Effect of continuous positive airway pressure on albuminuria in patients with obstructive sleep apnea: a meta-analysis

Chen, Ru; Huang, Zhiwei; Lin, Xiao; Lin, Jinfang; Yang, Mei

doi:10.1007/s11325-021-02393-1

Cited by 5 publications

(5 citation statements)

References 29 publications

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“…Another study by Daskalopoulou et al [22] observed that CPAP could reduce sympathetic nerve activity and alleviate proteinuria in OSAHS patients, with this effect persisting for a duration of three months. A meta-analysis further supported these findings, indicating a significant reduction in UACR in patients with OSAHS treated with CPAP [23]. In our investigation focusing on microalbuminuria in MS patients with OSAHS, PAP treatment emerged as a significant factor in reducing UACR.…”

Section: Discussionsupporting

confidence: 75%

The effect of PAP on UACR and metabolic indexes in patients with MS and OSAHS

Shen,

Zhou,

Qiu

et al. 2024

Sleep Breath

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Purpose To investigate the effects of positive airway pressure (PAP) device on urinary albumin to creatinine ratio (UACR) and metabolic indexes in patients with metabolic syndrome (MS) and obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods This study is a retrospective cohort study. Grouped according to whether to use PAP treatment, there were 25 cases in the PAP group and 44 cases in the no OSAHS treatment group. The PAP group received positive airway pressure device and routine treatment of MS. The no OSAHS treatment group received routine treatment of OSAHS and MS. The treatment period is 3 months. Results 1. The PAP group demonstrated significant reductions in Body Mass Index (BMI), Waist circumference (WC), Neck circumference (NC), Visceral fat area (VFA), Fasting C peptide (FCP), high-sensitivity C-reactive protein (hs-CRP), and UACR compared to the no OSAHS treatment group, with significant differences (P all <0.05). Among them, the UACR in the PAP group decreased significantly (from 86.05(52.55,131.61)mg/g to 16.76(8.70,25.12)mg/g, P<0.001). 2. Linear regression analysis using the decrease in UACR values as the dependent variable demonstrated a positive linear relationship with the decrease in BMI, VFA, fasting insulin (FINS), and homeostasis model assessment of insulin resistance (HOMA-IR). Furthermore, multiple linear regression analysis indicated that the decrease in VFA (B=0.537 [95% confidence interval, 0.084 to 0.989]; P = 0.021) and HOMA-IR (B=1.000 [95% confidence interval, 0.082 to 1.917]; P = 0.033) values independently correlated with decrease in UACR values. Conclusions PAP treatment can reduce UACR in patients with MS and OSAHS, and has the effect of improving metabolic disorders. The decrease of UACR in patients may be related to the decrease of visceral fat and the improvement of insulin resistance.

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Section: Discussionsupporting

confidence: 75%

The effect of PAP on UACR and metabolic indexes in patients with MS and OSAHS

Shen,

Zhou,

Qiu

et al. 2024

Sleep Breath

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“…Systematic reviews and meta-analyses confirm that OSA is independently associated with higher urinary albumin excretion rate compared to control subjects [ 204 , 205 ]. Therapy with positive airway pressure reduces albuminuria in OSA patients, either non-diabetic [ 192 , 206 , 207 ] or patients with diabetic kidney disease [ 208 , 209 ]. CPAP effect on albuminuria is more profound in patients with more severe OSA [ 197 ].…”

Section: Obstructive Sleep Apnea Is Associated With Insulin Resistanc...mentioning

confidence: 99%

Hypoxia-Induced Insulin Resistance Mediates the Elevated Cardiovascular Risk in Patients with Obstructive Sleep Apnea: A Comprehensive Review

Adeva-Andany,

Domínguez-Montero,

Castro-Quintela

et al. 2024

Rev. Cardiovasc. Med.

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Patients with obstructive sleep apnea (OSA) experience insulin resistance and its clinical consequences, including hypertriglyceridemia, reduced high density lipoprotein-associated cholesterol (HDL-c), visceral adiposity, hepatic steatosis, increased epicardial fat thickness, essential hypertension, glucose intolerance, increased risk for type 2 diabetes, chronic kidney disease, subclinical vascular damage, and increased risk for cardiovascular events. Obesity is a major contributor to OSA. The prevalence of OSA is almost universal among patients with severe obesity undergoing bariatric surgery. However, insulin resistance and its clinical complications occur in OSA patients irrespective of general obesity (body mass index). In OSA patients, apnea episodes during sleep induce oxyhemoglobin desaturation and tissue hypoxia. Insulin resistance is an adaptive response to tissue hypoxia and develops in conditions with limited tissue oxygen supply, including healthy subjects exposed to hypobaric hypoxia (high altitude) and OSA patients. Indicators of oxyhemoglobin desaturation have been robustly and independently linked to insulin resistance and its clinical manifestations in patients with OSA. Insulin resistance mediates the elevated rate of type 2 diabetes, chronic kidney disease, and cardiovascular disease unexplained with traditional cardiovascular risk factors present in OSA patients. Pathophysiological processes underlying hypoxia-induced insulin resistance involve hypoxia inducible factor-1 upregulation and peroxisome proliferator-activated receptor-gamma (PPAR- ) downregulation. In human adipose tissue, PPAR- activity promotes glucose transport into adipocytes, lipid droplet biogenesis, and whole-body insulin sensitivity. Silencing of PPAR- in the adipose tissue reduces glucose uptake and fat accumulation into adipocytes and promotes insulin resistance. In conclusion, tissue hypoxia drives insulin resistance and its clinical consequences in patients with OSA, regardless of body mass index.

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“…A recent meta-analysis, including six studies examined the effectiveness of CPAP treatment in reducing MAB in OSA patients. The results indicated that CPAP therapy had a positive effect on reducing MAB in these patients, suggesting that early intervention with CPAP could help prevent the occurrence of CKD and cardiovascular events and then improve outcomes [ 109 ]. In contrast, there is less evidence of MAB in pulmonary hypertension, although this association cannot be excluded.…”

Section: Microalbuminuria (Mab) In Chronic Lower Respiratory Diseases...mentioning

confidence: 99%

Lung Dysfunction and Chronic Kidney Disease: A Complex Network of Multiple Interactions

Gembillo

Calimeri

Tranchida

et al. 2023

JPM

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Chronic kidney disease (CKD) is a progressive disease that affects > 10% of the total population worldwide or >800 million people. CKD poses a particularly heavy burden in low- and middle-income countries, which are least able to cope with its consequences. It has become one of the leading causes of death worldwide and is one of the few non-communicable diseases where the number of related deaths has increased over the last two decades. The high number of people affected, and the significant negative impact of CKD should be a reason to increase efforts to improve prevention and treatment. The interaction of lung and kidney leads to highly complex and difficult clinical scenarios. CKD significantly affects the physiology of the lung by altering fluid homeostasis, acid-base balance and vascular tone. In the lung, haemodynamic disturbances lead to the development of alterations in ventilatory control, pulmonary congestion, capillary stress failure and pulmonary vascular disease. In the kidney, haemodynamic disturbances lead to sodium and water retention and the deterioration of renal function. In this article, we would like to draw attention to the importance of harmonising the definitions of clinical events in pneumology and renal medicine. We would also like to highlight the need for pulmonary function tests in routine clinical practise for the management of patients with CKD, in order to find new concepts for pathophysiological based disease-specific management strategies.

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Effect of continuous positive airway pressure on albuminuria in patients with obstructive sleep apnea: a meta-analysis

Cited by 5 publications

References 29 publications

The effect of PAP on UACR and metabolic indexes in patients with MS and OSAHS

The effect of PAP on UACR and metabolic indexes in patients with MS and OSAHS

Hypoxia-Induced Insulin Resistance Mediates the Elevated Cardiovascular Risk in Patients with Obstructive Sleep Apnea: A Comprehensive Review

Lung Dysfunction and Chronic Kidney Disease: A Complex Network of Multiple Interactions

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