natriuretic-peptide--brain and Sleep-Apnea-Syndromes

Positive airway pressure (PAP) has been recognized as an effective therapeutic option for sleep-disordered breathing (SDB) in patients with heart failure (HF), and it can improve left ventricular function. Whether PAP can ameliorate serum brain natriuretic peptide (BNP) levels, a biomarker of HF, is controversial. The purpose of the present study was to quantitatively assess the efficacy of PAP on BNP in patients with HF and SDB.. A systematic search of PubMed, Embase, Web of Science and Cochrane library identified six randomized controlled trials (RCTs), in which PAP was compared with medical therapy, subtherapeutic PAP or different types of PAP. The data of BNP were extracted and pooled into meta-analysis using STATA 12.0.. Totally 6 RCT studies (7 cohorts) with 222 patients were enrolled into analysis. The quality of each study was high and the heterogeneity (I(2) = 58.1%) was noted between studies. A significant reduction of BNP was observed after PAP treatment in patients with HF and SDB (SMD -0.517, 95% CI -0.764 to -0.270, z = 4.11, p = 0.000).. Our meta-analysis of RCTs demonstrated that PAP elicits significant reduction of BNP in patients with HF and SDB.

Topics: Continuous Positive Airway Pressure; Heart Failure; Humans; Natriuretic Peptide, Brain; Randomized Controlled Trials as Topic; Sleep Apnea Syndromes

Pulmonary hypertension (PH) has long been recognized as a complication of chronic respiratory disease. Recent studies have highlighted the adverse impact PH has on the clinical course of these conditions and have cast doubt on the role of hypoxia in their pathogenesis. Clinicians should carefully consider the possibility of PH during the diagnostic evaluation of chronic respiratory disorders. The usefulness of pharmacologic therapy directed toward PH remains to be determined.

Topics: Chronic Disease; Comorbidity; Humans; Hypertension, Pulmonary; Lung Diseases, Interstitial; Natriuretic Peptide, Brain; Oxygen Inhalation Therapy; Positive-Pressure Respiration; Pulmonary Disease, Chronic Obstructive; Pulmonary Wedge Pressure; Respiratory Tract Diseases; Sleep Apnea Syndromes

Adaptive servo-ventilation (ASV) is a ventilator algorithm able to correct breathing through anticyclic support of breathing in patients with central sleep apnea (CSA). So far, very few data exist regarding the role of ASV on acute heart failure with preserved ejection fraction (HFpEF).. We performed a single-center prospective, randomized, case-control study in consecutive acute HFpEF (left ventricle ejection fraction, LVEF ≥ 45%) patients with sleep-disordered breathing (SDB, apnea-hypopnea index, AHI > 15/h) and prevalence of CSA.. We included ten consecutive patients randomized for ASV on top of standard therapy for acute heart failure (group 1) versus standard care alone (group 2). ASV therapy significantly reduced AHI and CSA. An improvement in cardiac diastolic function was seen in group 1 compared to group 2 (E/E' 17.5 to 9.6, p < 0.02 vs 18.5 to 14.5, p = 0.4). Brain natriuretic peptide (BNP) markedly decreased in cases, but not in controls (298 to 84 pg/ml, p < 0.02 vs 280 to 120 pg/ml, p = 0.06). Right ventricle (RV) function significantly improved in group 1, differently from group 2.. An acute use of ASV seems effective in reducing BNP and improving diastolic and RV function in acute HFpEF patients with SDB and CSA, compared to standard treatment.

Topics: Acute Disease; Aged; Case-Control Studies; Comorbidity; Continuous Positive Airway Pressure; Diastole; Echocardiography; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Prospective Studies; Sleep Apnea Syndromes; Sleep Apnea, Central; Stroke Volume; Ventricular Function, Right

We tested the hypotheses that in patients with congestive heart failure (CHF) and sleep disordered breathing (SDB) auto-servoventilation (ASV) improves cardiac function and quality of life. Between March 2007 and September 2009, patients with stable CHF (left ventricular ejection fraction (LVEF) ≤ 40%) and SDB (apnoea/hypopnoea index ≥ 20 events · h(-1)) were randomised to receive either ASV (BiPAP ASV (Philips Respironics, Murrysville, PA, USA), n=37) and optimal medical management, or optimal medical management alone (n=35). Outcomes were assessed at baseline and 12 weeks. The apnoea/hypopnoea index assessed with polysomnography scored in one core laboratory was significantly more reduced in the ASV group (-39 ± 16 versus -1 ± 13 events · h(-1); p<0.001) with an average use of 4.5 ± 3.0 h · day(-1). Both groups showed similar improvements of the primary end-point LVEF (+3.4 ± 5 versus +3.5 ± 6%; p=0.915) assessed with echocardiography. In the ASV group, reduction of N-terminal pro-brain natriuretic peptide (NT-proBNP) was significantly greater (-360 ± 569 versus +135 ± 625 ng · mL(-1); p=0.010). No differences were observed between the groups in subjective quality of life. In patients with CHF and SDB, ASV reduced NT-proBNP levels, but improvement of LVEF or quality of life was not greater than in the control group. The data support that such patients can be randomised in large-scale, long-term trials of positive airway pressure therapy versus control to determine effects on cardiovascular outcome.

Topics: Aged; Algorithms; Continuous Positive Airway Pressure; Echocardiography; Electrocardiography; Electroencephalography; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Pilot Projects; Polysomnography; Positive-Pressure Respiration; Quality of Life; Sleep Apnea Syndromes; Snoring; Tidal Volume; Treatment Outcome; Ventricular Function, Left

Effective pharmacotherapy for heart failure with preserved left ventricular ejection fraction (HFpEF) is still unclear. Sleep-disordered breathing (SDB) causes cardiovascular dysfunction, giving rise to factors involved in HFpEF. However, it remains unclear whether adaptive servo-ventilation (ASV) improves cardiovascular function and long-term prognosis of patients with HFpEF and SDB.. Thirty-six patients with HFpEF (LVEF >50%) and moderate to severe SDB (apnoea-hypopnoea index >15/h) were enrolled. Study subjects (LVEF 56.0%, apnoea-hypopnoea index 36.5/h) were randomly assigned to two groups: 18 patients treated with medications and ASV (ASV group) and 18 patients not treated with ASV (non-ASV group). NYHA class, cardiac function including LVEF, left atrial volume index (LAVI), E/E', vascular function including flow-mediated dilatation (FMD) and cardio-ankle vascular index (CAVI), and levels of BNP and troponin T were determined at baseline and 6 months later. Patients were followed to register cardiac events after enrolment (follow-up 543 days). ASV therapy improved cardiac diastolic function and decreased CAVI and BNP (NYHA class, 2.3 to 1.5; LAVI, 48.6 to 42.6 mL/m(2); E/E', 12.8 to 7.1; CAVI, 9.0 to 7.7; BNP, 121.5 to 58.1 pg/mL, P < 0.0125, respectively). LVEF, FMD, and troponin T did not change significantly in either group. Importantly, the event-free rate was significantly higher in the ASV group than in the non-ASV group (94.4% vs. 61.1%, log-rank P < 0.05).. ASV may improve the prognosis of HFpEF patients with SDB, with favourable effects such as improvement of symptoms, cardiac diastolic function, and arterial stiffness. ASV may be a useful therapeutic tool for HFpEF patients with SDB.

Topics: Aged; Aged, 80 and over; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Polysomnography; Prognosis; Prospective Studies; Respiration, Artificial; Sleep Apnea Syndromes; Stroke Volume; Treatment Outcome; Troponin T

Cardiac pacing is ineffective in obstructive sleep apnea (SA), but it can alleviate central SA/Cheyne-Stokes respiration (CSA) in patients with heart failure (HF). We examined whether overnight overdrive ventricular pacing (OVP) has an effect on SA in pacemaker recipients with permanent atrial fibrillation (AF).. An apnea-hypopnea index (AHI) ≥ 15 was confirmed in 28/38 patients screened by finger pulse oximetry during overnight ventricular pacing at a backup rate of 40 bpm (BUV40). These patients (23 men, 77.9 ± 7.6 y, BMI 27.6 ± 5.1 kg/m(2)) were randomly assigned to 2 consecutive nocturnal ventilation polygraphies with BUV40 versus OVP at 20 bpm above the mean nocturnal heart rate observed during screening.. During BUV40 versus OVP, (1) mean heart rate was 49 ± 8 versus 71 ± 8 bpm (p < 0.0001) and percent ventricular pacing 36% ± 38% versus 96% ± 6% (p < 0.0001); (2) AHI was 35.4 ± 11.9 versus 32.5 ± 15.5 (p = ns), central AHI 23.9 ± 11.8 versus 19.1 ± 12.7 (p < 0.001), and obstructive AHI 11.6 ± 13.1 versus 13.5 ± 15.9 (p = ns). In 15/28 patients without HF, mean left ventricular ejection fraction (LVEF) was 51% ± 17%, AHI was 37.6 ± 11.0 during BUV40 and 39.0 ± 11.5 during OVP, versus 32.8 ± 12.9 and 24.9 ± 16.5 in 13/28 patients with HF (p = 0.02) and mean LVEF 35% ± 15% (p = 0.01). Between the 2 subgroups, (1) central AHI was 23.6 ± 12.4 during BUV40 and 21.5 ± 14.0 during OVP versus 24.1 ± 11.6 and 16.2 ± 10.7 (p = 0.05); (2) obstructive AHI was 14.0 ± 13.7 during BUV40 and 17.6 ± 16.5 during OVP versus 8.8 ± 12.3 and 8.7 ± 14.3 (p = ns).. The prevalence of SA, predominantly central, was high in our pacemaker recipients with permanent AF. In those with HF, a single overnight OVP resulted in modest improvement in central events.

Topics: Aged; Atrial Fibrillation; Female; Heart Rate; Humans; Male; Natriuretic Peptide, Brain; Oximetry; Pacemaker, Artificial; Polysomnography; Sleep Apnea Syndromes; Ventricular Function, Left

It is unclear whether adaptive servo-ventilation (ASV) is effective for all patients with heart failure (HF). The aim of the present study was therefore to investigate the effectiveness of ASV for all patients with HF.. Sixty-one patients with HF were recommended for ASV treatment, regardless of sleep-disordered breathing (SDB) severity and type. On the basis of the apnea-hypopnea index (AHI) results, patients were classified into 3 groups: 28 patients with AHI ≥ 40/h were designated as group A; 20 patients with AHI ≥ 20/h and <40/h were designated as group B; and 13 patients with AHI < 20/h were designated as group C. After ASV treatment, brain natriuretic peptide (BNP) levels and left ventricular ejection fraction (LVEF) were improved almost equally in the 3 groups (changes in BNP level: group A, -313 ± 480 pg/ml; group B, -401 ± 801 pg/ml; group C, -225 ± 240 pg/ml; P = 0.69; changes in LVEF: group A, 8.5 ± 11.3%; group B, 10.5 ± 9.6%; group C, 2.4 ± 12.4%; P = 0.17).. ASV treatment for patients with mild SDB resulted in almost equal improvements in BNP levels and LVEF compared to that in patients with moderate and severe SDB, demonstrating that ASV is effective for all patients with HF.

Topics: Aged; Aged, 80 and over; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Observation; Prospective Studies; Respiration, Artificial; Severity of Illness Index; Sleep Apnea Syndromes; Stroke Volume; Treatment Outcome

Exercise oscillatory ventilation (EOV) is a common pattern of breathing in heart failure (HF) patients, and indicates a poor prognosis.. To investigate the effects of adaptive servoventilation (ASV) on ventilatory response during exercise.. We studied 39 HF patients with left ventricular ejection fraction (LVEF) £ 45. Cardiorespiratory polygraphy, cardiopulmonary exercise testing (CPET), echocardiography, and measurement of N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration were performed. Twenty patients with Cheyne-Stokes respiration and apnoea-hypopnoea index (AHI) ≥ 15/h were identified. Of these, 11 patients were successfully titrated on ASV and continued therapy. In the third month of ASV treatment, polygraphy, CPET, echocardiography, and measurement of NT-proBNP concentration were performed again.. The EOV was detected at baseline in 12 (31%) HF patients, including eight (67%) who underwent ASV. The EOV was associated with significantly lower LVEF, peak oxygen uptake (VO(2)), and ventilatory anaerobic threshold (VAT), and a significantly higher left ventricular diastolic diameter (LVDD), slope of ventilatory equivalent for carbon dioxide (VE/VCO(2)), AHI, central AHI and NT-proBNP concentration. In seven patients with EOV, reversal of EOV in the third month of ASV therapy was observed; only in one patient did EOV persist (p = 0.0156).. The EOV can be reversed with ASV therapy. The EOV in association with central sleep apnoea and Cheyne- -Stokes respiration (CSA/CSR) is prevalent in HF patients and correlates with severity of the disease.

Topics: Adaptation, Physiological; Aged; Breathing Exercises; Cheyne-Stokes Respiration; Chronic Disease; Exercise; Exercise Test; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Sleep Apnea Syndromes; Ultrasonography

Sleep-disordered breathing (SDB) is thought to be a state of inflammation caused by hypoxic stress. Whether adaptive servo ventilation (ASV) attenuates the inflammatory response and improves the cardiac function of patients with congestive heart failure (CHF) accompanied by SDB was not been investigated.. Seventeen inpatients with New York Heart Association (NYHA) II or III underwent polysomnography. There was a positive correlation between the apnea hypopnea index and high-sensitivity C-reactive protein (hs-CRP) level (r=0.753, P=0.016). The patients were divided into ASV (n=10) and non-ASV groups (n=7), and CHF-parameters were measured before and after ASV treatment. Improvement was noted for the NYHA class in the ASV group but not in the non-ASV group. In contrast to the non-ASV group, the level of brain natriuretic peptide (BNP), ejection fraction, and hs-CRP levels in the ASV group significantly improved (BNP, 212.1 ± 181.2 to 77.3 ± 54.0 pg/ml [P<0.05]; ejection fraction, 43.5 ± 6.4 to 53.3 ± 6.1% [P=0.002]; hs-CRP, 0.85 ± 0.58 to 0.21 ± 0.19 mg/dl, [P=0.008]). The increase in ejection fraction was correlated with a decrease in the hs-CRP level (r=-0.753, P=0.001).. Anti-inflammatory effects of ASV are important contributors for improving cardiac function in patients with CHF accompanied by SDB. 

Topics: Aged; C-Reactive Protein; Chronic Disease; Female; Heart Failure; Humans; Inflammation; Male; Middle Aged; Natriuretic Peptide, Brain; Polysomnography; Positive-Pressure Respiration; Sleep Apnea Syndromes; Treatment Outcome

Sleep-disordered breathing is common in individuals with left ventricular (LV) dysfunction and has been treated with nocturnal positive airway pressure. We investigated whether treatment of central sleep apnea-hypopnea with bilevel positive airway pressure (BPAP) in ambulatory patients with idiopathic dilated cardiomyopathy (IDCM) might improve LV function.. Fifty-two consecutive patients with IDCM who underwent both cardiac catheterization and standard polysomnography were enrolled in the study; individuals with obstructive sleep apnea syndrome were excluded. Subjects with an apnea-hypopnea index (AHI) >or= 20 episodes per hour were randomized to receive medical therapy either alone (n = 11) or together with BPAP (n = 10).. LV end-diastolic pressure, pulmonary capillary wedge pressure, and plasma concentration of brain natriuretic peptide were significantly greater, and LV ejection fraction (LVEF) was significantly lower in patients with an AHI >or= 20/h (n = 21, 40.4%) than in those with an AHI < 20/h (n = 31, 59.6%). LVEF (30.5 +/- 1.6% vs 50.8 +/- 3.5%, p < 0.001) [mean +/- SE] and plasma concentration of brain natriuretic peptide (162.8 +/- 44.5 pg/mL vs 32.7 +/- 17.6 pg/mL, p = 0.02) were significantly increased and decreased, respectively, after treatment with BPAP (daily use, 4.8 +/- 0.3 h) for 3 months, whereas these parameters remained unchanged in the control subjects.. Our findings suggest that treatment of coexisting central sleep apnea-hypopnea with BPAP improves LV function in ambulatory patients with IDCM. BPAP should thus be considered as a nonpharmacologic adjunct to conventional drug therapy in such patients.

Topics: Adult; Aged; Blood Pressure; Cardiomyopathy, Dilated; Humans; Middle Aged; Natriuretic Peptide, Brain; Polysomnography; Positive-Pressure Respiration; Prospective Studies; Pulmonary Wedge Pressure; Sleep Apnea Syndromes; Sleep Apnea, Central; Stroke Volume; Survival Analysis; Treatment Outcome; Ventricular Dysfunction, Left; Wakefulness

The purpose of the present study was to assess the short-term effects of positive pressure ventilation (PPV) on plasma amino terminal-pro brain natriuretic peptide (NT-proBNP) levels in patients with congestive heart failure (CHF) and sleep apnea (SA).. Polysomnography was performed in 105 CHF patients. Twenty-six patients with CHF and SA were randomly assigned to a control group or a PPV group. Patients in the higher New York Heart Association classes had higher plasma levels of NT-proBNP. The plasma NT-proBNP concentration in the PPV group decreased.. Plasma NT-proBNP levels reflect the severity of CHF, and PPV can decrease plasma NT-proBNP levels in patients with CHF and SA.

Topics: Adult; Aged; Biomarkers; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Polysomnography; Sleep Apnea Syndromes; Ventilation

Sleep apnea (SA) exerts adverse effects in patients with congestive heart failure (CHF). Amino terminal-pro brain natriuretic peptide (NT-proBNP) is a useful target of CHF treatment. The purpose of this study was to assess the short-term effect of positive pressure ventilation (PPV) on the plasma concentration of NT-proBNP in patients with both CHF and SA.. One hundred and five patients diagnosed with CHF participated in the study. Medical history was recorded, and Doppler echocardiography and overnight polysomnography were performed. Seventy-seven patients were diagnosed as having SA. Patients with CHF and SA were randomly assigned to receive medical therapy alone (12 patients) or with the addition of PPV (14 patients) for 2 - 5 days.. Plasma NT-proBNP concentration was measured in 77 patients with CHF and SA. The plasma level of NT-proBNP was associated with the severity of CHF. Subjects with higher degree of NYHA class showed higher a level of NT-proBNP. After PPV treatment, the apnea-hypopnea index decreased (P < 0.001), the lowest SaO2 increased (P < 0.001), and the plasma concentration of NT-proBNP decreased as compared to the baseline levels (P < 0.05).. The plasma levels of NT-proBNP could reflect the severity of CHF, and PPV treatment could decrease the plasma NT-proBNP level in patients with CHF and SA.

Topics: Adult; Aged; Enzyme-Linked Immunosorbent Assay; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Positive-Pressure Respiration; Sleep Apnea Syndromes

Sleep disorders and sleep duration have attracted considerable attention as potential modifiable risk factors for the development and progression of heart failure (HF). However, whether these sleep behaviors could aggravate the underlying cardiac condition remains ambiguous. We evaluated the associations between the levels of plasma B-type natriuretic peptide (BNP) and sleep-disordered breathing (SDB), sleep quality and quantity, or daytime sleepiness in cardiovascular diseases (CVD) patients. A total of 1717 consecutive patients with CVD [median age, 66 years (55-74 years); female, 27.5%] were enrolled. SDB was screened by nocturnal pulse oximetry; sleep quality and quantity were determined by Pittsburg Sleep Quality Index, and daytime sleepiness was examined by Epworth Sleepiness Scale. The median plasma BNP level was 54.9 pg/ml (23.5-146.4 pg/ml). Multiple regression analyses showed that the BNP level in the highest quintile (BNP > 181.8 pg/ml) was associated with SDB (severe: OR, 5.88; 95% CI 3.17-10.88; moderate: OR, 3.62; 95% CI 2.17-6.02; mild: OR, 2.22: 95% CI 1.42-3.47). There were no significant associations between other sleep parameters and higher BNP levels. The relationship between SDB and BNP levels was unchanged regardless of the previous history of symptomatic HF. SDB was independently associated with the elevated plasma BNP level in patients with a variety of CVD.

Topics: Aged; Cardiovascular Diseases; Disorders of Excessive Somnolence; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Polysomnography; Sleep Apnea Syndromes

Cheyne-Stokes respiration (CSR), a kind of central sleep apnea, is referred to as a poor prognostic factor in heart failure patients with reduced ejection fraction (HFrEF). Matrix metalloproteinase (MMP) and B-type natriuretic peptide (BNP) play important roles in HFrEF patients and are markers of poor prognosis. However, there is no literature mentioning the changes in MMP and BNP in HFrEF patients with CSR.. From June 2018 to June 2019, 41 adult patients with stable heart failure and left ventricular ejection fraction < 50% were enrolled from the cardiology clinic. After history-taking and medication review to exclude possible central nervous system- or medication-related central sleep apnea, an overnight polysomnography study was performed, and CSR was identified. The morning serum MMP-2, MMP-9, and BNP levels were determined using enzyme-linked immunosorbent assay and fluorescence immunoassay techniques. A positive airway pressure device was applied to 7 patients for 3 months.. The serum MMP-2 and BNP levels were significantly higher in HFrEF patients with CSR than in patients without CSR. In addition, elevated serum MMP-2 levels correlated well with the severity of sleep apnea and intermittent hypoxia, which were represented as the apnea-hypopnea index and the oxygen desaturation index. No positive correlation was found between those markers and left ventricular ejection fraction. Finally, the treatment of sleep apnea with continuous positive airway pressure for 3 months tended to reduce the elevated serum MMP-2 levels.. Higher serum MMP-2 and BNP levels were found in HFrEF patients with CSR. Elevated MMP-2 levels were correlated with the severity of sleep apnea and intermittent hypoxia.. Chuang L-P, Pang J-HS, Lin S-W, et al. Elevated serum matrix metalloproteinase-2 levels in heart failure patients with reduced ejection fraction and Cheyne-Stokes respiration.

Topics: Cheyne-Stokes Respiration; Heart Failure; Humans; Hypoxia; Matrix Metalloproteinase 2; Natriuretic Peptide, Brain; Sleep Apnea Syndromes; Sleep Apnea, Central; Stroke Volume; Ventricular Function, Left

Depression and anxiety are common mental health problems that are strongly associated with sleep disturbances, according to community-based researches. However, this association has not been investigated among patients admitted for cardiovascular diseases (CVDs). We examined the prevalence of depression and anxiety in inpatients with various CVDs and their association with sleep disturbances.. This cross-sectional study included 1294 patients hospitalized for CVDs in a Japanese university hospital were evaluated for their mental status using the Hospital Anxiety and Depression Scale (HADS), for sleep-disordered breathing (SDB) using pulse oximetry, and for sleep quality using the Pittsburgh Sleep Quality Index (PSQI).. Patient characteristics were as below: mean age, 63.9±14.7 years; 25.7% female. Overall, 18.9% had depression (HADS-depression≥8) and 17.1% had anxiety (HADS-anxiety≥8). The presence of depression was associated with female sex, older age, higher plasma brain natriuretic peptide level, lower estimated glomerular filtration rate, and the prevalence of heart failure. Overall, 46.5% patients were categorized as having a poor sleep quality (PSQI>5), and 28.5% patients had SDB (3% oxygen desaturation index>15). Although depression and anxiety were not associated with SDB, they were independently associated with poor sleep quality (OR = 3.09, 95% CI 2.19-4.36; OR = 3.93, 95% CI 2.71-5.69, respectively).. Depression and anxiety were not uncommon in patients with CVDs. Poor sleep quality could be an important risk factor linked to psychological disturbances.

Topics: Aged; Anxiety; Cardiovascular Diseases; Cross-Sectional Studies; Depression; Female; Glomerular Filtration Rate; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Odds Ratio; Regression Analysis; Sleep; Sleep Apnea Syndromes

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

Sleep-disordered breathing (SDB) is highly prevalent in patients with diabetes mellitus (DM) and heart failure (HF) and contributes to poor cardiovascular outcomes. Enlarged glycemic variability (GV) is a risk factor of cardiac events independently of average blood glucose level, but the influence of SDB on GV is uncertain. In this study, we examined whether the impact of SDB on GV is modified by the presence of DM with or without HF.. Two hundred three patients (67.5±14.1 [SD] years old, 132 males) who were admitted to our institute for examination or treatment of DM and/or HF underwent continuous glucose monitoring and polysomnography. Both HbA1c (8.0±2.0 vs. 5.7±0.4%) and mean amplitude of glycemic excursion (MAGE, median: 95.5 vs. 63.5 mg/dl) were significantly higher in a DM group (n = 100) than in a non-DM group (n = 103), but apnea-hypopnea index (AHI: 29.0±22.7 vs. 29.3±21.5) was similar in the two groups. AHI was correlated with log MAGE in the non-DM group but not in the DM group, and multivariate regression analysis revealed that AHI was an independent variable for log MAGE in the non-DM group but not in the DM group. We then divided the non-DM patients into two subgroups according to BNP level (100 pg/ml). AHI was positively correlated with log MAGE (r = 0.74, p<0.001) in the non-DM low-BNP subgroup, but such a correlation was not found in the non-DM high-BNP subgroup. Continuous positive airway pressure (CPAP) reduced MAGE from 75.3 to 53.0 mg/dl in the non-DM group but did not reduce MAGE in the DM group.. Severity of SDB was associated with higher GV, but DM as well as HF diminished the contribution of SDB to GV. Treatment with CPAP was effective for reduction of GV only in patients without DM.

Topics: Aged; Blood Glucose; Blood Glucose Self-Monitoring; Continuous Positive Airway Pressure; Diabetes Mellitus, Type 2; Female; Humans; Male; Multivariate Analysis; Natriuretic Peptide, Brain; Regression Analysis; Respiration; Sleep; Sleep Apnea Syndromes

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

Compared with heart failure (HF) with reduced ejection fraction (HF-REF), the diagnosis of HF with preserved EF (HF-PEF) is more challenging. The aim of the study was to assess the prevalence of HF-PEF among patients hospitalized for HF, to evaluate the pertinence of HF-PEF diagnosis and to compare HF-PEF and HF-REF patients with respect to outcomes. The analysis included 661 Polish patients hospitalized for HF, selected from the European Society of Cardiology (ESC)-HF Long-Term Registry. Patients with an EF of ≥50% were included in the HF-PEF group and patients with an EF of <50% - in the HF-REF group. The primary end point was all-cause death at 1 year. The secondary end point was a composite of all-cause death and rehospitalization for HF at 1 year. HF-PEF was present in 187 patients (28%). Of those 187 patients, mitral inflow pattern was echocardiographically assessed in 116 patients (62%) and classified as restrictive/pseudonormal in 37 patients (20%). Compared with HF-REF subjects, patients with HF-PEF were older, more often female, and had a higher prevalence of hypertension, atrial fibrillation and sleep apnea. Despite lower B-type natriuretic peptide concentrations and lower prevalence of moderate-to-severe mitral regurgitation in patients with HF-PEF, congestive symptoms at admission were as severe as in patients with HF-REF. There were no significant differences in in-hospital mortality between the HF groups. One-year mortality was high in both groups (17% in HF-PEF vs 21% in HF-REF, p = 0.22). There was a trend toward a lower frequency of the secondary end point in the HF-PEF group (32% vs 40%, p = 0.07). In conclusion, in clinical practice, even easily obtainable echocardiographic indexes of diastolic dysfunction are relatively rarely acquired. One-year survival rate of patients with HF-PEF is not significantly better than that of patients with HF-REF.

Topics: Age Distribution; Aged; Aged, 80 and over; Atrial Fibrillation; Case-Control Studies; Comorbidity; Disease Progression; Echocardiography; Female; Heart Failure; Hospital Mortality; Hospitalization; Humans; Hypertension; Male; Middle Aged; Natriuretic Peptide, Brain; Poland; Prevalence; Prognosis; Registries; Severity of Illness Index; Sex Distribution; Sleep Apnea Syndromes; Stroke Volume

Chronic heart failure (CHF) has been shown to be associated with an increased incidence of sleep-disordered breathing. Whether treatment with noninvasivepositive-pressure ventilation (NPPV), including continuous positive airway pressure, bi-level positive airway pressure and adaptive servo-ventilation, improves clinical outcomes of CHF patients is still debated. 2,832 CHF patients were enrolled in our analysis. NPPV was significantly associated with improvement in left ventricular ejection fraction (39.39% vs. 34.24%; WMD, 5.06; 95% CI, 3.30-6.81; P < 0.00001) and plasma brain natriuretic peptide level (268.23 pg/ml vs. 455.55 pg/ml; WMD, -105.66; 95% CI, [-169.19]-[-42.13]; P = 0.001). However, NPPV did not reduce all-cause mortality (0.26% vs. 0.24%; OR, 1.13; 95% CI, 0.93-1.37; P = 0.22) or re-hospitalization rate (57.86% vs. 59.38%; OR, 0.47; 95% CI, 0.19-1.19; P = 0.02) as compared with conventional therapy. Despite no benefits on hard endpoints, NPPV may improve cardiac function of CHF patients. These data highlight the important role of NPPV in the therapy of CHF.

Topics: Adrenergic beta-Antagonists; Aged; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Chronic Disease; Female; Follow-Up Studies; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Noninvasive Ventilation; Odds Ratio; Patient Readmission; Prognosis; Quality of Life; Sample Size; Sleep Apnea Syndromes; Treatment Outcome; Ventricular Function, Left

Adaptive servo-ventilation (ASV) therapy using an innovative ventilator-originally developed to treat sleep-disordered breathing (SDB)-is a novel modality of noninvasive positive pressure ventilation and is gaining acceptance among Japanese cardiologists in expectation of its applicability to treat patients with chronic heart failure (CHF) based on its acute beneficial hemodynamic effects. We conducted a multicenter, retrospective, real-world observational study in 115 Japanese patients with CHF, who had undergone home ASV therapy for the first time from January through December 2009, to examine their profile and the effects on their symptoms and hemodynamics. Medical records were used to investigate New York Heart Association (NYHA) class, echocardiographic parameters including left ventricular ejection fraction (LVEF), cardiothoracic ratio (CTR), brain natriuretic peptide (BNP), and other variables. Most of the patients were categorized to NYHA classes II (44.4 %) and III (40.7 %). SDB severity was not determined in 44 patients, and SDB was not detected or was mild in 27 patients. In at least 71 patients (61.7 %), therefore, ASV therapy was not applied for the treatment of SDB. CHF was more severe, i.e., greater NYHA class, lower LVEF, and higher CTR, in 87 ASV-continued patients (75.7 %) than in 28 ASV-discontinued patients (24.3 %). However, SDB severity was not related to continuity of ASV. The combined proportion of NYHA classes III and IV (P = 0.012) and LVEF (P = 0.009) improved significantly after ASV therapy. CTR and BNP did not improve significantly after ASV therapy but showed significant beneficial changes in their time-course analysis (P < 0.05, respectively). Improvements in LVEF and NYHA class after ASV therapy were not influenced by SDB severity at onset. The present study suggests that ASV therapy would improve the symptoms and hemodynamics of CHF patients, regardless of SDB severity. A randomized clinical study to verify these effects is warranted.

Topics: Aged; Body Weight; Chronic Disease; Echocardiography; Female; Heart Failure; Hemodynamics; Humans; Japan; Logistic Models; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Positive-Pressure Respiration; Retrospective Studies; Severity of Illness Index; Sleep Apnea Syndromes; Treatment Outcome; Ventilators, Mechanical; Ventricular Function, Left

There is a close relationship between sleep disordered breathing (SDB) and heart failure. We performed home oxygen therapy (HOT) in patients with SAS undergoing dialysis, and investigated its effects on the heart function. The subjects were 10 SDB patients on dialysis. On retiring at night, oxygen was transnasally administered at 1.0 L/min. The human atrial natriuretic peptide (hANP), brain natriuretic peptide (BNP), total protein, Alb, cholesterol and phosphorus levels were measured before the start of oxygen therapy and after 6 weeks. The mean SpO2 increased from 93.5% [91.5, 97.0] to 96.3% [94.8, 97.4] (median [interquartile range]) (p = 0.015). The hANP (p = 0.0039), BNP (p = 0.0098) and serum Alb (p = 0.015) levels significantly improved. There were no significant changes in the cholesterol, phosphorus or total protein levels. These results suggest that nocturnal oxygen therapy improves indices of heart failure, contributing to the prevention and treatment of heart failure in dialysis patients with SDB.

Topics: Aged; Atrial Natriuretic Factor; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Oxygen; Quality of Life; Renal Dialysis; Sleep Apnea Syndromes

Sleep disordered breathing (SDB) and anemia influences the progression of chronic heart failure (CHF). Adaptive servo-ventilation (ASV) is an effective therapeutic device for treatment of CHF, however, the impacts of ASV on CHF patients with or without anemia remain unclear.A total of 139 patients with CHF and SDB were divided into two groups: those treated with ASV (n = 53) and without ASV (n = 86). All patients were prospectively followed after discharge with the endpoints of cardiac death or progressive heart failure requiring rehospitalization. There were 65 patients (47%) with anemia among all subjects. The apnea hypopnea index was improved, and plasma BNP and high sensitive C-reactive protein levels were decreased in both groups with and without anemia by ASV therapy. The Kaplan-Meier survival curve demonstrated that the cardiac event-free rate in patients with ASV was significantly higher than in those without ASV in the anemia group (P = 0.008). However, in the non-anemia group, the cardiac event-free rate was similarly high in patients both with and without ASV (P = 0.664). Multivariate Cox proportional hazard analysis demonstrated that ASV use was an independent predictor of cardiac events in the anemia group (P = 0.0308), but not in the non-anemia group.ASV treatment for CHF and SDB has more favorable impacts in patients with anemia than in those without anemia.

Topics: Anemia; C-Reactive Protein; Disease Progression; Female; Follow-Up Studies; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Patient Readmission; Prospective Studies; Respiration, Artificial; Sleep Apnea Syndromes; Survival Rate; Time Factors; Treatment Outcome

Topics: Acute Disease; Atrial Fibrillation; Cardiomegaly; Diabetes Mellitus, Type 2; Diuretics; Heart Failure; Hemorrhage; Humans; Hydrostatic Pressure; Hypertension; Leukocytosis; Lung Diseases; Lung Diseases, Interstitial; Male; Middle Aged; Natriuretic Peptide, Brain; Pulmonary Edema; Sleep Apnea Syndromes; Smoking; Tomography, X-Ray Computed; Ultrasonography

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

Sleep-disordered breathing (SDB) deteriorates the prognosis of patients with chronic heart failure (CHF). Adaptive servo ventilation (ASV) is a new therapeutic modality to treat SDB including Cheyne-Stokes respiration associated with central sleep apnea. Renal function plays critical roles in the progression of CHF and is a strong predictor of clinical outcomes. Cystatin C is a marker of renal function, and more sensitive than serum creatinine. The purpose of the present study was to examine whether ASV is effective for cardiac overload and renal dysfunction in CHF patients with SDB. Fifty patients with CHF and SDB (mean left ventricular ejection fraction 34.0 %, estimated glomerular filtration rate (eGFR) 62.8 ml/min/1.73 cm(2)) were examined. We performed polysomnography for two consecutive days (baseline and on ASV), and measured levels of serum N terminal-pro B-type natriuretic peptide (NT-pro BNP), cystatin C, and estimated glomerular filtration rate based on cystatin C (eGFR Cyst C). ASV significantly improved the apnea hypopnea index, central apnea index, obstructive apnea index, arousal index, mean SPO2, and lowest SPO2 compared to baseline. ASV decreased NT-pro BNP (1,109.0 (2,173.2) to 912.8 (1,576.7) pg/ml, p < 0.05), cystatin C (1.391 ± 0.550-1.348 ± 0.489 mg/l, p < 0.05), and increased eGFR Cyst C (61.9 ± 30.8-65.7 ± 33.8 ml/min/1.73 cm(2), p < 0.01). ASV improved SDB, reduced cardiac overload, and ameliorated renal function in CHF patients with SDB. ASV has short-term beneficial effects on not only SDB but also cardio-renal function. ASV might be a promising useful tool for CHF as an important non-pharmacotherapy with cardio-renal protection.

Topics: Aged; Biomarkers; Cheyne-Stokes Respiration; Chronic Disease; Creatinine; Cystatin C; Female; Glomerular Filtration Rate; Heart Failure; Humans; Kidney; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Polysomnography; Respiration, Artificial; Sleep Apnea Syndromes; Stroke Volume; Time Factors; Treatment Outcome; Ventricular Function, Left

Post-traumatic stress disorder (PTSD) is gaining increasing recognition as a risk factor for morbidity and mortality. The aim of this study was to examine the impact of PTSD and abnormal cardiovascular biomarkers on mortality in military veterans. Eight hundred ninety-one patients presenting for routine echocardiography were enrolled. Baseline clinical data and serum samples for biomarker measurement were obtained and echocardiography was performed at the time of enrollment. Patients were followed for up to 7.5 years for the end point of all-cause mortality. Ninety-one patients had PTSD at the time of enrollment. There were 33 deaths in patients with PTSD and 221 deaths in those without PTSD. Patients with PTSD had a trend toward worse survival on Kaplan-Meier analysis (p = 0.057). Among patients with elevated B-type natriuretic peptide (>60 pg/ml), those with PTSD had significantly increased mortality (p = 0.024). Among patients with PTSD, midregional proadrenomedullin (MR-proADM), creatinine, and C-terminal proendothelin-1 were significant univariate predictors of mortality (p = 0.006, p = 0.024, and p = 0.003, respectively). In a multivariate model, PTSD, B-type natriuretic peptide, and MR-proADM were independent predictors of mortality. In patients with PTSD, MR-proADM was a significant independent predictor of mortality after adjusting for B-type natriuretic peptide, cardiovascular risk factors, cancer, and sleep apnea. Adding MR-proADM to clinical predictors of mortality increased the C-statistic from 0.572 to 0.697 (p = 0.007). In conclusion, this study demonstrates an association among PTSD, abnormal cardiac biomarker levels, and increased mortality.

Topics: Adrenomedullin; Aged; Biomarkers; Creatinine; Echocardiography; Endothelin-1; Female; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Male; Multivariate Analysis; Natriuretic Peptide, Brain; Peptide Fragments; Protein Precursors; Sleep Apnea Syndromes; Stress Disorders, Post-Traumatic; United States; Veterans

Sleep disordered breathing (SDB) is highly prevalent in patients with cardiovascular disease, although it is not clear whether SDB has any link to coronary atherosclerotic burden in patients with stable coronary artery disease (CAD). This study sought to analyze the links between SDB, coronary atherosclerotic burden, and cardiac biomarkers in stable CAD patients.. We studied 83 consecutive patients who underwent coronary angiography or scheduled percutaneous coronary intervention. SDB was evaluated by an ambulatory polysomnographic monitoring device. Coronary atherosclerotic burden was evaluated by the Gensini score, and myocardial stress/injury were assessed by measuring plasma levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high sensitivity troponin T (hs-TnT). Patients with an apnea hypopnea index (AHI)≧15 events/h (n=32) showed significantly higher Gensini score (35.7±38.0 vs 20.1±19.7, p=0.033) than those with AHI<15. The higher AHI group showed significantly higher NT-proBNP (275.8±402.6 pg/ml vs 131.9±146.3 pg/ml, p=0.047) and hs-TnT levels (0.011±0.005 ng/ml vs 0.008±0.003 ng/ml, p=0.015). Furthermore it was revealed that AHI significantly correlated with the Gensini score (r=0.253, p=0.036), NT-proBNP (r=0.266, p=0.027), and hs-TnT (r=0.274, p=0.023), and multiple stepwise linear regression analysis revealed that AHI (β=0.257, p=0.029) and history of smoking (β=0.244, p=0.038) were independently correlated with Gensini score among clinical and SDB-related parameters.. Severity of SDB has a significant link to the severity of coronary atherosclerotic burden, which also reflected elevated NT-proBNP and hs-TnT as silent myocardial ischemia and minute myocardial injury even in stable CAD patients.

Topics: Aged; Biomarkers; C-Reactive Protein; Coronary Angiography; Coronary Artery Disease; Female; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Polysomnography; Regression Analysis; Severity of Illness Index; Sleep Apnea Syndromes; Troponin T

To determine the prevalence of primary nocturnal enuresis in children, to define the possible role of sleep-disordered breathing (SDB) related to adenotonsillar hypertrophy in enuresis, to explore the role of brain natriuretic peptide (BNP) levels in measuring the severity of SDB in enuretic children, and to evaluate the response to surgical interventions (adenotonsillectomy) in indicated enuretic patients.. Parental surveys of 5-10 year-old children were reviewed for SDB and enuresis. Children with SDB were clinically and radiologically examined. Plasma BNP levels were determined in 33 children with SDB and enuresis and in 30 otherwise healthy children of whom 15 had enuresis.. A total of 15.3% of the studied children had primary nocturnal enuresis, and 47 children with enuresis (30.7%) had SDB. There was a downward trend of enuresis and SDB as age increased. There appeared to be an association between the frequency of enuresis, snoring and adenotonsillar enlargement. Plasma BNP concentrations were significantly higher among enuretic children. All enuretic children with SDB underwent surgical intervention (33 patients), and an improvement was observed in 29 children (87.8%). Among them, 15 were cured completely, and 12 made a significant improvement in the initial 3 months, but two made just a partial improvement over one year, and four did not show any improvement over one year follow up. All enuretic children with SDB who underwent surgery exhibited a significant reduction in daytime enuresis.. The data suggests an association between nocturnal enuresis and adenotonsillar related SDB in children. Enuresis may add to the indications for surgical intervention in this group. Increased BNP levels may account for the increased prevalence of enuresis in context of SDB.

Topics: Adenoidectomy; Adenoids; Child; Child, Preschool; Female; Humans; Hyperplasia; Logistic Models; Male; Natriuretic Peptide, Brain; Nocturnal Enuresis; Palatine Tonsil; Prospective Studies; Sleep Apnea Syndromes; Tonsillectomy; Treatment Outcome

A high prevalence of nocturnal Cheyne-Stokes respiration (CSR) has been documented in patients with heart failure with normal left ventricular ejection fraction (HFNEF). The aim of the present study was to investigate the effects of adaptive servoventilation (ASV) for treatment of CSR in these patients. In 60 patients with HFNEF, defined according to current European Society of Cardiology guidelines, CSR was documented by polysomnography (apnoea/hypopnoea index (AHI) of >15 events x h(-1)). ASV treatment was offered to all patients; 21 initially rejected treatment, withdrew from treatment or presented noncompliant during follow-up (controls), whereas ongoing ASV therapy was initiated in 39 patients (ASV group). Echocardiography, cardiopulmonary exercise testing and measurement of N-terminal-pro-brain natriuretic peptide were performed at baseline and follow-up (11.6+/-3 months). ASV therapy led to a significant reduction in AHI, longest apnoea and hypopnoea length, maximum and mean oxygen desaturation by pulse oximetry, percentage of study time with an oxygen saturation of <90% and arousal index. In addition, significant positive effects could be confirmed on absolute and predicted peak oxygen consumption, oxygen consumption at the individual aerobic-anaerobic threshold, oxygen pulse, as well as left atrial size, and transmitral flow patterns (mean early diastolic lengthening velocity and the ratio of peak early Doppler mitral inflow velocity to this lengthening velocity). ASV effectively attenuates CSR in patients with HFNEF and improves heart failure symptoms and cardiac function. Whether or not this is accompanied by an improved prognosis remains to be determined.

Topics: Aged; Cardiac Catheterization; Cheyne-Stokes Respiration; Echocardiography; Exercise; Female; Heart Failure; Heart Ventricles; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Polysomnography; Prospective Studies; Sleep Apnea Syndromes

Cheyne-Stokes breathing (CSB) has been associated with heart failure (HF) patients for many years; however, its true prevalence and its prognostic implications are still obscure.. The goal of this study was to investigate the prevalence and the possible prognostic implications of nocturnal CSB in advanced heart failure patients.. We performed single night full polysomonography ambulatory sleep studies in 71 HF patients. We analyzed the patients' sleep studies, clinical and laboratory data, and 6 month mortality.. A total of 71 chronic systolic HF patients were analyzed, 60 males, 11 females, age 65 +/- 13 years. Mean left ventricular ejection fraction was 27% +/- 11%. Short episodes of CSB (at least 3 min duration) were present in all patients, and mean CSB duration was 1 hour. CSB duration was associated significantly with both high serum levels of N-terminal prohormone brain natriuretic peptide (NT-proBNP) as well as with 6 month mortality. Log CSB time had a significant correlation with log NT-proBNP (r = 0.5, P<.0001). Based on median CSB duration, the Kaplan-Meier survival curve analysis showed significant association with 6 month mortality (P = .03).. CSB prevalence in advanced HF patients is higher than previously reported and is associated with increased serum levels of NT-proBNP and higher 6 month mortality.

Topics: Aged; Cheyne-Stokes Respiration; Disease Progression; Electrocardiography, Ambulatory; Female; Health Status Indicators; Heart Failure, Systolic; Humans; Israel; Kaplan-Meier Estimate; Male; Middle Aged; Monitoring, Ambulatory; Natriuretic Peptide, Brain; Peptide Fragments; Polysomnography; Prospective Studies; Risk Factors; Severity of Illness Index; Sleep Apnea Syndromes; Statistics as Topic; Stroke Volume; Ventricular Function, Left

Sleep disorders, including sleep-disordered breathing and periodic limb movements during sleep, are associated with an increased risk for cardiovascular diseases, which are the leading causes of death in patients with ESRD. This study investigated the association between sleep disorders and mortality in patients with ESRD.. Thirty patients on maintenance hemodialysis, who were clinically stable for >2 months, underwent overnight polysomnography to evaluate sleep parameters.. All patients were followed for a median of 48 months (range: 14 to 62 months), and 14 of them died during the follow-up period. Among the sleep parameters, the percent of sleep time with arterial oxygen saturation <90% (T <90%), mean arterial oxygen saturation, and periodic limb movement index score were associated with significant increases in the risk of death. However, associations of the apnea-hypopnea index or oxygen desaturation index with mortality were NS. The hazard ratios (95% confidence intervals) for death per one SD increment in the log-transformed T <90% and periodic limb movement index score were 2.10 (1.06 to 4.15) and 2.48 (1.11 to 5.52), respectively, after adjusting for age.. We found that nocturnal hypoxemia and periodic limb movement during sleep, rather than apnea itself, were associated with an increased risk for death in patients with ESRD. However, conclusions from this study should be drawn with caution, because they are limited by the small sample size.

Topics: Adolescent; Adult; Aged; alpha-2-HS-Glycoprotein; Biomarkers; Blood Proteins; Cause of Death; Female; Humans; Hypoxia; Kaplan-Meier Estimate; Kidney Failure, Chronic; Male; Middle Aged; Natriuretic Peptide, Brain; Nocturnal Myoclonus Syndrome; Oxygen; Polysomnography; Proportional Hazards Models; Renal Dialysis; Republic of Korea; Risk Assessment; Risk Factors; Sleep; Sleep Apnea Syndromes; Time Factors; Troponin T; Young Adult

Because increased sympathetic nervous activity (SNA) in patients with dilated cardiomyopathy (DCM) associated with sleep breathing disorder (SBD) is known to deteriorate the prognosis of cardiac failure, (123)I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy was used as the investigative tool in the present study.. The study group comprised 53 patients (47 men, 6 women; mean age 56+/-3 years) with chronic stable DCM. Patients were divided into SBD(+) or SBD(-) group according to 24-h pulse oximetry results. SBD(+) was defined when the 3% oxygen desaturation index was more than 15/h during sleep. In total, 32 patients were SBD(-) and 21 were SBD(+). In both groups, pulse oximetry were performed during sleep and awakening pulse rate, and measurement of the blood levels of catecholamines and B-type natriuretic peptide was performed. MIBG myocardial scintigraphy and echocardiography were performed at the same time. No significant difference was found between the 2 groups in catecholamine levels or left ventricular ejection fraction. However, MIBG had a significantly increased washout rate and a significantly decreased delayed heart to mediastinum ratio in the SBD(+) group compared with the SBD(-) group.. SNA is increased in DCM patients when associated with SBD. MIBG myocardial scintigraphy may be a sensitive method of detecting increased SNA.

Topics: 3-Iodobenzylguanidine; Adult; Aged; Cardiomyopathy, Dilated; Catecholamines; Female; Humans; Male; Middle Aged; Myocardial Perfusion Imaging; Natriuretic Peptide, Brain; Oximetry; Oxygen; Radiography; Radiopharmaceuticals; Sleep; Sleep Apnea Syndromes; Sympathetic Nervous System

When sleep apnea-hypopnea syndrome (SAHS) and cardiovascular disease occur concurrently, prognosis is affected. Echocardiography can detect structural cardiac abnormalities but using this technique in all patients would place a heavy burden on resources. The objective of this study was to investigate whether the N-terminal fraction of brain natriuretic peptide (NT-proBNP) can be used as a marker for silent heart disease.. NT-proBNP concentration was measured in the 114 consecutive patients with SAHS who underwent echocardiography before starting treatment. Left and right ventricular systolic and diastolic function, as well as structural abnormalities, were studied. Correlations between NT-proBNP concentration and the abnormalities detected were investigated. A receiver operating characteristics (ROC) curve was plotted for NT-proBNP concentration and cardiac abnormalities.. Data for 98 patients were finally analyzed. NT-proBNP concentration was significantly correlated with ventricular septal thickness (r=0.63), posterior wall thickness (r=0.45), and left ventricular end-diastolic diameter (r=0.51) (P<.0001 for all correlations). The area under the ROC curve was significant (0.870; 95% confidence interval, 0.801-0.939; P<.0001). Assuming that specificity would be more useful for clinical practice, we calculated that NT-proBNP concentrations below 100 and 200 pg/mL could rule out structural abnormalities with a reliability of 90% and 100%, respectively.. NT-proBNP concentration was strongly correlated with echocardiographic abnormalities and so could be a useful tool for identifying patients who should be referred to the cardiologist.

Topics: Cardiology; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Referral and Consultation; Sleep Apnea Syndromes

Sleep-disordered breathing (SDB) is often encountered in morbid obesity (MO) in conjunction with insulin resistance (IR) and several cardio-vascular risk factors. Aminoterminal pro-brain natriuretic peptide (NT-proBNP) is a promising marker for left ventricular dysfunction (LVD) in MO. The aim of this study was to look for possible correlations between SDB, IR, heart structure and function indexes and NT-proBNP levels in MO female subjects.. Cross-sectional study involving 110 MO (44.5+/-0.7 kg m(-2)) apparently healthy, young (37.8+/-1.0 y.o.) female patients. NT-proBNP was measured using an ELISA kit (Roche). Echo-cardiograms were performed to quantify left ventricular ejection fraction values (LVEF), cardiac output (CO), left ventricular mass (LVM), left atria size (LA) and left ventricular filling pressures (the E/Em ratio). The Berlin Questionnaire (BQ) was used to assess the risk of SDB. IR and sensitivity were assessed using the HOMA index and adiponectin measurements, respectively.. All patients had a normal LVEF (>50%). Hypertension and Type 2 diabetes mellitus prevalences were 34.5 and 4.5% (respectively). Log-transformed NT-proBNP levels correlated with BQ categories (P<0.0005), creatinine (P<0.001), age (P<0.05), LVM (P<0.001), CO (P<0.001), LA (P<0.0005) and E/Em (P<0.01). NT-proBNP levels, LVD and LVM increased significantly along with BQ scores (P<0.0001). Stepwise multiple regression analysis identified BQ and log-transformed HOMA as independent variables predicting as much as 48.0% of log-transformed NT-proBNP's variability (dependent variable).. NT-proBNP levels are independently predicted by SDB and IR in asymptomatic MO women. Additionally, SDB worsens along with LVH and diastolic dysfunction. Larger prospective studies are warranted.

Topics: Adult; Biomarkers; Cross-Sectional Studies; Diabetes Mellitus, Type 2; Echocardiography; Female; Humans; Hypertension; Hypertrophy, Left Ventricular; Insulin Resistance; Linear Models; Natriuretic Peptide, Brain; Obesity, Morbid; Peptide Fragments; Predictive Value of Tests; Prevalence; Risk Factors; Sleep Apnea Syndromes

This study was conducted to evaluate whether brain (B-type) natriuretic peptide (BNP) changes during sleep are associated with the frequency and severity of apneic/hypopneic episodes, intermittent arousals, and hypoxia.. Sleep apnea is strongly associated with heart failure (HF) and could conceivably worsen HF through increased sympathetic activity, hemodynamic stress, hypoxemia, and oxidative stress. If apneic activity does cause acute stress in HF, it should increase BNP.. Sixty-four HF patients with New York Heart Association functional class II and III HF and ejection fraction <40% underwent a baseline sleep study. Five patients with no sleep apnea and 12 with severe sleep apnea underwent repeat sleep studies, during which blood was collected every 20 min for the measurement of BNP. Patients with severe sleep apnea also underwent a third sleep study with frequent BNP measurements while they were administered oxygen. This provided 643 observations with which to relate apnea to BNP. The association of log BNP with each of 6 markers of apnea severity was evaluated with repeated measures regression models.. There was no relationship between BNP and the number of apneic/hypopneic episodes or the number of arousals. However, the burden of hypoxemia (the time spent with oxygen saturation <90%) significantly predicted BNP concentrations; each 10% increase in duration of hypoxemia increased BNP by 9.6% (95% confidence interval: 1.5% to 17.7%, p = 0.02).. Hypoxemia appears to be an important factor that underlies the impact of sleep abnormalities on hemodynamic stress in patients with HF. Prevention of hypoxia might be especially important for these patients.

Topics: Female; Follow-Up Studies; Heart Failure; Hemodynamics; Humans; Hypoxia; Incidence; Male; Middle Aged; Natriuretic Peptide, Brain; Oxidative Stress; Oxygen; Retrospective Studies; Sleep Apnea Syndromes

Topics: Heart Failure; Hemodynamics; Humans; Hypoxia; Incidence; Natriuretic Peptide, Brain; Oxidative Stress; Oxygen; Sleep Apnea Syndromes

In this study, we assessed factors associated with cardiovascular risk in patients with sleep apnea-hypopnea syndrome (SAHS) through analysis of plasma concentrations of N-terminal prohormone brain natriuretic peptide (NTproBNP) and high-sensitivity C-reactive protein (hsCRP). In addition, we analyzed the effect of nasal continuous positive airway pressure (nCPAP) on these markers.. Forty-two patients with SAHS (mild to moderate in 15 cases and severe in 27) were compared with 14 individuals without SAHS. The participants were not receiving drug treatment and they did not have diabetes, hypertension, marked dyslipidemia, or cardiovascular disease, which was ruled out both clinically and by echocardiography and (99m)Tc-tetrofosmin scintigraphy at rest and during exercise. The effects of nCPAP in patients with severe SAHS were analyzed after 6 months of treatment.. Following adjustment for age, body mass index, and smoking habit, the mean concentrations of markers were not significantly higher in patients with severe SAHS than in those with mild-to-moderate SAHS or in control subjects. Nevertheless, in patients with SAHS the main factor influencing NTproBNP concentrations was the percentage of time with a nocturnal arterial oxygen saturation of less then 90% (r=0.37, P=.017). No variables predictive of hsCRP concentration were identified. The concentrations of the markers were reduced by nCPAP, but the differences were not statistically significant.. While nocturnal hypoxemia in SAHS is responsible for variations in the plasma concentration of NTproBNP (as a result of cardiovascular changes), SAHS appears not to be associated with the inflammatory marker hsCRP when patients with heart disease, cardiovascular risk factors, or those receiving pharmacologic treatment are excluded.

Topics: Adult; C-Reactive Protein; Continuous Positive Airway Pressure; Female; Hemodynamics; Humans; Inflammation; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies; Sleep Apnea Syndromes

Sleep-disordered breathing (SDB) is often encountered in morbid obesity (MO) in conjunction with insulin resistance (IR). Aminoterminal pro-brain natriuretic peptide (NT-proBNP) is a promising marker for left ventricular dysfunction (LVD) in MO. We sought to explore the factors that may influence the relationships of SDB and IR with NT-proBNP in MO women. We performed a cross-sectional pilot study involving 110 asymptomatic MO (44.5+/-0.7 kg/m2) young women. SDB risk was assessed using a modified version of the Berlin Questionnaire (BQ). IR was assessed using the homeostasis model assessment (HOMA) index and adiponectin levels. LVD was assessed using NT-proBNP and echocardiograms. In this study, NT-proBNP levels and LVD increased significantly along the BQ strata. Multiple regression analysis identified BQ and log-transformed HOMA as the independent variables predicting as much as 48.0% of the variability of logNT-proBNP. In conclusion, NT-pro-BNP levels are independently predicted by SDB and IR in asymptomatic MO women. Larger prospective studies are warranted.

Topics: Adiponectin; Adult; Biomarkers; Cross-Sectional Studies; Echocardiography; Female; Humans; Insulin Resistance; Middle Aged; Natriuretic Peptide, Brain; Obesity, Morbid; Peptide Fragments; Sleep Apnea Syndromes; Surveys and Questionnaires; Ventricular Dysfunction, Left

Sleep disordered breathing (SDB), especially Cheyne-Stokes respiration (CSR) is common in patients with chronic heart failure (CHF). Adaptive servoventilation (ASV) was recently introduced to treat CSR in CHF. The aim of this study was to investigate the effects of ASV on CSR and CHF parameters.. In 29 male patients (63.9+/-9 years, NYHA> or =II, left ventricular ejection fraction [LV-EF]< or =40%), cardiorespiratory polygraphy, cardiopulmonary exercise (CPX) testing, and echocardiography were performed and concentrations of NT-proBNP determined before and after 5.8+/-3.5 months (median 5.7 months) of ASV (AutoSet CS2, ResMed) treatment. All patients also received guideline-driven CHF therapy.. Apnoea-hypopnoea-index was reduced from 37.4+/-9.4/h to 3.9+/-4.1/h (p<0.001). Workload during CPX testing increased from 81+/-26 to 100+/-31 W (p=0.005), oxygen uptake (VO2) at the anaerobic threshold from 12.6+/-3 to 15.3+/-4 ml/kg/min (p=0.01) and predicted peak VO2 from 58+/-12% to 69+/-17% (p=0.007). LV-EF increased from 28.2+/-7% to 35.2+/-11% (p=0.001), and NT-proBNP levels decreased significantly (2285+/-2192 pg/ml to 1061+/-1293 pg/ml, p=0.01).. In selected patients with CHF and CSR, addition of ASV to standard heart failure therapy is able to improve SDB, CPX test results, LV-EF and NT-proBNP concentrations.

Topics: Aged; Cheyne-Stokes Respiration; Cohort Studies; Exercise Tolerance; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Positive-Pressure Respiration; Registries; Retrospective Studies; Sleep Apnea Syndromes; Stroke Volume

Topics: Cheyne-Stokes Respiration; Continuous Positive Airway Pressure; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Oxygen; Positive-Pressure Respiration; Randomized Controlled Trials as Topic; Sleep; Sleep Apnea Syndromes

Topics: Atrial Natriuretic Factor; Cardiovascular Diseases; Chronic Disease; Circadian Rhythm; Comorbidity; Continuous Positive Airway Pressure; Heart Failure; Humans; Natriuretic Peptide, Brain; Oxygen; Polysomnography; Sleep Apnea Syndromes; Wakefulness

We compared brain natriuretic peptide (BNP) levels in patients with obstructive sleep apnea (OSA) with and without cardiovascular disease to BNP in healthy control subjects. OSA was not associated with increased plasma BNP or atrial natriuretic peptide (ANP) in otherwise healthy subjects during wakefulness. Untreated OSA increased ANP overnight, and ANP levels decreased with treatment of OSA. However, OSA did not elicit acute overnight changes in BNP, either in normal subjects or in patients with coexisting cardiovascular disease (including chronic heart failure).

Topics: Adult; Aged; Atrial Natriuretic Factor; Cardiovascular Diseases; Chronic Disease; Circadian Rhythm; Comorbidity; Continuous Positive Airway Pressure; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Oxygen; Polysomnography; Reference Values; Sleep Apnea Syndromes; Wakefulness

In patients with congestive heart failure (CHF), sleep disordered breathing (SDB)--including obstructive and central sleep apnoea as well as periodic breathing--is a common condition and is believed to increase the risk of mortality. Treatment of SDB is considered important in the management of CHF. Improvements in SDB have a positive effect on cardiac output, measured with left ventricular ejection fraction (LVEF); on neurohormonal activity, measured as brain natriuretic peptide (BNP); and on the quality of life. Continuous positive airway pressure has been the traditional method used to treat SDB in patients with CHF, but compliance and tolerability are poor. A mandibular advancement device (MAD) is a dental device recommended for the treatment of sleep apnoea, but the method has never been evaluated in patients with CHF. The aims of the present studies were to evaluate the practical use of the MAD for the treatment of SDB in patients with CHF and to test the hypothesis that this intervention increases the dimensions of the pharyngeal airway (PAW), reduces SDB and BNP, and improves LVEF and the quality of life. Patients with mild to moderate CHF and SDB were evaluated using a portable polysomnographic device, lateral radiographs, cardiological and odontological examinations, and quality of life measures prior to and following intervention with an custom-made MAD. At the short-term follow-up 4-6 weeks after habituation with the MAD, the severity of SDB according to the apnoea-hypopnoea index had decreased from 25.1 +/- 9.4 (mean +/- SD) to 14.7 +/- 9.7 (p = 0.003). An increase in the inferior region of the PAW (7 +/- 5 mm) was observed on radiographs (p = 0.0001). However, no correlation between the effect of the MAD on the dimensions of the PAW and its effect on SDB was found. At the 6-month follow-up, the sleep apnoea-related symptoms had decreased by 31% (p = 0.003). Quality of life remained stable. BNP were reduced from 195.8 +/- 180.5 pg/ml to 148.1 +/- 139.9 pg/ml (p = 0.035). LVEF, however, remained unchanged. At the 12-month follow-up, 64 % of the patients were still using the MAD. Three patients withdrew from the study because of discomfort with the MAD. In most patients, MAD treatment had no severe side effect on the signs or symptoms of temporomandibular disorders. However, dental complications were observed. In conclusion, in patients with stable CHF who are experiencing problems with SDB, MAD intervention appears to reduce the severity of SD

Topics: Adult; Age Factors; Aged; Female; Follow-Up Studies; Heart Failure; Humans; Male; Mandibular Advancement; Middle Aged; Natriuretic Peptide, Brain; Patient Satisfaction; Pharynx; Polysomnography; Quality of Life; Radiography; Sleep Apnea Syndromes; Sleep Stages; Snoring; Stroke Volume; Survival Rate; Temporomandibular Joint Disorders

The nocturnal secretion profile of the newly identified natriuretic peptide (NP), brain natriuretic peptide (BNP), was studied in 14 patients with obstructive sleep apnoea syndrome (OSAS) (apnoea hypopnoea index: 60.5 +/- 3.4, mean +/- SE) during two separate nights before and during nasal continuous positive airway pressure (NCPAP) therapy. Plasma levels of NPs (atrial natriuretic peptides; ANP and BNP) were measured at 2-h intervals during sleep. Simultaneously, blood pressure was measured by a non-invasive method (Finapres, Ohmeda, Englewood, CO, USA) and urine was collected for determining volume and catecholamine levels. Urinary and serum sodium concentration were determined before and after the study. Eight non-snoring subjects were also studied for the investigation of normal nocturnal profiles of BNP levels. To understand the discrete secretion profiles of the two NPs during sleep, blood was sampled from an additional seven patients every 5 min over a 30-min period around 00.00 and 04.00 hours before NCPAP. In patients with OSAS, plasma BNP levels increased from the beginning of sleep (22:00 h) to the morning (06:00 h) before NCPAP therapy (P < 0.01, ANOVA). Baseline BNP levels were not significantly correlated with patient's clinical and polysomnographic parameters. However, in the latter half of the sleep period (02:00-06:00 h), increases in BNP levels during the night before NCPAP therapy were significantly correlated with blood pressure elevations (systolic: r = 0.784 P < 0.01, diastolic: r = 0.587 P < 0.01) and with apnoea duration (r = 0.582 P < 0.01). In normal subjects BP and BNP levels were not changed significantly during sleep. Plasma BNP levels were well correlated with concomitant ANP levels (P < 0.001). NCPAP therapy reduced ANP and BNP levels during sleep and in the morning (P < 0.01). Plasma levels of BNP at 5 min intervals before NCPAP therapy revealed few variations. On the other hand, ANP levels fluctuated over the 30-min period. Changes in BNP levels during sleep in the patients with OSAS may be related to blood pressure variations, but may be too small to play a significant physiological role in regulating diuresis in OSAS. Further work is required to determine the precise role of dual natriuretic system in cardiovascular load and natriuresis in OSAS.

Topics: Atrial Natriuretic Factor; Blood Pressure; Circadian Rhythm; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Polysomnography; Positive-Pressure Respiration; Severity of Illness Index; Sleep Apnea Syndromes