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

Abstract

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.(ABSTRACT TRUNCATED AT 250 WORDS)

Obstructive Sleep Apnea Syndrome Affects Left Ventricular Diastolic Function

“…In spite of the evident acute effects on blood pressure surges with nCPAP, a continued reduction in either nocturnal or diurnal blood pressure may be apparent only in hypertensive OSAS patients and not in normotensive patients, probably in relation to the pressor effect of decreased levels of atrial natriuretic peptide induced by nCPAP application despite the reduction in sympathetic drive. 41 The results of the present study do not allow us to determine whether longer therapy with nCPAP might result in a more significant reversal of diastolic abnormalities in OSAS patients. This could be possible, especially in OSAS patients with left ventricular hypertrophy, in view of the information reported by Cloward et al 37 with regression of ventricular hypertrophy after a minimum of 6 months with nCPAP.…”

The association of nocturia with sleep disorders and metabolic and chronic pulmonary conditions: data derived from the polysomnographic evaluations of 730 patients

“…In the literature there are studies reporting an association between obesity and increased frequency of nocturia in patients with OSA (12,13,16,18). In our study, although patients with moderate and severe OSA had increased body mass index and neck circumferences, we failed to demonstrate any effect of these parameters on the frequency of nocturia.…”

“…Moreover, it has been shown that as the severity of OSA increases, the frequency of nocturia increases, as well (6,8). Interestingly, the frequency of nocturia tends to decrease when OSA is treated with continuous positive airway pressure (11,12).…”

Nocturnal Continuous Positive Airway Pressure Decreases Daytime Sympathetic Traffic in Obstructive Sleep Apnea

“…[32][33][34] CPAP treatment reduces atrial natriuretic peptide secretion and sodium excretion. 32,34,35 Thus, the pressor effects of increased sodium retention might oppose the expected blood pressure-lowering effects of reduced sympathetic activity.…”