Atrial Natriuretic Peptide Release during Sleep in Patients with Obstructive Sleep Apnoea before and during Treatment with Nasal Continuous Positive Airway Pressure

1. Plasma levels of atrial natriuretic peptide (ANP) were measured in seven patients with obstructive sleep apnoea (OSA) while they were awake, during repetitive apnoea and during treatment with nasal continuous positive airway pressure (CPAP). 2. ANP levels in both pulmonary artery and peripheral venous samples were elevated during apnoeic sleep and reduced when apnoea was prevented by nasal CPAP. Mean values of pulmonary artery ANP were 116.3 ± 17.9 pg/ml during apnoea and 64.8 ± 15.2 pg/ml (P < 0.05) on nasal CPAP. 3. It is concluded that there is increased ANP release during sleep in patients with OSA and that CPAP treatment normalizes ANP secretion. These findings may explain previously identified urinary abnormalities in OSA.

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Effects of treatment with nasal continuous positive airway pressure on atrial natriuretic peptide and arginine vasopressin release during sleep in patients with obstructive sleep apnoea

Clinical Science ◽

10.1042/cs0800443 ◽

1991 ◽

Vol 80 (5) ◽

pp. 443-449 ◽

Cited By ~ 73

Author(s):

J. Krieger ◽

M. Follenius ◽

E. Sforza ◽

G. Brandenberger ◽

J. D. Peter

Keyword(s):

Continuous Positive Airway Pressure ◽

Atrial Natriuretic Peptide ◽

Natriuretic Peptide ◽

Obstructive Sleep Apnoea ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Sleep Apnoea ◽

Pressure Treatment ◽

Obstructive Sleep ◽

Atrial Natriuretic

1. Patients with obstructive sleep apnoea have increased diuresis during sleep, which decreases with nasal continuous positive airway pressure treatment. These changes have been attributed to an increased release of atrial natriuretic peptide in obstructive sleep apnoea, and its decrease with continuous positive airway pressure treatment. 2. In order to clarify the change in plasma atrial natriuretic peptide level and to investigate the underlying mechanisms, blood samples were taken at 10 min intervals from nine patients with obstructive sleep apnoea during two nights when the patients were either untreated or treated with continuous positive airway pressure. Polysomnographic monitoring, including transcutaneous oximetry, and measurement of oesophageal pressure were performed simultaneously. Plasma arginine vasopressin was also measured. 3. The plasma level of arginine vasopressin did not change. The level of atrial natriuretic peptide was high and exhibited secretion bursts in six out of the nine patients; it drastically decreased with continuous positive airway pressure treatment. 4. Across the patients, the mean plasma levels of atrial natriuretic peptide was correlated with the degree of hypoxaemia and the degree of oesophageal pressure swings during the sleep apnoeas. 5. Within the patients, cross-correlation studies suggested that the atrial natriuretic peptide secretory bursts were related either to the oesophageal pressure swings or to the apnoea-related hypoxaemia. 6. We conclude that release of atrial natriuretic peptide decreases with continuous positive airway pressure treatment in those patients with obstructive sleep apnoea who have increased release of atrial natriuretic peptide before treatment. 7. The results are in agreement with the hypothesis that the haemodynamic changes induced by the increased swings in intra-thoracic pressure during ineffective respiratory efforts or by the hypoxia-induced vasoconstriction play a role in these changes.

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Upper airway surgery benefits patients with obstructive sleep apnoea who cannot tolerate nasal continuous positive airway pressure

The Journal of Laryngology & Otology ◽

10.1258/002221504323012003 ◽

2004 ◽

Vol 118 (4) ◽

pp. 270-274 ◽

Cited By ~ 9

Author(s):

Melanie A. Souter ◽

Scott Stevenson ◽

Bryn Sparks ◽

Chris Drennan

Keyword(s):

Continuous Positive Airway Pressure ◽

Obstructive Sleep Apnoea ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Upper Airway ◽

Sleep Apnoea ◽

Upper Airway Surgery ◽

Nasal Cpap ◽

Airway Surgery ◽

Obstructive Sleep

Nasal continuous positive airway pressure (CPAP) is the mainstay of treatment for patients with moderate to severe obstructive sleep apnoea (OSA). However, tolerance and compliance are poor.An audit using the Christchurch Hospital ORL surgery database identified patients who underwent upper airway surgery for OSA. Tracheostomy and bimaxillary advancement patients were excluded. Adults with moderate to severe OSA (Desaturation Index (DI) >10 n.h-1), who had failed atrial of nasal CPAP, and had pre-operative and post-operative sleep study data were identified. Objective (DI) and Subjective (Epworth Sleepiness Score (ESS)) outcome measures were recorded.The database identified 69 patients who underwent surgery for snoring or OSA; of these, 25 patients formed the study group. Sixteen out of 25 improved (64 per cent) after surgery, seven out of 25 showed no change (28 per cent), two patients (eight per cent) showed deterioration in their DI. Forty-eight per cent of patients had >50 per cent post-operative improvement in DI. Fourteen out of 25 (56 per cent) had a post-operative DI <20 n.h-1. Seven out of 25 (28 per cent) had a post-operative DI <10 n.h-1. Upper airway surgery has a role in the managementof selected patients with OSA who cannot tolerate nasal CPAP.

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