Chest
Volume 127, Issue 5, May 2005, Pages 1667-1673
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Clinical Investigations
Brain Natriuretic Peptide in Patients With Congestive Heart Failure and Central Sleep Apnea

https://doi.org/10.1378/chest.127.5.1667Get rights and content

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.

Section snippets

Patients

We performed a prospective study in 90 consecutive patients of both sexes who had CHF due to systolic dysfunction (left ventricular ejection fraction [LVEF] ≤ 45%) and were being treated in the cardiology service of our hospital. All patients were receiving standard drug therapy for their CHF and were clinically stable, a condition defined as the absence of changes in the signs or symptoms of cardiac failure or in the medication dosage within the 4 weeks preceding their enrollment in the study.

Results

Five of the 90 patients (6%) were excluded from the study because they were found to have obstructive sleep apneas (AHI ≥ 10; obstructive apneas-hypopneas representing > 30% of all respiratory events). Of the 85 patients with CHF who were finally included in the study, 25 patients (28%) also had CSR-CSA (CHF-CSR-CSA group) with a mean AHI of 30.8 ± 3.4 and a mean DI of 37.2 ± 1.3. The remaining 60 patients (66%) had CHF without any SRBDs associated (CHF-no-SRBD group), and had a mean AHI of

Discussion

Our results show that patients with CHF and associated CSR-CSA present higher BNP levels than patients with CHF but without SRBDs. This difference persists after adjustment for age, gender, LVEF, plasma creatinine concentration, and the presence of diabetes. AHI and DI explain 30.5% of the variability in the BNP level. Finally, plasma BNP concentrations show high specificity and negative predictive value for the detection of CSR-CSA in patients with stable CHF.

CHF is a highly prevalent

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    This study was funded by RedRespira grant ISCiii-RTIC-03/11.

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

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