Effects of nasal CPAP on sympathetic activity in patients with heart failure and central sleep apnea.

Abstract

We hypothesized that (1) patients with congestive heart failure (CHF) and Cheyne-Stokes respiration with central sleep apnea (CSR-CSA) would have greater nocturnal urinary and daytime plasma norepinephrine concentrations (UNE and PNE, respectively) than those without CSR-CSA because of apneas, hypoxia and arousals from sleep and (2) attenuation of CSR-CSA by nasal continuous positive airway pressure (NCPAP) would reduce UNE and PNE concentrations. Eighteen patients with and 17 without CSR-CSA (Non-CSR-CSA group) were studied. Left ventricular ejection fraction was similar in the two groups, but overnight UNE and awake PNE concentrations were greater in the CSR-CSA group (30.2 +/- 2.5 nmol/mmol creatinine and 3.32 +/- 0.29 nmol/L) than in the Non-CSR-CSA group (15.8 +/- 2.1 nmol/mmol creatinine, p < 0.005, and 2.06 +/- 0.56 nmol/L, p < 0.05, respectively). Patients with CSR-CSA were randomized to a control group or to nightly NCPAP for 1 mo. CSR-CSA was attenuated in the NCPAP but not in the control group. The NCPAP group experienced greater reductions in UNE and PNE concentrations (-12.5 +/- 3.3 nmol/mmol creatinine and -0.74 +/- 0.40 nmol/L) than did the control group (-1.3 +/- 2.8 nmol/mmol creatinine, p < 0.025 and 1.16 +/- 0.66 nmol/L, p < 0.025, respectively). In conclusion, in patients with CHF, CSR-CSA is associated with elevated sympathoneural activity, which can be reduced by NCPAP.

• Authors: M T Naughton, D C Benard, P P Liu, R Rutherford, F Rankin, T D Bradley
• Journal: American journal of respiratory and critical care medicine (Am J Respir Crit Care Med) Vol. 152 Issue 2 Pg. 473-9 (Aug 1995) ISSN: 1073-449X [Print] United States
• PMID: 7633695 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Creatinine
• Norepinephrine
• Epinephrine

Topics

• Adolescent
• Adult
• Aged
• Cheyne-Stokes Respiration (metabolism, physiopathology)
• Circadian Rhythm
• Creatinine (urine)
• Epinephrine (blood, urine)
• Heart Failure (metabolism, physiopathology)
• Humans
• Hypoxia (metabolism, physiopathology)
• Male
• Middle Aged
• Norepinephrine (blood, urine)
• Nose
• Positive-Pressure Respiration (methods)
• Sleep Apnea Syndromes (metabolism, physiopathology)
• Sleep Stages
• Stroke Volume
• Sympathetic Nervous System (physiopathology)
• Ventricular Function, Left