Assessment of Human Natriuretic Peptides (B), Human N-Terminal Pro-BNP and Nor-epinephrine as Neurohumoral Markers in Sleep Disordered Breathing among Heart Failure Patients in Upper Egypt

Abstract

Objective: The purposes of this study are to: (1) Measure neurohumoral activation in heart failure patients with and without Sleep Disordered Breathing; (2) Assessment of neurohumoral markers with the severity of sleep apnea and severity of heart failure.Patients and methods: In this case report study, we studied 100 patients with heart failure (64 male, 36 female). All patients underwent echocardiography and a full night-attended polysomnography, in addition to neurohumoral evaluation.Results: Group (1) sleep Disordered Breathing (SDB) had significant increase in the plasma concentration level of BNP (591.50 ± 165.75 vs. 298.33 ± 86.63 pg/ml, P=0.001*), NT-proBNP (1750.05 ± 773.15 vs. 686.98 ± 377.88 pg/ml, P=0.001*) and nor epinephrine (NE) (616.12 ± 139.57 vs. 203.80 ± 64.30 pg/ml, P=0.001*) when compared with No-SDB. A significant increase in plasma level of NT-proBNP and nor-epinephrine (NE) in OSA was observed when compared with central sleep apnea (CSA). Increased neurohumoral markers with different severity of apnea hypopnea index (AHI). Moreover, a significant increase was observed in neurohumoral markers with increased severity of left ventricular ejection fraction (LVEF). Based on echocardiographic etiology of heart failure, patients with dilated cardiomyopathy had a significant increase in plasma level of BNP and NT-pro BNP. On the other hand, plasma concentration level of norepinephrine (NE) was significantly increased in patients with hypertensive heart disease.Conclusion: Heart failure patients with sleep disordered breathing were associated with higher levels of neurohumoral activation. Moreover N-TproBNP (<300m pg/ml) and nor epinephrine (NE)<300 pg/ml were predictors of OSA among heart failure.