Nierenfunktion bei hypertensiven Patienten mit obstruktiver Schlafapnoe

Büchner, Nikolaus; Henning, B; Hägele, K F; Quack, Ivo; Rump, Lars Christian

doi:10.1055/s-2004-818625

Cited by 11 publications

(7 citation statements)

References 12 publications

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“…Despite controlling for BMI, glycemic status, chronic inflammation (hs-CRP) and use of ACEI/ARB, we were unable to observe a correlation between albuminuria and OSA, but realize that we could not control for the doses and specific ACEI/ARB used by the patients. Lack of an association between OSA and albuminuria was also seen in another study in subjects with essential hypertension [23]. Our finding of diastolic BP to be the only significant correlate of ACR is not unusual as previous studies showed increased albuminuria in nondiabetic obese adults with presence of hypertension [24] and with greater diastolic BP [25].…”

Section: Discussionsupporting

confidence: 82%

“…A cohort study among elderly men (n = 508) showed odds ratio of 1.95 for OSA (RDI ≥15) with GFR <60 ml/min/1.73 m 2 as estimated by Mayo Clinic formula (but not by Cockcroft Gault or Modification of Diet in Renal Disease formula) [29]. Another study on subjects with essential hypertension showed a higher serum creatinine in the presence of OSA (but not a higher 24-hour urine albumin) [23]. In CKD patients evaluated for OSA (estimated creatinine clearance, CrCl, <40 ml/min), a weak correlation of AHI with estimated CrCl was found [30].…”

Section: Discussionmentioning

confidence: 99%

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Albuminuria and Renal Function in Obese Adults Evaluated for Obstructive Sleep Apnea

et al. 2009

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Background: Obstructive sleep apnea (OSA) is associated with hypertension, obesity and metabolic syndrome that are risk factors for cardiovascular and chronic kidney disease. Few data are available regarding renal parameters in patients with OSA. Methods: We conducted a cross-sectional study of 91 obese adults who had routine polysomnography before bariatric surgery. Presence and severity of OSA were determined by the apnea-hypopnea index (AHI <5 = no OSA and AHI ≥5 = OSA). Clinical and laboratory data were available within a month of polysomnography. Results: Mean ± SD age was 44.9 ± 9.9 years. There were 66 women. Mean ± SD body mass index was 48.3 ± 8.9 kg/m² with hypertension and type 2 diabetes present in 55 and 31 subjects, respectively. There were 36 subjects with no OSA and 55 with OSA. The two groups had similar demographic characteristics, blood pressure (BP), lipid profile and medication use except for difference in mean ± SD hemoglobin A1c (5.6 ± 0.6% in no OSA, 6.0 ± 0.8% in OSA; p = 0.029) and use of renin-angiotensin system blocking agents (22.2% in no OSA, 46.4% in OSA; p = 0.024). Median (interquartile range) urine albumin:creatinine ratio (ACR) was not different between the two groups [6 (4–14.5) mg/g in no OSA, 8 (5–16) mg/g in OSA; p = 0.723], while significant difference existed in serum creatinine (0.8 ± 0.2 mg/dl in no OSA, 0.9 ± 0.2 mg/dl in OSA, p = 0.013). Age- and gender-adjusted correlations were observed between log-log ACR and systolic BP (r = 0.265; p = 0.016), log-log ACR and diastolic BP (r = 0.245; p = 0.026) and between serum creatinine and log AHI (r = 0.188, p = 0.089). Multiple linear regression analysis demonstrated log-log ACR to be associated with diastolic BP (p = 0.046), while serum creatinine was associated with log AHI (p = 0.044). Conclusion: In obese adults, increasing severity of OSA is associated with higher serum creatinine but not greater degree of albuminuria.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Albuminuria and Renal Function in Obese Adults Evaluated for Obstructive Sleep Apnea

et al. 2009

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“…So fand sich ein unabhängiger Zusammenhang zwischen Schlafapnoe und einer eingeschränkten Nierenfunktion. Patienten mit Schlafapnoe wiesen ein signifikant erhöhtes Serumkreatinin auf [21]. Diese Ergebnisse stehen im Einklang mit einer aktuellen österreichischen Studie.…”

Section: Einfluss Einer Schlafapnoe Auf Die Nierenfunktionunclassified

Schlafapnoesyndrom bei chronischer Niereninsuffizienz

2010

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Die obstruktive Schlafapnoe ist die häu-figste Form der schlafbezogenen Atemstö-rungen. Einer großen Studie zufolge leiden 2% der Frauen und 4% der Männer zwischen 30 und 60 Jahren an Schlafapnoe. Allerdings wurde in dieser Untersuchung die Diagnose der Schlafapnoe nur bei eindeutiger Tagesmüdigkeit gestellt [1]. Bedenkt man, dass viele Patienten keine Tagesmüdigkeit oder -schläfrigkeit beklagen, dürfte die Prävalenz eher noch höher liegen. Aktuell wird höchstens 1% der Bevölkerung behandelt. Das bedeutet, dass selbst bei konservativer Schät-zung bei mindestens 80-90% der Betroffenen die Diagnose eines Schlafapnoesyndroms gar nicht gestellt wird. Diese Zahlen sind alarmierend, handelt es sich doch meist um Patienten mit einem erhöhten kardiovaskulären Risiko, das durch die Schlafapnoe nochmals deutlich gesteigert wird. In zahlreichen Studien konnte gezeigt werden, dass bis zu 50% aller Patienten mit therapierefraktärer Hypertonie, 50-75% mit einer absoluten Arrhythmie bei Vorhofflimmern, 50-70% mit Linksherzinsuffizienz und 30% mit koronarer Herzkrankheit an einer Schlafapnoe leiden [2]. > Schlafbezogene Atemstörungen treten bei Niereninsuffizienz häufiger auf Patienten mit eingeschränkter Nierenfunktion nehmen eine Sonderstellung ein. Einerseits ist die Niereninsuffizienz ein unabhängiger kardiovaskulärer Risikomarker, andererseits bestehen bei diesen Patienten häufig weitere internistische Begleiterkrankungen. Schon in frühen Stadien der Niereninsuffizienz ist das Risiko einer schlafbezogenen Atmungsstörung signifikant erhöht [3]. Für Dialysepatienten wird die durchschnittliche Prävalenz mit mehr als 50% angegeben [5, 6]. Peritoneal-und Hämodialysepatienten sind gleichermaßen betroffen.

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“…In mild to moderate sleep apnoea, RI correlates with AHI after correction for age [31]. One study shows elevated creatinine and decreased endogenous creatinine clearance in OSA [32]. Intermittent hypoxia leads to increased urinary uric acid excretion, which decreases after CPAP therapy [33].…”

Section: Sleep Apnoea and Chronic Kidney Diseasementioning

confidence: 99%

“…Intermittent hypoxia leads to increased urinary uric acid excretion, which decreases after CPAP therapy [33]. The debate on proteinuria associated with OSA is still open [32,[34][35][36]. Glomerular hypertrophy may lead, together with the frequently coexisting obesity and hypertension, to changes of the glomerulus, described as focal segmental glomerulosclerosis [37,38].…”

Section: Sleep Apnoea and Chronic Kidney Diseasementioning

confidence: 99%

Obstructive sleep apnoea: clinical signs, diagnosis and treatment

Kuhlmann

Bormann

Becker

2008

Nephrology Dialysis Transplantation

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Normal and disturbed sleepHumans spend one-third of their lifetime sleeping. It has only been ∼50 years since it was recognized that sleep is not simply a passive state characterized by the absence of wakefulness, but rather a condition that has a typical structure with electrophysiologically, clearly distinguishable phases that follow one another according to a characteristic pattern in healthy subjects. Using electroencephalogram (EEG), electrooculogram (EOG) and electromyogram (EMG), sleep is classified as rapid eye movement (REM) sleep or one of four different non-REM sleep stages. Altogether, one spends ∼20-25% of the total sleep time in deep sleep and REM sleep, respectively, and ∼50% in light sleep. After the age of 50, the percentage of deep and REM sleep decreases, whereas light sleep and periods of wakefulness during the night increases.During the night, 4-6 sleep cycles are completed lasting 70-90 min and consisting of an initial period of light sleep, followed by deep sleep and finally REM sleep. Whereas deep sleep is predominantly present during the first hours of sleep, there is an increase in REM sleep in the second half of the night, often accompanied by dreaming. Breathing during sleep and sleep-disordered breathingThe transition from wakefulness to sleep is characterized by marked changes in all aspects of ventilation in healthy subjects. Upper airway resistance more than doubles, due to a reduction in pharyngeal muscle tone. Ventilatory drive as well as the ventilatory response to hypercapnia and hypoxia decreases. Minute ventilation decreases by ∼10%, and as Sleep apnoeaFour different patterns of sleep-disordered breathing can be determined: apnoeas, hypopnoea, hypoventilation and respiratory events that do not fulfil the criteria of apnoeas and hypopnoea but cause arousal from sleep. An airflow reduction by ≥90% for ≥10 s is called apnoea, and an airflow reduction of ≥50% to <90% for at least 10 s that causes oxygen desaturation of ≥4% is called hypopnoea. Hypoventilation is defined as a reduction in ventilation for at least 5 min with an increase in PCO 2 of >50 mmHg or a desaturation of <85% according to the most widely used definition.These respiratory events can be of the obstructive type with persisting breathing efforts or of the central type without any respiratory movements [1]. Clinically, mixed apnoeas are often present, in which the initial central apnoea develops into an obstructive one, but from a therapeutic point of view, mixed apnoeas are treated like obstructive ones, and therefore mixed apnoeas are part of obstructive sleep apnoea. To quantify breathing disorders, the mean number of apnoeas and hypopnoeas per hour of sleep, the apnoea-hypopnoea index (AHI), is calculated. More than five episodes of disturbed breathing per hour of sleep are considered pathological, because in epidemiological studies the risk of cardiovascular disorders started to increase from an AHI of 5.Apnoeas, hypopnoea and other respiratory events are terminated by a central nervous alarm reaction (aro...

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Nierenfunktion bei hypertensiven Patienten mit obstruktiver Schlafapnoe

Abstract: Our results suggest an independent association between OSA and impaired renal function. Further prospective studies will have to be done to elucidate the pathophysiological mechanisms.

Cited by 11 publications

References 12 publications

Albuminuria and Renal Function in Obese Adults Evaluated for Obstructive Sleep Apnea

Albuminuria and Renal Function in Obese Adults Evaluated for Obstructive Sleep Apnea

Schlafapnoesyndrom bei chronischer Niereninsuffizienz

Obstructive sleep apnoea: clinical signs, diagnosis and treatment

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