA, and the elevated hs-CRP levels can be decreased by CPAP. This suggests that OSA could activate vascular inflammation in CAD patients despite current best practice medications.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers; C-Reactive Protein; Cardiovascular Diseases; Continuous Positive Airway Pressure; Cross-Sectional Studies; Endothelin-1; Female; Fibrinogen; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Polysomnography; Sleep Apnea, Obstructive

Obstructive sleep apnea is associated with decreased R-R interval length and overall R-R interval variability in the electrocardiogram along with increased morning brain natriuretic peptide (BNP) blood levels. These findings indicate enhanced sympathetic tone and cardiac strain. In this study, it was hypothesized that adenotonsillectomy (AT) in children with sleep apnea is accompanied by improvement in polysomnography indices, increase in length and variability of R-R interval, and reduction in BNP levels.. Polysomnography and measurements of morning BNP levels were performed before and 4-6months after AT. Mean and standard deviation of R-R interval were calculated from polysomnography electrocardiogram recordings.. Twenty-one children were studied. Apnea-hypopnea index and log-transformed BNP levels decreased postoperatively from 8.4±7.6 episodes/h and 2.2±0.7, to 1.8±1.4 episodes/h and 1.9±0.3, respectively (p<0.05). Mean R-R interval increased from 703.2±137.4ms (Stage 2), 699.3±135.8ms (Stage 3), 707.4±128.9ms (Stage 4) and 660.5±140.1ms (Stage REM), to 773.5±122.7ms (Stage 2), 765.7±73.7ms (Stage 3), 771.2±71.6ms (Stage 4), and 738.6±81.7ms (Stage REM), respectively (p<0.05 for comparisons pre- vs. post-operatively). Standard deviation of R-R in Stage 2 increased from 88.5±29.6 to 122.7±67ms (p=0.045).. Increase in nocturnal length of R-R interval and decrease in BNP levels after AT for sleep apnea may reflect postoperative reduction in sympathetic tone and cardiac strain.

Topics: Adenoidectomy; Child; Electrocardiography; Female; Heart Rate; Humans; Male; Natriuretic Peptide, Brain; Pilot Projects; Polysomnography; Sleep Apnea, Obstructive; Snoring; Sympathetic Nervous System; Tonsillectomy

In order to study special characteristics of chronotropic reaction to physical exercise on veloergometer in the presence of obstructive sleep apnea (OSA) we examined 84 patients with manifestations of chronic systolic heart failure (HF). Chronotropic insufficiency was found in 88% of patients predominantly in combination with insufficient lowering of heart rate after exercise. At the same time it was more rarely registered in patients with OSA (56.4%). Insufficient lowering of heart rate by the end of first minute of rest was similarly associated with HF and OSA.. it is necessary to consider simultaneously chronotropic reserve and character of HR recovery after exercise.

Topics: Aged; Chronic Disease; Echocardiography; Exercise Test; Exercise Tolerance; Female; Heart Failure, Systolic; Heart Rate; Humans; Male; Middle Aged; Monitoring, Physiologic; Natriuretic Peptide, Brain; Peptide Fragments; Physical Fitness; Risk Factors; Severity of Illness Index; Sleep Apnea, Obstructive

To evaluate the effect of continuous positive airway pressure (CPAP) therapy on pro-brain natriuretic peptide (BNP) and cardiac markers in patients with obstructive sleep apnea syndrome and normal cardiac function.. Thirty-three consecutive patients with sleep apnea syndrome were analysed for serum pro-BNP and cardiac markers prior to and after 6 months of CPAP therapy.. Twenty five patients had normal (83.3%) while remaining five (16.7%) revealed high pro-BNP values. We did not detect any significant difference between severity of obstructive sleep apnea syndrome and serum pro-BNP levels (p = 0.534). A statistically significant difference was not observed between basal and sixth-month creatine kinase (CK), creatine kinase-MB (CK-MB), troponin I, pro-BNP, aspartate transaminase (AST), and CK levels in patients with sleep apnea syndrome (p > 0.05).. Obstructive sleep apnea syndrome does not induce myocardial damage enough to increase serum pro-BNP, CK, CK-MB, troponin I, and AST levels. Markers sensitive to ischemia could be preferred to evaluate effect of obstructive sleep apnea syndrome.

Topics: Adult; Aspartate Aminotransferases; Continuous Positive Airway Pressure; Creatine Kinase; Creatine Kinase, MB Form; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Polysomnography; Prospective Studies; Protein Precursors; Reference Values; Sleep Apnea, Obstructive; Troponin I

In Japan, there are two sleep-disordered breathing (SDB)-related problems, which include diagnosing SDB using a portable device (PD) and treating mild-to-moderate SDB (mm-SDB) using continuous positive airway pressure (CPAP) for severe SDB (s-SDB) in obstructive sleep apnea (OSA) patients. Our aims were to evaluate the effectiveness of a PD in diagnosing SDB in patients with cardiovascular disease (CVD), and to assess the difference between mm-SDB [apnea-hypopnea index (AHI): 20-40h(-1)] and s-SDB (AHI: >40h(-1)) using brain natriuretic peptide (BNP) in OSA patients.. After their underlying CVD was treated, full-night sleep studies using polysomnography (PSG) and PD were performed on the same day.. Eighty-three patients underwent full-night PSG simultaneously with PD. The average duration of the sleep study was 8.6+/-6.2 days. There was a tendency for a higher AHI value obtained with PSG (PSG, 28.9+/-24.3h(-1); PD, 22.3+/-16.7h(-1); p=0.05). However, the specificity and sensitivity of diagnosing SDB using PD were 86% and 81%, respectively. Using PD, twenty-nine OSA patients had mm-SDB and eleven patients had s-SDB. The BNP value was higher in the mm-SDB patients (318+/-550pg/ml) than in the s-SDB patients (202+/-160pg/ml).. The PD was effective in diagnosing SDB in patients with CVD. The BNP value was higher in the mm-SDB patients. Therefore, they need to be treated with CPAP to treat underlying CVD.

Topics: Aged; Cardiology; Cardiovascular Diseases; Continuous Positive Airway Pressure; Female; Humans; Male; Natriuretic Peptide, Brain; Polysomnography; Sleep Apnea, Obstructive

N-terminal pro-B-type natriuretic peptide (NT-proBNP), a marker of ventricular strain, and C-reactive protein (CRP), a marker of inflammation, are reportedly elevated in school-aged children with obstructive sleep apnea (OSA). We hypothesized that cardiovascular morbidity affects circulating markers and their echocardiographic and polysomnographic (PSG) correlates in young children with OSA.. We assessed young children undergoing adenotonsillectomy (TA) for OSA by polysomnography, echocardiography, and serum CRP and NT-proBNP levels.. A total of 90 children with OSA (mean age 19 +/- 7 months; 71.2% male; BMI, z = 0.62 +/- 1.04) and 45 age- and sex-matched controls were included. Three months following TA, 72 children were reassessed for NT-proBNP and CRP. NT-proBNP level (pg/mL) was higher in subjects with OSA (189.1 +/- 112.7) vs control subjects (104.8 +/- 49.5; P = .006). Both NT-proBNP (187.8 +/- 114 vs 86 +/- 32.6; P = .002) and CRP levels (mg %) (0.49 +/- 0.41 vs 0.1 +/- 0.17; P < .05) decreased following TA. Doppler pulse wave measuring tricuspid regurgitation (TR), a reflection of pulmonary hypertension, correlated with CRP (r = 0.61, P < .01) but not NT-proBNP (r = -0.14, P = .53) levels. Left ventricle end-diastolic diameter (LVEDD) was at the maximal normal range (0.91 +/- 0.11), but did not correlate with CRP or NT-proBNP levels. Both CRP level and TR correlated with PSG variables reflecting nocturnal hypoxemia, whereas NT-proBNP level and LVEDD did not. Echocardiography in 40 children (out of 90) showed a decline in TR that was abnormal before TA and correlated with the decrease in CRP following TA.. NT-proBNP levels are increased in children with OSA and decrease following TA. Echocardiographic parameters suggesting increased pulmonary pressure in young children with OSA are related to nocturnal hypoxemia and systemic inflammation, which also decrease following therapy.

Topics: Body Mass Index; C-Reactive Protein; Cardiac Output; Case-Control Studies; Child, Preschool; Cohort Studies; Echocardiography, Doppler; Female; Humans; Infant; Male; Natriuretic Peptide, Brain; Peptide Fragments; Polysomnography; Sleep Apnea, Obstructive; Tricuspid Valve Insufficiency

There is a relationship between obstructive sleep apnea (OSA) and heart failure (HF). Peak oxygen consumption (peak VO(2)), heart rate recovery, and N-terminal-pro-BNP (NT-proBNP) are strong prognostic predictors in HF. The effects of nasal continuous positive airway pressure (nCPAP) on these parameters in OSA patients are not well defined.. Forty patients with newly diagnosed OSA [apnea-hypopnea index (AHI) 37 (20-65) h(-1)] underwent cardiopulmonary exercise testing for assessment of peak VO(2) and heart rate recovery at one (HRR-1) and two (HRR-2) minutes after exercise termination as well as NT-proBNP measurement at baseline and after 7.9+/-1.4 months of effective nCPAP (nightly usage>3.5 h). The effects of nCPAP were compared in patients with mild-to-moderate (AHI<30 h(-1); n=16) vs. severe (AHI>or=30 h(-1); n=24) OSA.. In the group as a whole, peak VO(2) (baseline: 31.9+/-9.3 vs. follow-up: 33.7+/-9.0 ml/kg/min; p=0.02) and HRR-2 [38 (32-43) vs. 42 (32-47) bpm; p=0.01] but not HRR-1 [22 (15-26) vs. 22 (16-27) bpm; p=0.16] improved from baseline to follow-up. The effect on peak VO(2) was mainly driven by a trend towards an increase in patients with mild-to-moderate OSA (31.8+/-10.7 vs. 33.9+/-10.2 ml/kg/min; p=0.08), whereas an effect on HRR-1 [20 (15-23) vs. 21 (16-26) bpm; p=0.03] and HRR-2 [38 (29-42) vs. 42 (33-47) bpm; p=0.004] was observed only in those with severe OSA. NT-proBNP levels remained unchanged [21 (11-45) vs. 26 (5-52) pg/ml; p=0.6].. Treatment with nCPAP is associated with an improvement in peak VO(2) and heart rate recovery in patients with OSA.

Topics: Case-Control Studies; Continuous Positive Airway Pressure; Exercise Test; Exercise Tolerance; Female; Heart Rate; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Oxygen; Peptide Fragments; Polysomnography; Sleep Apnea, Obstructive

The influence of obstructive sleep apnea syndrome (OSAS) on left ventricular function remains controversial. We examined the influence of OSAS on global left ventricular function using the myocardial performance index (Tei index) and plasma brain natriuretic peptide (BNP) level and investigated the effect of nasal continuous positive airway pressure (nCPAP) on these parameters. We obtained echocardiographic indexes including the Tei index and BNP concentrations from 27 patients with OSAS whose mean apnea-hypopnea index was 42.2+/-21.5 events/hour and who were undergoing nCPAP and from 22 control subjects. We defined global left ventricular dysfunction (GLVD) as a Tei index >or=0.50 and high BNP as >or=20 pg/ml. Compared with controls, the Tei index of patients with OSAS was significantly increased (p <0.01) and prevalence of GLVD was high (19%, p<0.05). The correlation between the Tei index and apnea-hypopnea index was significant (r=0.447, p<0.05). Although BNP levels were higher in patients with OSAS than in controls, the difference did not reach significance. BNP level was high in 37% of patients with OSAS and in only 9% of controls (p<0.05). The Tei index of patients with OSAS was significantly decreased after 1 month and 3 months of nCPAP (p<0.01), and prevalence of GLVD significantly decreased from 19% to 4% (p<0.05). In contrast, BNP significantly decreased at 3 months after nCPAP (p<0.05). In conclusion, patients with moderate to severe OSAS frequently have impaired global left ventricular myocardial performance, which can be reversed at the early stage after starting nCPAP.

Topics: Continuous Positive Airway Pressure; Echocardiography; Heart Ventricles; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Plethysmography; Prevalence; Risk Factors; Sleep Apnea, Obstructive; Treatment Outcome; Ventricular Dysfunction, Left; Ventricular Function, Left

N-terminal pro-brain natriuretic peptide (NT-ProBNP) has emerged as an important marker of cardiac stress and may reflect the severity of underlying cardiac dysfunction, which is thought to be associated with obstructive sleep apnoea syndrome (OSAS).. This study evaluated the plasma concentration of NT-ProBNP in 60 consecutive patients (median age 55.7 years, median body mass index (BMI) 31.8) who were referred to a sleep laboratory with a suspicion of OSAS. Each subject underwent measurement of morning NT-ProBNP plasma levels, polysomnography and echocardiography. Patients were treated with nasal continuous or bilevel positive airway pressure ventilation (nCPAP/BIPAP) or without mechanical respiratory support, depending on clinical symptoms and results of polysomnography. Three months after treatment of OSAS 28 of the patients were reassessed for re-evaluation of NT-ProBNP and polysomnography.. Low or high levels of NT-proBNP were not associated with AHI and other sleep related indices (p>0.3). There was no correlation between NT-proBNP and AHI or other sleep related indices. In multiple regression analysis, NT-proBNP was significantly correlated with left ventricular ejection fraction, creatinine clearance and the presence of systemic arterial hypertension but not with AHI.. Our results show by a robust multiple regression analysis, that NT-pro BNP is not associated with OSAS and NT-pro BNP cannot be used as a sensitive marker for underlying cardiovascular abnormalities in patients with OSAS.

Topics: Adult; Biomarkers; Female; Heart Diseases; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Polysomnography; Predictive Value of Tests; Regression Analysis; Sleep Apnea, Obstructive

Topics: Body Mass Index; Cardiovascular Diseases; Echocardiography; Endothelium, Vascular; Exercise Test; Humans; Natriuretic Peptide, Brain; Oxygen; Peptide Fragments; Predictive Value of Tests; Sleep Apnea, Obstructive; Vasodilation

The obstructive sleep apnea syndrome (OSAS) is associated with cardiovascular abnormalities including left ventricular hypertrophy, left ventricular diastolic dysfunction, and endothelial dysfunction. The present study evaluated whether N-terminal pro-B-type natriuretic peptide (NT-proBNP) and peak oxygen consumption (peak VO(2)), both integral markers of cardiovascular function, are related to OSAS severity. In addition, we tested whether NT-proBNP levels depend on body composition in OSAS patients, similar to what has been reported in patients without OSAS. Eighty-nine patients with untreated OSAS underwent NT-proBNP measurement, dual X-ray absorptiometry, and cardiopulmonary exercise testing. In a representative subgroup (n = 32), transthoracic echocardiography was performed. The severity of OSAS was classified based on apnea-hypopnea index (AHI) values as mild (AHI 5-15 h(-1)), moderate (AHI 15-30 h(-1)), and severe (AHI >30 h(-1)). OSAS was mild in 19 (21%), moderate in 21 (24%), and severe in 49 (55%) patients. NT-proBNP levels did not differ among patients with mild [30 (10-57)], moderate [37 (14-55)], and severe [24 (13-49) pg/ml; p = 0.8] OSAS and were not related to body mass index (r = 0.07; p = 0.5), percent lean body mass (r = -0.17; p = 0.1), and percent fat mass (r = 0.18; p = 0.1). Percent predicted peak VO(2) was on average normal and did not differ among patients with mild (115 +/- 26), moderate (112 +/- 23), and severe OSAS (106 +/- 29%; p = 0.4). Body weight-indexed peak VO(2) did not differ among patients with mild (31.9 +/- 10.3), moderate (32.1 +/- 7.9), and severe OSAS (30.0 +/- 9.9 ml kg(-1) min(-1); p = 0.6) either. Lower NT-proBNP (beta = -0.2; p = 0.02) was independently but weakly associated with higher body weight-indexed peak VO(2). In the echocardiography subgroup, NT-proBNP was not significantly related to left ventricular mass index (r = 0.26; p = 0.2). In conclusion, NT-proBNP and peak VO(2) are not related to OSAS severity, and NT-proBNP poorly reflects left ventricular hypertrophy in OSAS. The lack of a relationship between NT-proBNP and OSAS severity is not due to a significant influence of body composition on NT-proBNP. There is an association between higher NT-proBNP and lower peak VO(2), indicating that NT-proBNP is a marker of cardiorespiratory fitness in patients with OSAS. However, the association is too weak to be clinically useful.

Topics: Adult; Body Composition; Body Mass Index; Cardiovascular Diseases; Echocardiography; Electrocardiography; Exercise Test; Female; Humans; Hypertrophy, Left Ventricular; Male; Middle Aged; Natriuretic Peptide, Brain; Oxygen; Peptide Fragments; Polysomnography; Predictive Value of Tests; Risk Factors; Sleep Apnea, Obstructive

To examine whether increased plasma levels of B-type natriuretic peptide (BNP) are associated with cardiac structural and functional abnormalities in obstructive sleep apnoea (OSA) patients, taking into consideration the confounding effect of obesity.. In a cross-sectional study, polysomnography, echocardiography and the measurement of the serum levels of BNP were performed in 235 consecutive subjects (age 52 +/- 14 years) visiting our sleep clinic. Left ventricular hypertrophy (LVH) [left ventricular mass index (LVMI) > or = 125 g/m in men, and > or = 110 g/m in women] and cardiac diastolic function (E/A ratio) were determined by echocardiography.. The LVMI, prevalence rate of LVH and body mass index (BMI) were higher, and the E/A ratio lower in the subjects with severe OSA (apnoea-hypopnoea index > or = 30/h, n = 146, LVH 80%) than in those with mild to moderate OSA (n = 89, LVH 35%; P < 0.01), although plasma BNP levels were similar in the two groups. Although the log-transformed plasma BNP level showed a negative correlation with BMI, the results of binary logistic regression analysis demonstrated that the quintile value of BNP was an independent significant variable for the identification of LVH (adjusted odds ratio in quintile 5 = 4.01, 95% confidence interval 1.18-13.70, P < 0.01), even after adjusting for obesity and other risk factors.. An increased likelihood of cardiac structural and functional abnormalities was observed with increasing severity of OSA. Increased plasma levels of BNP do seem to reflect an increased likelihood of LVH in patients with severe OSA.

Topics: Body Mass Index; Cross-Sectional Studies; Echocardiography; Female; Humans; Hypertrophy, Left Ventricular; Male; Middle Aged; Natriuretic Peptide, Brain; Polysomnography; Reproducibility of Results; Sleep Apnea, Obstructive; Ventricular Function, Left

The mechanisms involved in the development and maintenance of hypertension in obstructive sleep apnoea (OSA) are not clear. We hypothesized that OSA patients have an abnormal renal handling of sodium and water during the night.. We studied 29 OSA patients and 19 healthy controls at night with serial determinations of atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), arginine vasopressin (AVP), aldosterone (Aldo), fractional urinary excretion of sodium (FE(Na)), free water clearance (C(H2O)), urinary excretion of aquaporin 2 (u-AQP2), systolic blood pressure (SBP), diastolic blood pressure (DBP) and oxygen saturation.. OSA patients had a higher FE(Na) (0.6 (0.4-1.0) versus 0.4 (0.3-0.6) %; p = 0.017), SBP (129 (114-145) versus 114 (106-122) mmHg; p = 0.001) and DBP (81 (72-87) versus 71 (65-74) mmHg; p<0.001) than healthy controls at night. In hypertensive OSA patients, the FE(Na) correlated significantly with the change in nocturnal DBP (r (2) = 0.411; p = 0.010). Mean level of AVP during the night was higher in OSA patients compared with healthy controls (1.1 (0.8-1.4) versus 0.8 (0.6-1.1) pmol/L; p = 0.033) and correlated with SBP. ANP, BNP, Aldo, C(H2O) and u-AQP2 were the same in OSA and controls.. We conclude that the higher fractional excretion of sodium in OSA is most likely attributable to pressure natriuresis. The correlation between mean AVP and blood pressure suggests that AVP may be part of the pathogenetic mechanism underlying hypertension in these patients.

Topics: Adult; Age Factors; Aldosterone; Aquaporin 2; Arginine Vasopressin; Atrial Natriuretic Factor; Blood Pressure; Female; Humans; Hypertension; Kidney; Male; Middle Aged; Natriuresis; Natriuretic Peptide, Brain; Oxygen; Potassium; Sex Factors; Sleep Apnea, Obstructive; Sodium; Vasopressins; Water

Habitual snoring and obstructive sleep apnea have been associated with bed-wetting in children, and effective obstructive sleep apnea treatment may improve enuresis.. The purpose of this work was to assess whether habitual snoring is associated with increased incidence of enuresis and whether severity of obstructive sleep apnea correlates with enuretic frequency and to evaluate brain natriuretic peptide levels.. Parental surveys of 5- to 7-year-old children were reviewed for habitual snoring and enuresis. Enuresis was also assessed in a cohort of 378 children with habitual snoring undergoing overnight polysomnographic evaluation, and brain natriuretic peptide plasma levels were determined in 20 children with obstructive sleep apnea, 20 with habitual snoring without obstructive sleep apnea, and 20 nonsnoring children, matched for enuresis.. There were 17,646 surveys completed (50.6% boys; 18.3% black). A total of 1976 (11.2%) of these children were habitual snoring (53% boys; 25.2% black). A total of 531 habitual snoring children also had enuresis (26.9%), with a predominant representation of boys (472 boys [87.5%]). Among the 15670 nonsnoring children, enuresis was reported in 1821 children (11.6%), of whom 88.8% were boys. However, enuresis among 378 children with habitual snoring did not correlate with the magnitude of sleep respiratory disturbances. Indeed, enuresis was reported in 33 of 149 children with obstructive sleep apnea (obstructive apnea hypopnea index: >2 per hour of total sleep time; 53% boys) as compared with 36 habitual snoring children with enuresis (62% boys) and obstructive apnea hypopnea index <2 per hour of total sleep time. Brain natriuretic peptide levels were elevated among children with enuresis and were marginally increased among children with obstructive sleep apnea.. Habitual snoring is associated with increased prevalence of enuresis, and brain natriuretic peptide levels are increased in enuretic children with further increases with obstructive sleep apnea. However, the prevalence of enuresis is not modified by severity of sleep disturbance. Even mild increases in sleep pressure because of habitual snoring may raise the arousal threshold and promote enuresis, particularly among prone children, that is, those with elevated brain natriuretic peptide levels.

Topics: Child; Child, Preschool; Circadian Rhythm; Female; Humans; Male; Natriuretic Peptide, Brain; Nocturnal Enuresis; Polysomnography; Sleep Apnea, Obstructive; Snoring

Cheyne-Stokes respiration (CSR) is indicative of adverse outcome in patients with chronic heart failure (CHF). We evaluated the use of brain natriuretic peptide (BNP) plasma levels to predict CSR in CHF patients. In this cross-sectional study, overnight polygraphy and cardiac work-up were performed and neurohumoral activation was determined in 102 consecutive CHF patients (25-82 years). Demographic characteristics did not significantly differ among patients with (n=38) or without CSR (n=64); BNP (median: 377 vs. 142 pg/ml, p<0.001) and norepinephrine levels (459+/-283 vs. 346+/-204 pg/ml, p=0.02) were significantly increased in patients with CSR. BNP concentrations were significantly associated with the central apnoea/hypopnoea index (y=253+/-5.3x; r=0.26, p=0.01). The area under the ROC curve that used BNP to predict CSR was 0.780 (95% CI: 0.688 to 0.873). Using established cut-off limits of BNP plasma levels, heart failure patients with BNP levels >500 pg/ml displayed a 13 fold increased risk of CSR (95% CI: 2.34-73.50; p=0.03) compared to patients with BNP levels <100 pg/ml. In multiple logistic regression analysis p(a)CO2 (point estimate 0.84, 95% CI: 0.72 to 0.98; p=0.02) and higher BNP class (point estimate 3.14, 95% CI: 1.38-7.144; p=0.006) emerged as parameters independently predicting the presence of CSR in our cohort of CHF patients. In conclusion, CSR is associated with neurohumoral activation in CHF patients. Specifically, BNP levels are associated with the severity of cardiac and sleep-related disease, and may be helpful in the diagnosis of CSR and more appropriate use of polysomnography in CHF patients.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Cheyne-Stokes Respiration; Cohort Studies; Cross-Sectional Studies; Female; Heart Failure; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Predictive Value of Tests; Prospective Studies; Risk Factors; ROC Curve; Sleep Apnea, Obstructive

Topics: Atrial Natriuretic Factor; Blood Pressure; Body Mass Index; Case-Control Studies; Diuresis; Humans; Kidney; Natriuretic Peptide, Brain; Sleep Apnea, Obstructive; Sodium

Obstructive sleep-disordered breathing is accompanied by episodic increases in left ventricle afterload due to large negative swings in intrathoracic pressure and repetitive surges in arterial pressure. Brain natriuretic peptide (BNP) is released by ventricular myocytes in response to pressure and volume overload. It was hypothesized that in children with snoring, overnight change in BNP levels is correlated with severity of disturbance in respiration.. Evening and morning plasma levels of BNP were measured in children with snoring referred for polysomnography.. A sleep disorders laboratory in a university hospital.. Twenty-two children with apnea-hypopnea index (AHI) > or = 5/h (mean +/- SD age, 6.4 +/- 2.5 years), 60 children with AHI < 5/h (mean age, 7 +/- 2.9 years), and 27 control subjects without snoring (mean age, 7.8 +/- 3.7 years) were recruited.. Overnight change in BNP (log-transformed ratio of morning-to-evening levels) was larger in children with AHI > or = 5/h, compared to those with AHI < 5/h or to control subjects (0.1 +/- 0.19 vs 0.01 +/- 0.14 vs - 0.06 +/- 0.18; p < 0.05). Children with AHI > or = 5/h had an odds ratio of 4.33 (95% confidence interval, 1.34 to 14) for change in peptide levels > 0.15 relatively to subjects with AHI < 5/h. AHI and oxygen saturation of hemoglobin nadir were significant predictors of overnight change in peptide levels.. In children with snoring, overnight increase in BNP levels is correlated with severity of disturbance in respiration during sleep, which may indicate presence of nocturnal cardiac strain.

Topics: Adolescent; Case-Control Studies; Child; Child, Preschool; Circadian Rhythm; Female; Heart Ventricles; Humans; Hypertrophy, Left Ventricular; Linear Models; Male; Natriuretic Peptide, Brain; Polysomnography; Severity of Illness Index; Sleep Apnea, Obstructive; Snoring

Patients with obstructive sleep apnea syndrome (OSAS) have an elevated incidence of cardiovascular events that may be related to an increased ventricular load and hypoxemia caused by apneas and hypopneas. N-terminal pro-brain natriuretic peptide (NTproBNP) appears to be an excellent marker of myocardial stretch and could serve as an indicator of subclinical cardiac stress, thereby identifying a patient population at risk for cardiac effects from OSAS. Adult patients presenting with suspected OSAS and scheduled for nocturnal polysomnography were recruited. Patients with heart or renal failure or severe lung disease were excluded. NTproBNP was measured the evening before and the morning after sleep. Blood pressure (BP) was monitored intermittently throughout the night. Fifteen male and 15 female subjects with a mean +/- SD body mass index of 38.2 +/- 9.8 were studied. Mean Apnea-Hypopnea Index (AHI) was 38.4 +/- 26, with 17 subjects having severe OSAS (AHI > 30). No subject had a significant rise in BP. NTproBNP values overnight decreased in 19 patients and rose in 11 (mean change 3.8 +/- 33 pg mL(-1)), but only one patient had an abnormal morning value. Three patients had an abnormal NTproBNP value prior to sleep, but their levels decreased with sleep. No correlations were detected between the evening baseline or postsleep NTproBNP levels and OSAS. Monitoring pre- and postsleep NTproBNP levels revealed no association with the occurrence or degree of OSAS, making it unlikely that NTproBNP could serve as a marker of cardiac stress in OSAS patients with stable BP and without overt heart failure.

Topics: Adult; Arousal; Female; Humans; Male; Middle Aged; Myocardial Contraction; Natriuretic Peptide, Brain; Peptide Fragments; Polysomnography; Risk Assessment; Risk Factors; Sleep Apnea, Obstructive; Ventricular Dysfunction, Left

Topics: Continuous Positive Airway Pressure; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Randomized Controlled Trials as Topic; Sleep Apnea, Obstructive