The correlation between central sleep apnea and serum leptin levels in patients with chronic heart failure_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LI Huimin , XIONG Mengqing ,  HU Ke , DONG Minglin , HU Weihua

Respiratory Department, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P. R. China;

Corresponding?author：

HU Ke, Email: hukejx@163.com

Keywords：

Central sleep apnea; Leptin; Chronic heart failure

DOI：

10.7507/1671-6205.201712006

Video：

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Objective To assess the correlation between central sleep apnea (CSA) and serum leptin (LEP) levels in patients with chronic heart failure. Methods The level of serum LEP and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured by forward-looking method in patients with chronic heart failure who underwent polysomnography during hospitalization from December 2015 to April 2017 in Department of Cardiology and Respiratory Medicine, Renmin Hospital of Wuhan University. And its correlation with CSA was analyzed. Patients were divided into three groups according to the left ventricular ejection fraction (LVEF), and then according to the presence or absence of CSA into CSA group and without SDB group. Results Of the 71 patients with heart failure, 31 had LVEF≥45%, 19 were between 35% and 45% and 21 were≤35% ; 32 of whom were CSA and 39 had no SDB. The lEP concentrations in the LVEF subgroup of CSA groups were significantly lower than those in the control group without SDB, with significantly higher levels of NT-proBNP. Logistic regression showed that CSA was associated with logarithmic LEP (lnLEP) (OR=0.047, 0.030, 0.021, P<0.05). In severe heart failure (LVEF≤35%) group, high NT-proBNP was the risk of CSA (OR=5.942, P=0.045) and the incidence of CSA was as high as 71.4%, which was significantly higher than other groups. However, after adjustment for confounding factors such as age, sex and body mass index (BMI), the correlation no longer existed (OR=6.432, P=0.105). Moreover, CSA with severe cardiac insufficiency had lower LEP than those without SDB. After adjustment for confounding factors such as age, sex and BMI, CSA and lnLEP remained significantly correlated (OR=0.013, P=0.002). Meanwhile, linear correlation analysis also showed that NT-proBNP was negatively correlated with lnLEP (R=–0.751, P<0.001). After adjusting for age, sex, and BMI, this relationship still existed (R=–0.607, P=0.004). Conclusion Decreased levels of leptin and elevated NT-proBNP in patients with chronic heart failure may indicate the presence of CSA.

Citation： LI Huimin, XIONG Mengqing, HU Ke, DONG Minglin, HU Weihua. The correlation between central sleep apnea and serum leptin levels in patients with chronic heart failure. Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(5): 499-503. doi: 10.7507/1671-6205.201712006 Copy

1.	Oldenburg O, Wellmann B, Buchholz A, et al. Nocturnal hypoxaemia is associated with increased mortality in stable heart failure patients. Eur Heart J, 2016, 37(21): 1695-1703.
2.	Dickstein K, Cohen-Solal A, Filippatos G, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur J Heart Fail, 2008, 10(10): 933-989.
3.	何權瀛. 如何認識由慢性心力衰竭所引起的中樞性睡眠呼吸暫停. 中華結核和呼吸雜志, 2017, 40(2): 144-146.
4.	de Haro MC, Figueiredo VN, de Faria AP, et al. High-circulating leptin levels are associated with increased blood pressure in uncontrolled resistant hypertension. J Hum Hypertens, 2013, 27(4): 225-230.
5.	Hilzendeger AM, da Costa Goncalves AC, Plehm R, et al. Autonomic dysregulation in ob/ob mice is improved by inhibition of angiotensin-converting enzyme. J Mol Med (Berl), 2010, 88(4): 383-390.
6.	張延斌, 彭勇, 楊煜, 等. 慢性心力衰竭患者血漿瘦素水平的變化. 中國病理生理雜志, 2007, 23(11): 2270-2271.
7.	翟英慧. 男性慢性心力衰竭患者血清瘦素水平的變化. 中華老年多器官疾病雜志, 2006, 5(1): 51.
8.	Cundrle I Jr, Somers VK, Singh P, et al. Low leptin concentration may identify heart failure patients with central sleep apnea. J Sleep Res, 2018, 27(2): 240-243.
9.	Cundrle I Jr, Somers VK, Singh P, et al. Leptin deficiency promotes central sleep apnea in patients with heart failure. Chest, 2014, 145(1): 72-78.
10.	中華醫學會心血管病分會, 中華心血管病雜志編輯委員會. 中國心力衰竭診斷和治療指南 2014. 中華心血管病雜志, 2014, 42(2): 98-122.
11.	Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med, 2012, 8(5): 597-619.
12.	Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest, 2014, 146(5): 1387-1394.
13.	Malli F, Papaioannou AI, Gourgoulianis KI, et al. The role of leptin in the respiratory system: an overview. Respir Res, 2010, 11(1): 152.
14.	賀群, 李明暉. 阻塞性睡眠呼吸暫停低通氣綜合征程度與血壓變異性和血清瘦素相關性研究. 中華全科醫學, 2017, 15(2): 258-260.
15.	Cusin I, Sainsbury A, Doyle P, et al. The ob gene and insulin. A relationship leading to clues to the understanding of obesity. Diabetes, 1995, 44(12): 1467-1470.
16.	顧衛瓊, 洪潔, 張翼飛, 等. 肥胖人群中血清瘦素、游離脂肪酸和脂聯素水平的相互關系. 中華內分泌代謝雜志, 2003, 19(3): 169-172.
17.	張珺輝. 睡眠呼吸暫停/低通氣綜合征的危害性及健康指導. 中國全科醫學, 2002, 5(3): 185-187.
18.	Tkacova R, Hall M, Liu P, et al. Left ventricular volume in patients with heart failure and cheyne-stokes respiration during sleep. Am J Respir Crit Care Med, 1997, 156(5): 1549-1555.
19.	Andreas S. Central sleep apnea and chronic heart failure. Sleep, 2000, 15(23): S220-223.
20.	Xie A, Skatrud JB, Puleo DS, et al. Apnea-hypopnea threshold for CO₂ in patients with congestive heart failure. Am J Respir Crit Care Med, 2002, 165(9): 1245-1250.
21.	Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur J Heart Failure, 2016, 18(8): 891-975.
22.	Yuan K, Yu J, Shah A, et al. Leptin reduces plasma ANP level via nitric oxide-dependent mechanism. Am J Physiol Regul Integr Comp Physiol, 2010, 298(4): R1007-R1016.

1. Oldenburg O, Wellmann B, Buchholz A, et al. Nocturnal hypoxaemia is associated with increased mortality in stable heart failure patients. Eur Heart J, 2016, 37(21): 1695-1703.
2. Dickstein K, Cohen-Solal A, Filippatos G, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur J Heart Fail, 2008, 10(10): 933-989.
3. 何權瀛. 如何認識由慢性心力衰竭所引起的中樞性睡眠呼吸暫停. 中華結核和呼吸雜志, 2017, 40(2): 144-146.
4. de Haro MC, Figueiredo VN, de Faria AP, et al. High-circulating leptin levels are associated with increased blood pressure in uncontrolled resistant hypertension. J Hum Hypertens, 2013, 27(4): 225-230.
5. Hilzendeger AM, da Costa Goncalves AC, Plehm R, et al. Autonomic dysregulation in ob/ob mice is improved by inhibition of angiotensin-converting enzyme. J Mol Med (Berl), 2010, 88(4): 383-390.
6. 張延斌, 彭勇, 楊煜, 等. 慢性心力衰竭患者血漿瘦素水平的變化. 中國病理生理雜志, 2007, 23(11): 2270-2271.
7. 翟英慧. 男性慢性心力衰竭患者血清瘦素水平的變化. 中華老年多器官疾病雜志, 2006, 5(1): 51.
8. Cundrle I Jr, Somers VK, Singh P, et al. Low leptin concentration may identify heart failure patients with central sleep apnea. J Sleep Res, 2018, 27(2): 240-243.
9. Cundrle I Jr, Somers VK, Singh P, et al. Leptin deficiency promotes central sleep apnea in patients with heart failure. Chest, 2014, 145(1): 72-78.
10. 中華醫學會心血管病分會, 中華心血管病雜志編輯委員會. 中國心力衰竭診斷和治療指南 2014. 中華心血管病雜志, 2014, 42(2): 98-122.
11. Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med, 2012, 8(5): 597-619.
12. Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest, 2014, 146(5): 1387-1394.
13. Malli F, Papaioannou AI, Gourgoulianis KI, et al. The role of leptin in the respiratory system: an overview. Respir Res, 2010, 11(1): 152.
14. 賀群, 李明暉. 阻塞性睡眠呼吸暫停低通氣綜合征程度與血壓變異性和血清瘦素相關性研究. 中華全科醫學, 2017, 15(2): 258-260.
15. Cusin I, Sainsbury A, Doyle P, et al. The ob gene and insulin. A relationship leading to clues to the understanding of obesity. Diabetes, 1995, 44(12): 1467-1470.
16. 顧衛瓊, 洪潔, 張翼飛, 等. 肥胖人群中血清瘦素、游離脂肪酸和脂聯素水平的相互關系. 中華內分泌代謝雜志, 2003, 19(3): 169-172.
17. 張珺輝. 睡眠呼吸暫停/低通氣綜合征的危害性及健康指導. 中國全科醫學, 2002, 5(3): 185-187.
18. Tkacova R, Hall M, Liu P, et al. Left ventricular volume in patients with heart failure and cheyne-stokes respiration during sleep. Am J Respir Crit Care Med, 1997, 156(5): 1549-1555.
19. Andreas S. Central sleep apnea and chronic heart failure. Sleep, 2000, 15(23): S220-223.
20. Xie A, Skatrud JB, Puleo DS, et al. Apnea-hypopnea threshold for CO₂ in patients with congestive heart failure. Am J Respir Crit Care Med, 2002, 165(9): 1245-1250.
21. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur J Heart Failure, 2016, 18(8): 891-975.
22. Yuan K, Yu J, Shah A, et al. Leptin reduces plasma ANP level via nitric oxide-dependent mechanism. Am J Physiol Regul Integr Comp Physiol, 2010, 298(4): R1007-R1016.

Chinese Journal of Respiratory and Critical Care Medicine

The correlation between central sleep apnea and serum leptin levels in patients with chronic heart failure

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