The effect of positive pressure ventilation treatment on apelin and ischemic modified albumine levels in patients with heart failure and sleep disordered breathing

Sleep disordered breathing is an important cause of cardiovascular morbidity and mortality and coexistence with heart failure is common. Thus treatment of this comorbidity is important. Apelin has cardiovascular effects as well as take part in regulation of food intake, fluid metabolism, experimental pain models, bone metabolism, and prevention of oxidative stress in human adipocytes. Ischemia modified albumin (IMA) is an indicator of ischemia that increases due to hypoxia especially in acute myocardial infarction. This study was performed between April 2016 and May 2017 at Gaziantep University Faculty of Medicine, Department of Chest Diseases. Patients with heart failure (echocardiographic ejection fraction (EF) ≤ 50%), eligible for PAP treatment, over 18 years of age and willing to participitate to the study were prospectively enrolled to the study. Polysomnography (PSG) was performed. Venous blood was taken for apelin 13 and IMA levels. Sleep-disordered breathing was detected in 96% of the patients. These patients were underwent Bilevel Positive Airway Pressure (BPAP) titration. Venous blood was obtained in the morning of BPAP titration from 21 patients who tolerated BPAP titration. While the baseline of apelin 13 level was found 8.635±6.344 pg /ml, first day of BPAP was found 16.353±11.999 pg/ ml (p=0.022). The baseline of IMA level was found 4.511 ± 2.026 IU/ml whereas first day of BPAP decreased to 3.977±1.985 (p=0.302). The BPAP device was prescribed (n=21). 11 of these patients with BPAP use were reached after 3 months and control blood was collected. In these patients, while apelin 13 values were 6.021 ± 3.529 pg/ml, at the end of the third month was detected 8.458±3.510 pg/ml (p=0.117). There was no statistically significant decrease in BPAP 3rd month according to the baseline of IMA levels (p=0.445). In conclusion, apelin 13 which is thought to be cardioprotective was found to increase only in the acute phase with BPAP treatment in patients with heart failure and sleep disordered breathing but there was no significant change in IMA level. Key words: Obstructive sleep apnea syndrome, central sleep apnea syndrome, apelin, heart failure, IMA