Obstructive sleep apnea during rapid eye movement sleep in patients with diabetic kidney disease

Abstract

Study Objectives: Although recent studies suggest that obstructive sleep apnea during rapid eye movement (REM) is associated with different cardiometabolic and neurocognitive risks compared with non-REM (NREM) sleep, there is no information on whether obstructive sleep apnea during REM and/or NREM sleep is independently associated with diabetic kidney disease (DKD). Methods: In this cross-sectional study, 303 patients with type 2 diabetes who were followed up at our diabetes outpatient clinic underwent all-night polysomnography. Logistic regression analysis was performed to determine the separate effects of obstructive sleep apnea during REM and/or NREM sleep (REM and/or NREM-apnea-hypopnea index [AHI]) and several other polysomnography parameters on DKD after adjustment for several known risk factors for DKD.

Is kidney a new organ target in patients with obstructive sleep apnea? Research priorities in a rapidly evolving field

“…As already shown, REM-OSA can have distinct features from NREM-OSA regarding cardiometabolic and neurocognitive endpoints [81,82]. In the context of CKD, AHI in REM sleep, and not in NREM, showed independent correlations with the risk of CKD in a group patients with diabetes, underlining the specific effects of REM sleep in OSA patients as predictor of worse kidney outcomes [80]. Finally, special attention should be paid on the relationships between REM-AHI and associated hypertension [83], as this sleep stage may be highly relevant to risk of development of CKD in OSA patients.…”

“…In a cross-sectional study, severity of OSA is related to a higher risk of albuminuria (a marker of kidney injury) in patients with diabetes, [76]. Of particular interest is the special contribution of REM related OSA in the interaction between diabetes and risk of CKD [80]. As already shown, REM-OSA can have distinct features from NREM-OSA regarding cardiometabolic and neurocognitive endpoints [81,82].…”

Therapeutic effect of laparoscopic sleeve gastrectomy on obstructive sleep apnea and relationship of type 2 diabetes in Japanese patients with severe obesity

“…Multivariate analyses showed that HbA1c at 1 year after LSG was the correlated factor of OSA improvement. Some studies clarified that diabetic retinopathy (odds ratio 2.875, 95% confident interval 1.224–6.752; P = 0.0015) and glycemic control impairment (β 0.063, 95% confident interval 0.025–0.101; P = 0.001) are strongly correlated with REM‐AHI 30 , 31 . Therefore, chronic intermittent hypoxia as a result of OSA causes altered ventilatory control and oxidative stress in developing type 2 diabetes, and chronic hyperglycemia also contributes to an accelerated increase in oxidative stress 32 , 33 .…”

Approach the Patient With Obstructive Sleep Apnea and Obesity

“…Accumulating data indicate that the deleterious effect of OSA on glycemia is greater with REM-OSA than non-REM (nREM)-OSA ( 16 ), as detailed in the section on REM OSA. The risk of diabetes-related renal disease is also greatest in those with REM-related OSA ( 42 ).…”