Abstract
Study ObjectivesObstructive sleep apnea (OSA) might lead to oxidative stress, inflammation and elevated circulating copeptin, proANP and proADM levels. We aimed to evaluate whether the levels of these prohormones are higher in patients with OSA and whether they might change under continuous positive airway pressure (CPAP) therapy, serving as potential proxies for the diagnosis and therapy-response in OSA.MethodsA total of 310 patients with suspicion of OSA were recruited. Screening for OSA was performed using overnight pulse oximetry followed by polygraphy and a venous puncture in the morning. All patients diagnosed with OSA underwent CPAP adaptation. A venous puncture was conducted in the night before CPAP and in the following morning. At 1 and 6 months of treatment, polygraphy was performed, followed by a venous puncture in the morning. In the acquired blood, copeptin, proANP and proADM levels were measured.ResultsWe analyzed 232 patients with OSA and 30 patients without OSA. Our results indicated that only copeptin levels differed significantly among patients with and without OSA at baseline. In OSA patients, the levels of proADM significantly changed after 1 and 6 months on CPAP therapy, when compared to baseline (p < 0.001 and p = 0.020). Additionally, proANP levels significantly decreased after 12 h on CPAP therapy, as compared to baseline levels (p < 0.001).ConclusionsCopeptin is significantly associated with the presence of OSA. ProANP levels might serve as a potential proxy for the acute response to non-invasive ventilation (12 h), while proADM reflects the long-term response (1 and 6 months).
Highlights
Obstructive sleep apnea (OSA) is a disorder characterised by repetitive upper airway obstruction during sleep, that might lead to intermittent hypoxia, sleep fragmentation and daytime symptoms such as excessive sleepiness, the so-called obstructive sleep apnea syndrome (OSAS) [1]
Repetitive rises in blood pressure and apnea-induced stress in OSA may contribute as a trigger to release several prohormones, such as the pro-atrial natriuretic peptide, the pro-adrenomedullin and the pro-arginine vasopressin [4, 5]
The objective of this study was to evaluate whether copeptin, pro-atrial natriuretic peptide (proANP) and proADM levels are higher in patients with OSA and whether they might change under continuous positive airway pressure (CPAP) therapy, serving as potential proxies for the diagnosis and therapy-response in OSA
Summary
Obstructive sleep apnea (OSA) is a disorder characterised by repetitive upper airway obstruction during sleep, that might lead to intermittent hypoxia, sleep fragmentation and daytime symptoms such as excessive sleepiness, the so-called obstructive sleep apnea syndrome (OSAS) [1]. Chemoreflex-mediated vascular sympathetic activation and vasoconstriction intensify as apnea progresses, in association with increases in blood pressure [3]. Repetitive rises in blood pressure and apnea-induced stress in OSA may contribute as a trigger to release several prohormones, such as the pro-atrial natriuretic peptide (proANP), the pro-adrenomedullin (proADM) and the pro-arginine vasopressin (proAVP or copeptin) [4, 5]. Oxidative stress [11, 12], inflammation [13] and apoptosis [14,15,16] can induce ADM synthesis. All of these stimuli might be active in the case of OSA
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