Usui Yasuhiro, Tomiyama Hirofumi, Hashimoto Hideki, Takata Yoshifumi, Inoue Yuichi, Asano Kihiro, Kurohane Saiko, Shiina Kazuki, Hirayama Yoji, Yamashina Akira
Department of Cardiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.
J Hypertens. 2008 Jan;26(1):117-23. doi: 10.1097/HJH.0b013e3282f06eb4.
To examine whether increased plasma levels of B-type natriuretic peptide (BNP) are associated with cardiac structural and functional abnormalities in obstructive sleep apnoea (OSA) patients, taking into consideration the confounding effect of obesity.
In a cross-sectional study, polysomnography, echocardiography and the measurement of the serum levels of BNP were performed in 235 consecutive subjects (age 52 +/- 14 years) visiting our sleep clinic. Left ventricular hypertrophy (LVH) [left ventricular mass index (LVMI) > or = 125 g/m in men, and > or = 110 g/m in women] and cardiac diastolic function (E/A ratio) were determined by echocardiography.
The LVMI, prevalence rate of LVH and body mass index (BMI) were higher, and the E/A ratio lower in the subjects with severe OSA (apnoea-hypopnoea index > or = 30/h, n = 146, LVH 80%) than in those with mild to moderate OSA (n = 89, LVH 35%; P < 0.01), although plasma BNP levels were similar in the two groups. Although the log-transformed plasma BNP level showed a negative correlation with BMI, the results of binary logistic regression analysis demonstrated that the quintile value of BNP was an independent significant variable for the identification of LVH (adjusted odds ratio in quintile 5 = 4.01, 95% confidence interval 1.18-13.70, P < 0.01), even after adjusting for obesity and other risk factors.
An increased likelihood of cardiac structural and functional abnormalities was observed with increasing severity of OSA. Increased plasma levels of BNP do seem to reflect an increased likelihood of LVH in patients with severe OSA.
考虑到肥胖的混杂效应，研究阻塞性睡眠呼吸暂停（OSA）患者血浆B型利钠肽（BNP）水平升高是否与心脏结构和功能异常相关。
在一项横断面研究中，对连续就诊于我们睡眠诊所的235名受试者（年龄52±14岁）进行了多导睡眠图、超声心动图检查以及BNP血清水平测定。通过超声心动图确定左心室肥厚（LVH）[男性左心室质量指数（LVMI）≥125 g/m²，女性≥110 g/m²]和心脏舒张功能（E/A比值）。
重度OSA患者（呼吸暂停低通气指数≥30/h，n = 146，LVH 80%）的LVMI、LVH患病率和体重指数（BMI）较高，E/A比值较低，而轻度至中度OSA患者（n = 89，LVH 35%；P < 0.01），尽管两组血浆BNP水平相似。虽然经对数转换的血浆BNP水平与BMI呈负相关，但二元逻辑回归分析结果表明，即使在调整肥胖和其他危险因素后，BNP的五分位数仍是识别LVH的独立显著变量（五分位数5的调整优势比 = 4.01，95%置信区间1.18 - 13.70，P < 0.01）。
随着OSA严重程度增加，观察到心脏结构和功能异常的可能性增加。血浆BNP水平升高似乎确实反映了重度OSA患者LVH可能性增加。
