0
Clinical Investigations: SLEEP AND BREATHING |

Brain Natriuretic Peptide in Patients With Congestive Heart Failure and Central Sleep Apnea*

Carmen Carmona-Bernal, MD; Esther Quintana-Gallego, MD; Manuel Villa-Gil, PhD; Angeles Sánchez-Armengol, MD; Angel Martínez-Martínez, MD; Francisco Capote, MD
Author and Funding Information

*From the Medical-Surgical Unit of Respiratory Diseases (Drs. Carmona-Bernal, Quintana-Gallego, Sánchez-Armengol, and Capote), the Department of Cardiology (Drs. Villa-Gil and Martínez-Martínez), Virgen del Rocío University Hospital, Seville, Spain.

Correspondence to: Carmen Carmona-Bernal, MD, C/ Pérez Galdós, 7, E-41500 Alcalá de Guadaira, Seville, Spain; e-mail: ccarmona@cica.es



Chest. 2005;127(5):1667-1673. doi:10.1378/chest.127.5.1667
Text Size: A A A
Published online

Study objective: To assess the possible relationship between Cheyne-Stokes respiration (CSR) associated with central sleep apnea (CSA) syndrome and brain natriuretic peptide (BNP) in an outpatient population presenting with stable congestive heart failure (CHF).

Measurements and results: Ninety patients with CHF due to systolic dysfunction (left ventricular ejection fraction ≤ 45%) were prospectively studied. Each patient underwent conventional polysomnography to establish the diagnosis of CSR-CSA and determination of the BNP level. The correlation between BNP levels and the apnea-hypopnea index (AHI) and desaturation index (DI) was evaluated, as was the accuracy of BNP in identifying CHF-associated CSR-CSA, as determined by the area under the receiver operating characteristic (ROC) curve. Possible confounding variables were assessed, and a stepwise multiple regression analysis was applied to identify those factors that best predicted the variability in BNP levels. Five of the 90 patients were excluded from the study as they presented with obstructive sleep apnea syndrome. Of the remaining 85 patients, 25 (28%) presented with associated CSR-CSA. The mean (±SEM) BNP level was higher in this group (166.44 ± 29.6 pg/mL) than in the group with isolated CHF (62.01 ± 13.6 pg/mL; p < 0.001). There was a moderate correlation between BNP levels and AHI. The ROC curve that best identified CSR-CSA was obtained with a BNP cutoff value of 116.25 pg/mL (sensitivity, 62%; specificity, 92%; accuracy, 83%). Differences between the two groups in terms of BNP levels persisted after adjusting for the confounding variables that were analyzed. Only AHI and DI were independently related to the BNP level, and both explain the 30.5% variability.

Conclusion: Patients with CHF and CSR-CSA have higher BNP levels than those without CSR-CSA. Our results suggest that CSR-CSA and BNP levels are related. However, the possibility that both factors might be independent expressions of the functional status of CHF patients cannot be ruled out.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
Guidelines
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543