Obstructive Sleep Apnea and Diabetic Nephropathy

Tahrani, Abd A; Ali, Asad; Raymond, Neil T.; Begum, Safia; Dubb, Kiran; Altaf, Q.; Piya, Milan K.; Barnett, Anthony; Stevens, Martin J.

doi:10.2337/dc13-0450

Cited by 101 publications

(126 citation statements)

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“…We previously reported that OSA is associated with peripheral neuropathy, nephropathy, and estimated glomerular filtration rate decline in patients with T2D independently of obesity (10,11). We also previously showed that OSA is independently associated with increased nitrosative and oxidative stress as well as impaired microvascular regulation in patients with T2D (10).…”

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confidence: 99%

Obstructive Sleep Apnea and Retinopathy in Patients with Type 2 Diabetes. A Longitudinal Study

Altaf

Dodson

Ali

et al. 2017

Am J Respir Crit Care Med

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Rationale: Obstructive sleep apnea (OSA) is associated with several pathophysiological deficits found in diabetic retinopathy (DR). Hence, it's plausible that OSA could play a role in the pathogenesis of sight-threatening DR (STDR).Objectives: To assess the relationship between OSA and DR in patients with type 2 diabetes and to assess whether OSA is associated with its progression.Methods: A longitudinal study was conducted in diabetes clinics within two U.K. hospitals. Patients known to have any respiratory disorder (including OSA) were excluded. DR was assessed using twofield 45-degree retinal images for each eye. OSA was assessed using a home-based multichannel cardiorespiratory device. Measurements and Main Results:A total of 230 patients were included. STDR and OSA prevalence rates were 36.1% and 63.9%, respectively. STDR prevalence was higher in patients with OSA than in those without OSA (42.9% vs. 24.1%; P = 0.004). After adjustment for confounders, OSA remained independently associated with STDR (odds ratio, 2.3; 95% confidence interval, 1.1-4.9; P = 0.04). After a median (interquartile range) follow-up of 43.0 (37.0-51.0) months, patients with OSA were more likely than patients without OSA to develop preproliferative/proliferative DR (18.4% vs. 6.1%; P = 0.02). After adjustment for confounders, OSA remained an independent predictor of progression to preproliferative/proliferative DR (odds ratio, 5.2; 95% CI confidence interval, 1.2-23.0; P = 0.03). Patients who received continuous positive airway pressure treatment were significantly less likely to develop preproliferative/proliferative DR.Conclusions: OSA is associated with STDR in patients with type 2 diabetes. OSA is an independent predictor for the progression to preproliferative/proliferative DR. Continuous positive airway pressure treatment was associated with reduction in preproliferative/proliferative DR. Interventional studies are needed to assess the impact of OSA treatment on STDR.

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confidence: 99%

Obstructive Sleep Apnea and Retinopathy in Patients with Type 2 Diabetes. A Longitudinal Study

Altaf

Dodson

Ali

et al. 2017

Am J Respir Crit Care Med

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“…123 The progression to albuminuria was numerically but not statistically greater in patients with OSA compared those without OSA (22.6 % versus 13.3 %; p=0.23). 123 In the same observational longitudinal study the use of CPAP was associated with a favourable impact on eGFR decline over the follow-up In a study of Japanese patients with T2D, an ODI≥5 was independently associated with microalbuminuria in women but not in men after adjustment for confounders. 124 Another cross-sectional study showed no relationship between OSA and microalbuminuria in patients with T2D, but this study was of a small sample size (n=52).…”

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confidence: 97%

“…moderate to severe OSA) and OSA was an independent predictor of study end eGFR (B=−4.2; p=0.03) and eGFR decline. 123 Baseline AHI was also an independent predictor of study end eGFR after adjustment (B= −4.6, p=0.02). 123 The progression to albuminuria was numerically but not statistically greater in patients with OSA compared those without OSA (22.6 % versus 13.3 %; p=0.23).…”

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confidence: 98%

“…123 Baseline AHI was also an independent predictor of study end eGFR after adjustment (B= −4.6, p=0.02). 123 The progression to albuminuria was numerically but not statistically greater in patients with OSA compared those without OSA (22.6 % versus 13.3 %; p=0.23). 123 In the same observational longitudinal study the use of CPAP was associated with a favourable impact on eGFR decline over the follow-up In a study of Japanese patients with T2D, an ODI≥5 was independently associated with microalbuminuria in women but not in men after adjustment for confounders.…”

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Obstructive Sleep Apnoea and Vascular Disease in Patients with Type 2 Diabetes

Tahrani¹

2015

US Endocrinology

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Obstructive sleep apnoea (OSA) is common and is associated with many vascular risk factors, such as hypertension, insulin resistance, albuminuria, dyslipidaemia, increased inflammation and endothelial dysfunction. Epidemiological studies have shown that OSA is associated with increased cardiovascular disease (CVD) and that continuous positive airway pressure (CPAP) might reduce CVD events in patients with OSA. In addition, OSA has also been shown to be associated with albuminuria, chronic kidney disease, a wide range of ocular diseases and peripheral neuropathy. Considering that CVD and microvascular complications are major contributors to the morbidity, mortality and the economic burden of diabetes and that OSA is common in patients with type 2 diabetes (T2D), it is important to understand the role of OSA in the development and/or progression of vascular disease in patients with T2D and to explore the impact of CPAP on diabetes-related vascular outcomes. The purpose of this article is to review the evidence for the relationship and impact of OSA on vascular disease and vascular risk factors particularly in patients with T2D. KeywordsType 2 diabetes, obstructive sleep apnoea, vascular disease, vascular risk Diabetes-related macro-and microvascular complications contribute significantly to the increased morbidity, mortality, worsened quality of life and social and financial burden observed in patients with diabetes. [1][2][3][4][5] Hence, reducing the development and/or the progression of these complications is one of the main aims of treatment in patients with diabetes.Over the last 2 decades, strategies resulting in the improvements of glycaemic control, blood pressure (BP) and lipids and the use of renin angiotensin aldosterone inhibitors, resulted in reductions in cardiovascular disease (CVD) in patients with diabetes, but there was little impact on diabetic microvascular complications. 6 Nonetheless, both CVD and microvascular complications remain common and a better understanding of the pathogenesis of these complications is needed in order to identify new treatment strategies.Obstructive sleep apnoea (OSA) is common in patients with type 2 diabetes (T2D) (up to 86 % prevalence), which is not surprising considering that increasing age and obesity are common risk factors to both conditions. 7,8 OSA is characterised by upper airway instability during sleep that results in recurrent upper airway obstruction resulting in either complete or partial cessation of airflow (i.e. apnoea and hypopnoea, respectively). 9The recurrent obstructions of the upper airway usually result in recurrent oxygen desaturations/re-saturations, cyclical changes in intrathoracic pressure (as the patient attempts to breath against a blocked airway) and recurrent micro arousals that cause sleep fragmentation and reduction in slow wave and rapid eye movement (REM) sleep and result in termination of the apnoea/hypopnoea episodes. 9Several large epidemiological studies and randomised controlled trials (RCTs) have shown that OSA was ...

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“…The potential causative role of OSA in the development of these important comorbidities is the subject of recent dedicated reviews in the Journal of Thoracic Disease (7,86), and will not be discussed in detail here. Notably, OSA may hasten the development of diabetic nephropathy (DN), as evidenced by an increased prevalence of OSA in subjects with DN, and an increased rate of progression of CKD in OSA patients, in a cohort of 224 type 2 diabetes followed over 2.5 years (87).…”

Section: Conventional Ckd Risk Factors and Osamentioning

confidence: 99%

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

Gildeh¹,

Drakatos²,

Higgins³

et al. 2016

J. Thorac. Dis.

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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.

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Obstructive Sleep Apnea and Diabetic Nephropathy

Cited by 101 publications

References 41 publications

Obstructive Sleep Apnea and Retinopathy in Patients with Type 2 Diabetes. A Longitudinal Study

Obstructive Sleep Apnea and Retinopathy in Patients with Type 2 Diabetes. A Longitudinal Study

Obstructive Sleep Apnoea and Vascular Disease in Patients with Type 2 Diabetes

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

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