Sleep Apnea Is Associated with Cardiovascular Risk Factors among Kidney Transplant Patients

Molnar, Miklos Z.; Lázár, Alpár S.; Lindner, Anett; Fornadi, Katalin; Czira, Maria E.; Dunai, Andrea; Zoller, Rezső; Szentkirályi, András; Rosivall, László; Shapiro, Colin M.; Novák, Márta; Mucsi, István

doi:10.2215/cjn.04030609

Cited by 43 publications

(32 citation statements)

References 35 publications

(31 reference statements)

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“…[28][29][30][31][32][33][34] Potentially eligible patients were selected from all prevalent adult kTx recipients (total clinic population; n = 1,214) who were regularly followed at a single outpatient academic transplant center, the kidney transplant clinic of the Department of Transplantation and Surgery at the Semmelweis University, Budapest, Hungary (Figure 1). All patients followed at the clinic on December 31, 2006 were considered for enrollment in the Malnutrition and INflammation In Transplant (MINIT-HU) study.…”

Section: Sample Of Patients and Data Collectionmentioning

confidence: 99%

“…The creation of the cohort has been described previously. [28][29][30][31][32][33][34] From these 150 eligible patients, 100 individuals agreed to participate and they underwent 1-night PSG (kTx participant sample). From this sample of 100 patients, 3 were excluded from our analysis because of a missing depression score and 2 were excluded because of antidepressant pharmacotherapy.…”

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confidence: 99%

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Depressive Symptoms Are Associated With Objectively Measured Sleep Parameters in Kidney Transplant Recipients

Rónai

Szentkirályi

Lázár

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: Both depression and sleep complaints are very prevalent among kidney transplant (kTx) recipients. However, details of the complex relationship between sleep and depression in this population are not well documented. Thus, we investigated the association between depressive symptoms and sleep macrostructure parameters among prevalent kTx recipients. Methods: Ninety-five kTx recipients participated in the study (54 males, mean ± standard devation age 51 ± 13 years, body mass index 26 ± 4 kg/m 2 , estimated glomerular filtration rate 53 ± 19 ml/min/1.73 m 2 ). Symptoms of depression were assessed by the Center for Epidemiologic Studies -Depression Scale (CES-D). After 1-night polysomnography each recording was visually scored and sleep macrostructure was analyzed. Results: The CES-D score was significantly associated with the amount of stage 2 sleep (r = 0.20, P < .05), rapid eye movement (REM) latency (r = 0.21, P < .05) and REM percentage (r = −0.24, P < .05), but not with the amount of slow wave sleep (r = −0.12, P > .05). In multivariable linear regression models the CES-D score was independently associated with the amount of stage 2 sleep (β: 0.205; confidence interval: 0.001-0.409; P = .05) and REM latency (β: 0.234; confidence interval: 0.001-0.468; P = .05) after adjustment for potential confounders. I NTRO DUCTI O NDepression is one of the most prevalent mental health conditions in patients with chronic kidney disease (CKD) [1][2][3][4] ; furthermore, it is an important determinant of impaired quality of life. 5,6 Among kidney transplant (kTx) recipients, depression is associated with reduced adherence and also with increased morbidity, graft loss, and mortality. [7][8][9][10][11][12][13] Poor sleep and various sleep problems are also frequent complaints among kTx recipients.14,15 Earlier we reported that chronic insomnia was independently associated with the presence of depression in kTx recipients. 16 In the general population there is a strong and bidirectional relationship between depression and sleep.17 This is also reflected in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition definition of major depression (MD), 18 as sleep complaints are core symptoms of MD. Several objective sleep parameters are different in patients with MD than in healthy control patients. Patients with MD have decreased amounts of slow wave sleep (SWS) and shortened rapid eye movement (REM) latency with increased amounts of REM sleep. The exact mechanisms and factors that may link depression to poor clinical outcomes among kTx recipients are not yet well defined. In a recent review focusing on kTx and depression, 23 sleep is not mentioned. This may be due to the complete lack of polysomnography (PSG) studies that assess the association between sleep and depression in this population. The frequent co-occurrence of subjective sleep complaints and depression among kTx recipients 16 suggests that the relationship between the two conditions may be similar to the association described in the g...

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Section: Sample Of Patients and Data Collectionmentioning

confidence: 99%

mentioning

confidence: 99%

Depressive Symptoms Are Associated With Objectively Measured Sleep Parameters in Kidney Transplant Recipients

Rónai

Szentkirályi

Lázár

et al. 2017

Journal of Clinical Sleep Medicine

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“…The complex pathophysiology that links OSA to cardiovascular risk may also have a detrimental effect on kidney function. Patients with OSA experience glomerular hyperfiltration, which is alleviated by short-term CPAP treatment,13 but our previous studies in kidney transplant recipients found no association between OSA and deterioration of kidney function 14 15. Only one recently published study assessed the association of OSA with kidney function decline and progression to CKD in non-transplant patients 16…”

Section: Introductionmentioning

confidence: 99%

Association of incident obstructive sleep apnoea with outcomes in a large cohort of US veterans

Molnar

Mucsi

Novák

et al. 2015

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Rationale There is a paucity of large cohort studies examining the association of obstructive sleep apnea(OSA) with clinical outcomes including all-cause mortality, coronary heart disease(CHD), strokes and chronic kidney disease(CKD). Objectives We hypothesized that a diagnosis of incident OSA is associated with higher risks of these adverse clinical outcomes. Methods, Measurements In a nationally representative cohort of over 3 million(n=3,079,514) US veterans(93% male) with baseline estimated glomerular filtration rate (eGFR)≥60 ml/min/1.73m2, we examined the association between the diagnosis of incident OSA, treated and untreated with continuous positive airway pressure(CPAP), and: 1) all-cause mortality, 2) incident CHD, 3) incident strokes, 4)incident CKD defined as eGFR<60 ml/min/1.73m2, and 5)slopes of eGFR. Main Results Compared to OSA negative patients, untreated and treated OSA was associated with 86% higher mortality risk,(adjusted hazard ratio and 95% confidence interval: 1.86(1.81-1.91)) and 35% (1.35(1.21-1.51)), respectively. Similarly, untreated and treated OSA was associated with 3.5 times(3.54(3.40-3.69)) and 3 times(3.06(2.62-3.56)) higher risk of incident CHD; 3.5 times higher risk of incident strokes(3.48(3.28-3.64) and 3.50(2.92-4.19)) for untreated and treated OSA, respectively. The risk of incident CKD was also significantly higher in untreated(2.27(2.19-2.36)) and treated(2.79(2.48-3.13)) OSA patients. The median (interquartile range) of the eGFR slope was −0.41(−2.01 - 0.99), −0.61(−2.69 - 0.93) and −0.87(−3.00 - 0.70)ml/min/1.73m2 in OSA negative, untreated and treated OSA positive patients, respectively. Conclusions In this large and contemporary cohort of more than 3 million US veterans, a diagnosis of incident OSA was associated with higher mortality, incident CHD, stroke and CKD and with faster kidney function decline.

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“…In previous surgical studies, OSA patients were more likely to have several common comorbidities including cardiac and vascular disease, hypertension 15-20 , congestive heart failure and stroke 17,18 ; dyslipidemia 17 and diabetes 17 than the general population. Most of these comorbidities are related to obesity 17-19,21 and associated with increased risk of perioperative and postoperative complications 22 .…”

Section: Introductionmentioning

confidence: 99%

Morbidity and Mortality Rates After Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea

Pásseri

Choi

Kaban

et al. 2016

Journal of Oral and Maxillofacial Surgery

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Purpose To compare morbidity and mortality rates in obstructive sleep apnea (OSA) versus dentofacial deformity (DFD) patients undergoing equivalent maxillofacial surgical procedures. Patients and Methods Patients with OSA who underwent maxillomandibular advancement with genial advancement (MMA), at Massachusetts General Hospital Department of Oral and Maxillofacial Surgery, from December 2002 to June 2011, were matched to patients with DFD undergoing similar maxillofacial procedures during the same time period. They were compared with regards to demographic variables, medical comorbidities, perioperative management, intraoperative, early and late postoperative complications and mortality. Results A study group of 28 patients with OSA and a control group of 26 patients with DFD were compared. The patients with OSA were older (41.9±12.5 vs. 21.7±8.6years), had a higher ASA classification (2.0±0.5 vs. 1.3±0.6) and BMI (29.6±4.7 vs. 23.0±3.1kg/m2). They also had a greater number of medical comorbidities (2.4±2.3 vs. 0.7±1.0). More OSA than DFD patients had complications (28, 100% vs.19, 73%, p=0.003) and the total number of complications in the OSA group was higher (108 vs. 33, p<0.001). In the OSA group, 13.9% and in the DFD group 3.0% of the complications were classified as major. The absolute risk of a complication for the OSA group was 3.9 vs . 1.3 for the DFD group. The relative risk of complications in OSA compared to DFD was 3.0. No difference in mortality was found. Conclusions OSA patients were older, had more comorbidities and ultimately had a greater number of early, late, minor and major complications than those in the DFD group. The incidence of mortality in both groups was zero. MMA appears to be a safe procedure with regards to mortality but OSA patients should be counseled preoperatively regarding the relative increased risk of complications.

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Sleep Apnea Is Associated with Cardiovascular Risk Factors among Kidney Transplant Patients

Cited by 43 publications

References 35 publications

Depressive Symptoms Are Associated With Objectively Measured Sleep Parameters in Kidney Transplant Recipients

Depressive Symptoms Are Associated With Objectively Measured Sleep Parameters in Kidney Transplant Recipients

Association of incident obstructive sleep apnoea with outcomes in a large cohort of US veterans

Morbidity and Mortality Rates After Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea

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