The effect of surgical and non-surgical weight loss on N-terminal pro-B-type natriuretic peptide and its relation to obstructive sleep apnea and pulmonary function

Anne-Marie Gabrielsen, Torbjørn Omland, Mette Brokner, Jan Magnus Fredheim, Jens Jordan, Sverre Lehmann, May Brit Lund, Jøran Hjelmesæth, Dag Hofsø, Anne-Marie Gabrielsen, Torbjørn Omland, Mette Brokner, Jan Magnus Fredheim, Jens Jordan, Sverre Lehmann, May Brit Lund, Jøran Hjelmesæth, Dag Hofsø

Abstract

Background: Obesity is a major risk factor for obstructive sleep apnea, impaired pulmonary function and heart failure, but obesity is also associated with paradoxically low levels of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP). In subjects with severe obesity undergoing weight loss treatment, we assessed the associations between changes in severity of obstructive sleep apnea, pulmonary function and serum NT-proBNP levels.

Methods: One-year non-randomized controlled clinical trial. Participants, 69.6 % women, mean (SD) age 44.6 (10.8) years and body mass index (BMI) 45.1 (5.6) kg/m(2), underwent gastric bypass surgery (n = 76) or intensive lifestyle intervention (n = 63), resulting in 30 (8) % and 8 (9) % weight loss, respectively. The reference group included 30 normal weight, healthy, gender and age matched controls. Sleep recordings, arterial blood gases, pulmonary function and blood tests were assessed before and 1 year after the interventions.

Results: NT-proBNP concentrations increased significantly more after surgery than after lifestyle intervention. The post intervention values in both groups were significantly higher than in a normal weight healthy reference group. In the whole study population changes (∆) in NT-proBNP correlated significantly with changes in both BMI (r = -0.213) and apnea hypopnea index (AHI, r = -0.354). ∆NT-proBNP was, independent of age, gender and ∆BMI, associated with ∆AHI (beta -0.216, p = 0.021). ∆AHI was, independent of ∆BMI, significantly associated with changes in pO2 (beta -0.204), pCO2 (beta 0.199), forced vital capacity (beta -0.168) and forced expiratory volume first second (beta -0.160).

Conclusions: Gastric bypass surgery was associated with a greater increase in NT-proBNP concentrations than non-surgical weight loss treatment. Reduced AHI was, independent of weight loss, associated with increased NT-proBNP levels and improved dynamic lung volumes and daytime blood gases. Clinical Trial Registration ClinicalTrials.gov NCT00273104, retrospectively registered Jan 5, 2006 (study start Dec 2005).

Keywords: Natriuretic peptides; Obesity; Respiration; Sleep apnea.

Figures

Fig. 1
Fig. 1
Median NT-proBNP-levels (25–75 percentiles) at baseline and after gastric bypass surgery (n = 71) and lifestyle intervention (n = 62). p values indicate significant changes within and between the intervention groups. The grey background represents the 25–75 percentile for the NT-proBNP levels in the normal weight healthy reference group (n = 30)
Fig. 2
Fig. 2
Scatter plot demonstrating the correlations between changes in NT-proBNP and changes in BMI after gastric bypass surgery and intensive lifestyle intervention
Fig. 3
Fig. 3
Median NT-proBNP-levels (25–75 percentiles) levels at baseline in subjects with AHI

Fig. 4

Scatter plot demonstrating the correlations…

Fig. 4

Scatter plot demonstrating the correlations between changes in NT-proBNP levels and changes in…

Fig. 4
Scatter plot demonstrating the correlations between changes in NT-proBNP levels and changes in AHI after gastric bypass surgery and intensive lifestyle intervention
Fig. 4
Fig. 4
Scatter plot demonstrating the correlations between changes in NT-proBNP levels and changes in AHI after gastric bypass surgery and intensive lifestyle intervention

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