Relationship between inflammatory biomarkers and sleep-disordered breathing in patients with heart failure
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ORIGINAL ARTICLE
Relationship between inflammatory biomarkers and sleep‑disordered breathing in patients with heart failure Akihiro Sato1,2 · Takao Kato1 · Takatoshi Kasai1,2,3 · Sayaki Ishiwata1,2 · Shoichiro Yatsu1 · Hiroki Matsumoto1 · Jun Shitara1 · Azusa Murata1 · Megumi Shimizu1 · Shoko Suda1 · Yuya Matsue1,2 · Ryo Naito1,2 · Masaru Hiki1 · Hiroyuki Daida1 Received: 29 July 2020 / Accepted: 25 September 2020 © Japanese Society of Sleep Research 2020
Abstract Inflammation activation is associated with adverse outcomes in patients with heart failure (HF). Sleep-disordered breathing (SDB) observed in 50% of patients with HF worsens the clinical outcome of HF, possibly through the exacerbation of inflammation. However, data on inflammation activation related to SDB are limited in patients with HF. We investigated the relationship between SDB severity and serum levels of C-reactive protein (CRP) and tumor necrotic factor (TNF)-α in HF patients with systolic dysfunction. Nineteen patients with HF were enrolled (mean age, 67.3 years; 16 men; mean ejection fraction, 33.6%). No significant correlation was observed between log-transformed CRP level and apnea–hypopnea index (AHI). In univariable analysis for serum CRP level, the percentage of rapid eye movement (REM) sleep per total sleep time was the only significant factor. The lower the percentage of REM sleep, the higher was the CRP level (coefficient, − 0.474; P = 0.047). In contrast, the serum TNF-α level was significantly correlated with age, ischemic etiology, diabetes mellitus, estimated glomerular filtration rate (eGFR), and AHI. In multivariable analysis, eGFR (coefficient, − 0.486; P = 0.017) and AHI (coefficient, 0.399; P = 0.044) significantly and independently correlated with TNF-α level. The severity of SDB expressed as AHI was directly related to the circulating level of TNF-α, but not circulating CRP level, in HF patients with systolic dysfunction. Keywords Apnea–hypopnea index · C-reactive protein · Polysomnography · Tumor necrotic factor-α
Introduction Inflammation is associated with adverse outcomes in patients with heart failure (HF) [1, 2]. Studies have highlighted the close relationship between elevated levels of circulating inflammatory biomarkers and increased mortality Akihiro Sato and Takao Kato contributed equally to this work. * Takatoshi Kasai kasai‑[email protected] 1
Department of Cardiovascular Medicine, Juntendo University School of Medicine, 2‑1‑1 Hongo, Bunkyo‑ku, Tokyo 113‑8421, Japan
2
Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, 2‑1‑1 Hongo, Bunkyo‑ku, Tokyo 113‑8421, Japan
3
Sleep and Sleep Disordered Breathing Center, Juntendo University Hospital, 2‑1‑1 Hongo, Bunkyo‑ku, Tokyo 113‑8421, Japan
and morbidity in patients with HF [3, 4]. HF condition activates inflammation [3, 5], which is further exacerbated by comorbidities such as sleep-disordered breathing (SDB). SDB, one of the common comorbidities in patients with HF (approximately 50% of HF patients exhibit SDB
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