title: Leptin deficiency promotes central sleep apnea in patients with heart failure.
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 &lt; .05 was considered significant.
  
  
  RESULTS
  Subjects with CSA had higher ANP and brain natriuretic peptide (BNP) concentrations (P &lt; .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 &lt; .01) and lower leptin concentrations (8 ± 10.7 ng/mL vs 17.1 ± 8.8 ng/mL, P &lt; .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.
authors.affiliation: Department of Anesthesiology and Intensive Care, International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic.
authors.forename: Ivan
authors.initials: I
authors.lastname: Cundrle
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
authors.forename: Virend K
authors.initials: VK
authors.lastname: Somers
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
authors.forename: Prachi
authors.initials: P
authors.lastname: Singh
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Johnson
authors.affiliation: Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Scott
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
authors.forename: Christelle
authors.initials: C
authors.lastname: van der Walt
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN. Electronic address: olson.lyle@mayo.edu.
authors.forename: Lyle J
authors.initials: LJ
authors.lastname: Olson
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities; D009320:Atrial Natriuretic Factor / Q000097:blood*; D016022:Case-Control Studies; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000150:complications; D006801:Humans; D020738:Leptin / Q000097:blood / Q000172:deficiency*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D017286:Polysomnography; D020182:Sleep Apnea, Central / Q000097:blood* / Q000150:complications
chemical_list: D020738:Leptin; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor
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