Emerging co-morbidities of obstructive sleep apnea: cognition, kidney disease, and cancer

Abstract

Obstructive sleep apnea (OSA) causes daytime fatigue and sleepiness, and has an established relationship with cardiovascular and metabolic disease. Recent years have seen the emergence of an evidence base linking OSA with an increased risk of degenerative neurological disease and associated cognitive impairment, an accelerated rate of decline in kidney function with an increased risk of clinically significant chronic kidney disease (CKD), and with a significantly higher rate of cancer incidence and death. This review evaluates the evidence base linking OSA with these seemingly unrelated co-morbidities, and explores potential mechanistic links underpinning their development in patients with OSA, including intermittent hypoxia (IH), sleep fragmentation, sympathetic excitation, and immune dysregulation.

Single‐Dose Pharmacokinetics and Safety of Solriamfetol in Participants With Normal or Impaired Renal Function and With End‐Stage Renal Disease Requiring Hemodialysis

“…[16][17][18][19][20][21] Reviews of study data on the relationship between OSA and chronic kidney disease/ESRD suggest that both conditions may mutually increase risks of their concomitant occurrence, possibly through other comorbidities and risk factors common to each, such as hypertension, obesity, cardiovascular disease, metabolic disorders, and diabetes. [22][23][24] However, some data also suggest that OSA may be a direct, independent risk factor for chronic kidney disease, possibly through pathogenic mechanisms such as hypoxia and reninangiotensin system activation. [22][23][24] Therefore, clinicians treating patients with excessive daytime sleepiness who have OSA should take into consideration potential risk factors for impaired renal function.…”

“…[22][23][24] However, some data also suggest that OSA may be a direct, independent risk factor for chronic kidney disease, possibly through pathogenic mechanisms such as hypoxia and reninangiotensin system activation. [22][23][24] Therefore, clinicians treating patients with excessive daytime sleepiness who have OSA should take into consideration potential risk factors for impaired renal function.…”

Reviewing the relationship between OSA and cognition: Where do we go from here?

“…More worrying still, true prevalence may be underestimated as many individuals with OSA remain undiagnosed . This is critical because the longer OSA goes untreated the greater the risk of hypertension, heart disease, stroke, kidney disease and type 2 diabetes, plus motor vehicle accidents . The metabolic and vascular consequences, in turn, increase the severity of OSA and the risk of both cognitive impairment and dementia, and potentially bring forward the age of onset of mild cognitive impairment and Alzheimer's disease (AD) …”

Sleep apnea: Altered brain connectivity underlying a working-memory challenge

“…The latter hypothesis has been supported by neuroimaging studies addressing the neural correlates of cognitive impairment in OSA, typically with tasks tapping working-memory such as the n-back task. Different studies have reported increased or decreased brain activity, particularly in frontal ( Thomas et al, 2005 ) and hippocampal ( Castronovo et al, 2009 ) cortex, attributed either to compensatory mechanisms supporting performance ( Castronovo et al, 2009 ) or to brain damage secondary to nocturnal hypoxemia ( Ayalon et al, 2010 ; Gildeh et al, 2016 ). The former interpretation is supported by evidence on the effects of continuous positive airway pressure (cPAP) treatment.…”