Chronic kidney disease in European patients with obstructive sleep apnea: the ESADA cohort study

Abstract

The cross-sectional relationship of obstructive sleep apnea with moderate to severe chronic kidney disease, defined as an estimated glomerular filtration rate <60 mL min ∙1.73 m , was investigated in a large cohort of patients with suspected obstructive sleep apnea studied by nocturnal polysomnography or cardiorespiratory polygraphy. Data were obtained from the European Sleep Apnea Database, where information from unselected adult patients with suspected obstructive sleep apnea afferent to 26 European sleep centres had been prospectively collected. Both the Modification of Diet in Renal Disease and the Chronic Kidney Disease-Epidemiology Collaboration equations were used for the assessment of estimated glomerular filtration rate. The analysed sample included 7700 subjects, 71% male, aged 51.9 ± 12.5 years. Severe obstructive sleep apnea (apnea-hypopnea index ≥30) was found in 34% of subjects. The lowest nocturnal oxygen saturation was 81 ± 10.2%. Chronic kidney disease prevalence in the whole sample was 8.7% or 6.1%, according to the Modification of Diet in Renal Disease or the Chronic Kidney Disease-Epidemiology Collaboration equations, respectively. Subjects with lower estimated glomerular filtration rate were older, more obese, more often female, had worse obstructive sleep apnea and more co-morbidities (P < 0.001, each). With both equations, independent predictors of estimated glomerular filtration rate <60 were: chronic heart failure; female gender; systemic hypertension; older age; higher body mass index; and worse lowest nocturnal oxygen saturation. It was concluded that in obstructive sleep apnea, chronic kidney disease is largely predicted by co-morbidities and anthropometric characteristics. In addition, severe nocturnal hypoxaemia, even for only a small part of the night, may play an important role as a risk factor for kidney dysfunction.

SAS score: Targeting high-specificity for efficient population-wide monitoring of obstructive sleep apnea

“…In general, SDB produces an impaired quality of life, including an increased risk of causing motor-vehicle accidents. SDB also increases the mortality rate [9], because it contributes to the development of cardiovascular diseases [10] such as hypertension [11], type 2 diabetes [12], cancer [13], and chronic kidney disease [14]. Because it is associated with many co-morbidities [15], SDB has several distinct clinical phenotypes.…”

In reply: Perioperative nocturnal hypoxemia matters in surgical patients with obstructive sleep apnea

“…For example, Marrone et al demonstrated in a cohort of patients (from the European Sleep Apnea Database) that the combination of severe OSA and nocturnal hypoxemia might be an important risk factor for kidney dysfunction. 5 We have read with great interest the letter of Chung et al 6 wherein they highlighted the deleterious influence of nocturnal hypoxemia on the postoperative complication rate. Their letter confirmed to us that future studies must be specifically designed to recognize the possible influence of the nocturnal hypoxemia/severe OSA combination vs nocturnal hypoxemia alone or severe OSA alone.…”

Obstructive sleep apnea and chronic kidney disease: open questions on a potential public health problem

“…One consequence was that in most subjects under investigation OSA, when present, was mild or moderate and, more than else, characterised by mild oxygen desaturations. Studies that found a relationship between hypoxemia and kidney function usually had populations where severe or protracted hypoxic levels were reached (6,7,9,10,16). Conversely, other studies reporting no effect of hypoxemia mainly included subjects with mild respiratory disorders and desaturations (8).…”

“…In clinical populations of suspected OSA patients, the link between OSA and CKD appeared stronger in female subjects (9,14). One limitation of Adams' study is that it cannot provide any information on possible gender-related differences in the general population, since it included only male subjects (26).…”

“…Cross-sectional studies, mostly performed in patients recruited in sleep laboratories for suspected OSA, analysed estimated glomerular filtration rate (eGFR), albumin excretion, or, more rarely, both of them (3)(4)(5)(6)(7)(8)(9). Some relationship between OSA and CKD was found in most studies, but discordant data were often reported, especially about the possible correlates of CKD in OSA [apnea/ hypopnea index (AHI) or severity of nocturnal hypoxemia].…”