Risk of chronic kidney disease in patients with obstructive sleep apnea

Sleep

article

Beaudin, Andrew E¹  Raneri, Jill K³  Ahmed, Sofia B⁴  Hirsch Allen, A J Marcus⁶  Nocon, Andrhea⁷  Gomes, Teresa⁸  Gakwaya, Simon⁹  Series, Fréderic⁹  Kimoff, John⁸  Skomro, Robert P⁷  Ayas, Najib T⁶  Hanly, Patrick J² 

[1] Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary;Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary;Sleep Centre, Foothills Medical Centre;Department of Medicine, Cumming School of Medicine, University of Calgary;Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary;Department of Medicine, Respiratory and Critical Care Divisions, University of British Columbia;Division of Respirology, Critical Care and Sleep Medicine, University of Saskatchewan;Respiratory Division and Sleep Laboratory, McGill University Health Centre;Unité de recherche en pneumologie, Centre de recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval

关键词: obstructive sleep apnea;    chronic kidney disease;    glomerular filtration rate;    albumin:creatinine ratio;   

DOI  :  10.1093/sleep/zsab267

学科分类：生理学

来源: American Academy of Sleep Medicine

【 摘 要 】

Study Objectives Chronic kidney disease (CKD) is a global health concern and a major risk factor for cardiovascular morbidity and mortality. Obstructive sleep apnea (OSA) may exacerbate this risk by contributing to the development of CKD. This study investigated the prevalence and patient awareness of the risk of CKD progression in individuals with OSA.Methods Adults referred to five Canadian academic sleep centers for suspected OSA completed a questionnaire, a home sleep apnea test or in-lab polysomnography and provided blood and urine samples for measurement of estimated glomerular filtration rate (eGFR) and the albumin:creatinine ratio (ACR), respectively. The risk of CKD progression was estimated from a heat map incorporating both eGFR and ACR.Results 1295 adults (42% female, 54 ± 13 years) were categorized based on the oxygen desaturation index (4% desaturation): <15 (no/mild OSA, n = 552), 15−30 (moderate OSA, n30 (severe OSA, n = 421). After stratification, 13.6% of the no/mild OSA group, 28.9% of the moderate OSA group, and 30.9% of the severe OSA group had a moderate-to-very high risk of CKD progression (p < .001), which was defined as an eGFR <60 mL/min/1.73 m2, an ACR ≥3 mg/mmol, or both. Compared to those with no/mild OSA, the odds ratio for moderate-to-very high risk of CKD progression was 2.63 (95% CI: 1.79−3.85) for moderate OSA and 2.96 (2.04–4.30) for severe OSA after adjustment for CKD risk factors. Among patients at increased risk of CKD progression, 73% were unaware they had abnormal kidney function.Conclusion Patients with moderate and severe OSA have an increased risk of CKD progression independent of other CKD risk factors; most patients are unaware of this increased risk.

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