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. 2014 Jan;145(1):72-78.
doi: 10.1378/chest.12-2914.

Leptin deficiency promotes central sleep apnea in patients with heart failure

Ivan Cundrle Jr  1 , Virend K Somers  2 , Prachi Singh  2 , Bruce D Johnson  2 , Christopher G Scott  3 , Christelle van der Walt  2 , Lyle J Olson  4
Affiliations

Leptin deficiency promotes central sleep apnea in patients with heart failure

Ivan Cundrle Jr et al. Chest. 2014 Jan.

Abstract

Background: Leptin-deficient animals hyperventilate. Leptin expression by adipocytes is attenuated by atrial natriuretic peptide (ANP). Increased circulating natriuretic peptides (NPs) are associated with an increased risk of central sleep apnea (CSA). This study tested whether serum leptin concentration is inversely correlated to NP concentration and decreased in patients with heart failure (HF) and CSA.

Methods: Subjects with HF (N = 29) were studied by measuring leptin, NPs, CO2 chemosensitivity (Δminute ventilation [V.e]/Δpartial pressure of end-tidal CO2 [Petco2]), and ventilatory efficiency (V.e/CO2 output [V.co2]) and were classified as CSA or no sleep-disordered breathing by polysomnography. CSA was defined as a central apnea-hypopnea index ≥ 15. The Student t test, Mann-Whitney U test, and logistic regression were used for analysis, and data were summarized as mean ± SD; P < .05 was considered significant.

Results: Subjects with CSA had higher ANP and brain natriuretic peptide (BNP) concentrations (P < .05), ΔV.e/ΔPetco2 (2.39 ± 1.03 L/min/mm Hg vs 1.54 ± 0.35 L/min/mm Hg, P = .01), and V.e/V.co2 (43 ± 9 vs 34 ± 7, P < .01) and lower leptin concentrations (8 ± 10.7 ng/mL vs 17.1 ± 8.8 ng/mL, P < .01). Logistic regression analysis (adjusted for age, sex, and BMI) demonstrated leptin (OR = 0.07; 95% CI, 0.01-0.71; P = .04) and BNP (OR = 4.45; 95% CI, 1.1-17.9; P = .05) to be independently associated with CSA.

Conclusions: In patients with HF and CSA, leptin concentration is low and is inversely related to NP concentration. Counterregulatory interactions of leptin and NP may be important in ventilatory control in HF.

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Figures

Figure 1.
Figure 1.
Distribution of mean serum leptin concentrations (ng/mL) in subjects with CSA compared with subjects with no sleep apnea. Mean values with CIs are also shown. CSA = central sleep apnea.
Figure 2.
Figure 2.
Relationship between serum leptin concentration (ng/mL) and ANP concentration in subjects with heart failure. ANP = atrial natriuretic peptide.
See this image and copyright information in PMC

Comment in

  • Leptin and ventilation in heart failure.
    Javaheri S, Schwartz A. Javaheri S, et al. Chest. 2015 May;147(5):e197-e198. doi: 10.1378/chest.15-0113. Chest. 2015. PMID: 25940272 No abstract available.
  • Response.
    Cundrle I Jr, Singh P, Johnson BD, Scott CG, Olson LJ. Cundrle I Jr, et al. Chest. 2015 May;147(5):e198. doi: 10.1378/chest.15-0326. Chest. 2015. PMID: 25940273 No abstract available.

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