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N-terminal pro-B-type natriuretic peptide and functional capacity in patients with obstructive sleep apnea

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Abstract

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 VO2), 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 VO2 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 VO2 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 (β = −0.2; p = 0.02) was independently but weakly associated with higher body weight-indexed peak VO2. 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 VO2 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 VO2, indicating that NT-proBNP is a marker of cardiorespiratory fitness in patients with OSAS. However, the association is too weak to be clinically useful.

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Acknowledgment

The excellent technical assistance by Monika Ott is greatly appreciated. This study was supported by Swiss National Foundation (Grant No. 3200-068115 to T.M., O.D.S., and C.H.).

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Authors and Affiliations

  1. Division of Cardiology, Kantonsspital, St. Gallen, Switzerland

    Micha T. Maeder, Peter Ammann & Hans Rickli

  2. Multidisciplinary Sleep Center and Division of Pulmonary Medicine, Kantonsspital, St. Gallen, Switzerland

    Otto D. Schoch

  3. Institute for Clinical Chemistry and Hematology, Kantonsspital, St. Gallen, Switzerland

    Wolfgang Korte

  4. Center of Geriatric Medicine and Rehabilitation, Bürgerspital, St. Gallen, Switzerland

    Christoph Hürny & Thomas Münzer

  5. Cardiology Division, Palo Alto Veterans Affairs Medical Center, Stanford University, Palo Alto, CA, USA

    Jonathan Myers

  6. Division of Cardiology, University Hospital, Petersgraben 4, 4031, Basel, Switzerland

    Micha T. Maeder

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  1. Micha T. Maeder
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  3. Hans Rickli
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Correspondence to Micha T. Maeder.

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Maeder, M.T., Ammann, P., Rickli, H. et al. N-terminal pro-B-type natriuretic peptide and functional capacity in patients with obstructive sleep apnea. Sleep Breath 12, 7–16 (2008). https://doi.org/10.1007/s11325-007-0143-9

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