C-Reactive Protein Is Elevated in Heart Failure Patients with Central Sleep Apnea and Cheyne-Stokes Respiration

Background: Manifestation of central sleep apnea (CSA) with Cheyne-Stokes respiration is of major prognostic impact in chronic heart failure (CHF). Inflammatory processes have been linked to a progression of cardiovascular diseases, including heart failure. While an association of C-reactive protein (CRP) levels to obstructive sleep apnea has been documented before, there is a lack of information regarding variation of CRP levels in patients with CSA. Objectives: The objective of this study was to investigate a potential association of CRP levels to CSA severity in CHF patients. Methods: High sensitivity CRP levels were analyzed in 966 patients with CHF (BMI 26.3 +/- 4.6, New York Heart Association class 2.6 +/- 0.5, left ventricular ejection fraction 29.4 +/- 7.9%, N-terminal pro-brain natriuretic peptide, NT-proBNP, level 2,209 +/- 3,315 pg/ml) without sleep-disordered breathing (SDB; Apnea-Hypopnea Index, AHI, < 5/h) or various degrees of CSA, documented by in-hospital cardiorespiratory polygraphy or polysomnography. Results: The CRP concentration in CHF patients was 0.550 +/- 0.794 mg/dl in patients without SDB (AHI 0-4/h, n = 403) versus 0.488 +/- 0.708 mg/dl in patients with mild CSA (AHI 5-14/h, n = 123, p = n.s.) and 0.660 +/- 0.963 mg/dl in patients with moderate CSA (AHI 15-29/h, n = 160, p = n.s.). In patients with severe CSA (AHI = 30/h, n = 280), significantly higher CRP concentrations were documented (0.893 +/- 1.384 mg/dl, p < 0.05). Stepwise regression analysis revealed AHI, NT-proBNP and heart rate to be independently associated with elevated CRP levels. Conclusion: Severe CSA in CHF patients is associated with elevated levels of CRP, a systemic marker of inflammation and cardiovascular risk. This might explain in part the negative prognostic impact of CSA in these patients. Copyright (C) 2013 S. Karger AG, Basel