Low leptin concentration has been shown to be associated with central sleep apnea in heart failure patients. We hypothesized that low leptin concentration predicts central sleep apnea. Consecutive ambulatory New York Heart Association (NYHA) classes I-IV heart failure patients were studied prospectively, including measurement of serum leptin, echocardiography and polysomnography. Sleep apnea was defined by type (central/mixed/obstructive) and by apnea-hypopnea index ≥5 by polysomnography. Subjects were divided into four groups by polysomnography: (1) central sleep apnea, (2) mixed apnea, (3) no apnea and (4) obstructive sleep apnea. Fifty-six subjects were included. Eighteen subjects were diagnosed with central sleep apnea, 15 with mixed apnea, 12 with obstructive apnea and 11 with no sleep apnea. Leptin concentration was significantly lower in central sleep apnea compared to obstructive apnea (8 ± 10.7 ng mL-1 versus 19.7 ± 14.7 ng mL-1 , P ˂ 0.01) or no sleep apnea (8 ± 10.7 ng mL-1 versus 17.1 ± 8.4 ng mL-1 , P ˂ 0.01). Logistic regression showed leptin to be associated independently with central sleep apnea [odds ratio (OR): 0.19; 95% confidence interval (CI): 0.06-0.62; area under the curve (AUC): 0.80, P < 0.01]. For the detection of central sleep apnea, a cut-off value for leptin concentration 5 ng mL-1 yielded a sensitivity of 50% and specificity of 89%. In conclusion, a low leptin concentration may have utility for the screening of heart failure patients for central sleep apnea.

Department of Biomedical Statistics and Informatics Mayo Clinic Rochester MN USA

Division of Cardiovascular Diseases Mayo Clinic Rochester MN USA

International Clinical Research Center and Department of Anesthesiology and Intensive Care St Anne's University Hospital Brno Czech Republic

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Arzt M, Floras JS, Logan AG, et al. Suppression of Central Sleep Apnea by Continuous Positive Airway Pressure and Transplant-Free Survival in Heart Failure. Circulation. 2007;115:3173–3180. PubMed

Arzt M, Woehrle H, Oldenburg O, et al. Prevalence and Predictors of Sleep-Disordered Breathing in Patients With Stable Chronic Heart Failure: The SchlaHF Registry. JACC Heart Fail. 2016;4:116–125. PubMed

Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. J Clin Sleep Med. 2012;8:597–619. PubMed PMC

Calvin AD, Somers VK, van der Walt C, Scott CG, Olson LJ. Relation of natriuretic peptide concentrations to central sleep apnea in patients with heart failure. Chest. 2011;140:1517–1523. PubMed PMC

Carmona-Bernal C, Quintana-Gallego E, Villa-Gil M, Sánchez-Armengol A, Martínez-Martínez A, Capote F. Brain natriuretic peptide in patients with congestive heart failure and central sleep apnea. Chest. 2005;127:1667–1673. PubMed

Cundrle I, Somers VK, Singh P, et al. Leptin deficiency promotes central sleep apnea in patients with heart failure. Chest. 2014;145:72–78. PubMed PMC

Fain JN, Kanu A, Bahouth SW, Cowan GSM, Lloyd Hiler M. Inhibition of leptin release by atrial natriuretic peptide (ANP) in human adipocytes. Biochem Pharmacol. 2003;65:1883–1888. PubMed

Iber C, Ancoli-Israel S, Chesson A, Quan SF for the American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology, and Technical Specifications. 1. Westchester, Illinois: American Academy of Sleep Medicine; 2007.

Khayat R, Abraham W, Patt B, et al. Central sleep apnea is a predictor of cardiac readmission in hospitalized patients with systolic heart failure. J Card Fail. 2012;18:534–540. PubMed PMC

Oldenburg O, Wellmann B, Buchholz A, et al. Nocturnal hypoxaemia is associated with increased mortality in stable heart failure patients. Eur Heart J. 2016;37:1695–1703. PubMed

Ruhl CE, Harris TB, Ding J, et al. Body mass index and serum leptin concentration independently estimate percentage body fat in older adults. Am J Clin Nutr. 2007;85:1121–1126. PubMed

Sériès F, Kimoff RJ, Morrison D, et al. Prospective evaluation of nocturnal oximetry for detection of sleep-related breathing disturbances in patients with chronic heart failure. Chest. 2005;127:1507–1514. PubMed

Sin DD, Fitzgerald F, Parker JD, Newton G, Floras JS, Bradley TD. Risk Factors for Central and Obstructive Sleep Apnea in 450 Men And Women with Congestive Heart Failure. Am J Respir Crit Care Med. 1999;160:1101–1106. PubMed

Yuan K, Yu J, Shah A, et al. Leptin reduces plasma ANP level via nitric oxide-dependent mechanism. Am J Physiol Regul Integr Comp Physiol. 2010;298:R1007–1016. PubMed