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Original Research |

Relation of Natriuretic Peptide Concentrations to Central Sleep Apnea in Patients With Heart FailureNatriuretic Peptides and Central Sleep Apnea

Andrew D. Calvin, MD, MPH; Virend K. Somers, MD, PhD, FCCP; Christelle van der Walt, RPSGT; Christopher G. Scott, MS; Lyle J. Olson, MD; for the American Academy of Sleep Medicine
Author and Funding Information

From the Division of Cardiovascular Diseases (Drs Calvin, Somers, and Olson; Ms van der Walt; and Mr Scott), and Department of Biomedical Statistics and Informatics (Mr Scott), Mayo Clinic, Rochester, MN.

Correspondence to: Lyle J. Olson, MD, Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905; e-mail: olson.lyle@mayo.edu

Values are from the 33 male subjects only and presented as mean ± SD unless otherwise noted. ACE/ARB = angiotensin converting enzyme inhibitor or angiotensin II receptor blocker; CSA = central sleep apnea; eGFR = estimated glomerular filtration rate; HF = heart failure; LVEF = left ventricular ejection fraction; NYHA = New York Heart Association.

Values are presented as mean ± SD. AHI = apnea-hypopnea index; Sao2 = arterial oxygen saturation by transcutaneous oxygen sensor while awake or during the entire sleep period; T90% = time with arterial oxygen saturation < 90%. See Table 1 legend for expansion of other abbreviations.

ANP = atrial natriuretic peptide; BNP = brain natriuretic peptide. See Table 1 legend for expansion of other abbreviations.

LR− = negative likelihood ratio; LR+ = positive likelihood ratio; NPV = negative predictive value; PPV = positive predictive value. See Table 1 and 3 legends for expansion of other abbreviations.

Funding/Support: This work was supported by the Mayo Clinic Clinician-Investigator Training Program (A. D. C.); Mayo Foundation; American Heart Association [Grant 04-50103Z]; National Heart Lung and Blood Institute [Grants HL65176, HL70302, and HL73211]; and the National Center for Research Resources (NCRR) [Grant 1ULI RR024150], a component of the National Institutes of Health and the National Institutes of Health Roadmap for Medical Research.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Funding/Support: This work was supported by the Mayo Clinic Clinician-Investigator Training Program (A. D. C.); Mayo Foundation; American Heart Association [Grant 04-50103Z]; National Heart Lung and Blood Institute [Grants HL65176, HL70302, and HL73211]; and the National Center for Research Resources (NCRR) [Grant 1ULI RR024150], a component of the National Institutes of Health and the National Institutes of Health Roadmap for Medical Research.

Funding/Support: This work was supported by the Mayo Clinic Clinician-Investigator Training Program (A. D. C.); Mayo Foundation; American Heart Association [Grant 04-50103Z]; National Heart Lung and Blood Institute [Grants HL65176, HL70302, and HL73211]; and the National Center for Research Resources (NCRR) [Grant 1ULI RR024150], a component of the National Institutes of Health and the National Institutes of Health Roadmap for Medical Research.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Chest. 2011;140(6):1517-1523. doi:10.1378/chest.10-2472
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Background:  Central sleep apnea (CSA) is frequent among patients with heart failure (HF) and associated with increased morbidity and mortality. Elevated cardiac filling pressures promote CSA and atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) secretion. We hypothesized that circulating natriuretic peptide concentrations predict CSA.

Methods:  Consecutive patients with HF (n = 44) with left ventricular ejection fraction (LVEF) ≤ 35% underwent polysomnography for detection of CSA. CSA was defined as an apnea-hypopnea index ≥ 15 with ≥ 50% central apneic events. The relation of natriuretic peptide concentrations to CSA was evaluated by estimation of ORs and receiver operator characteristics (ROCs).

Results:  Twenty-seven subjects (61%) had CSA, with men more frequently affected than women (73% vs 27%; OR, 7.1; P = .01); given that only three women had CSA, further analysis was restricted to men. Subjects with CSA had higher mean ANP (4,336 pg/mL vs 2,510 pg/mL, P = .03) and BNP concentrations (746 pg/mL vs 379 pg/mL, P = .05). ANP and BNP concentrations were significantly related to CSA (OR, 3.7 per 3,000 pg/mL, P = .03 and OR, 1.5 per 200 pg/mL, P = .04, respectively), whereas age, LVEF, and New York Heart Association functional class were not. Concentrations of ANP and BNP were predictive of CSA as ROC demonstrated areas under the curve of 0.75 and 0.73, respectively.

Conclusions:  Risk of CSA is related to severity of HF. ANP and BNP concentrations performed similarly for detection of CSA; low concentrations appear associated with low risk for CSA in men.

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