Risk of chronic kidney disease in patients with obstructive sleep apnea

• Published in: Sleep (New York, N.Y.) Vol. 45; no. 2; p. 1
• Main Authors: Beaudin, Andrew E, Raneri, Jill K, Ahmed, Sofia B, Hirsch Allen, A J Marcus, Nocon, Andrhea, Gomes, Teresa, Gakwaya, Simon, Series, Fréderic, Kimoff, John, Skomro, Robert P, Ayas, Najib T, Hanly, Patrick J
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 14.02.2022
• Subjects: Adult; Adults; Albumin; Canada; Cardiovascular disease; Care and treatment; Chronic kidney failure; Creatinine; Critical care; Editor's Choice; Ethics; Female; Glomerular Filtration Rate; Health aspects; Humans; Kidney diseases; Laboratories; Longitudinal studies; Male; Medical research; Medicine; Medicine, Experimental; Morbidity; Mortality; Patients; Polysomnography; Questionnaires; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - epidemiology; Risk Factors; Sleep apnea; Sleep apnea syndromes; Sleep Apnea, Obstructive - complications; Sleep Apnea, Obstructive - epidemiology; Sleep Disordered Breathing; Transplants & implants; Urine; World health; Canada; Alberta; obstructive sleep apnea; chronic kidney disease; albumin:creatinine ratio; glomerular filtration rate
• ISSN: 0161-8105; 1550-9109
• DOI: 10.1093/sleep/zsab267

Abstract Study Objectives Chronic kidney disease (CKD) is a global health concern and a major risk factor for cardiovascular morbidity and mortality. Obstructive sleep apnea (OSA) may exacerbate this risk by contributing to the development of CKD. This study investigated the prevalence and patient awareness of the risk of CKD progression in individuals with OSA. Methods Adults referred to five Canadian academic sleep centers for suspected OSA completed a questionnaire, a home sleep apnea test or in-lab polysomnography and provided blood and urine samples for measurement of estimated glomerular filtration rate (eGFR) and the albumin:creatinine ratio (ACR), respectively. The risk of CKD progression was estimated from a heat map incorporating both eGFR and ACR. Results 1295 adults (42% female, 54 ± 13 years) were categorized based on the oxygen desaturation index (4% desaturation): <15 (no/mild OSA, n = 552), 15−30 (moderate OSA, n = 322), and >30 (severe OSA, n = 421). After stratification, 13.6% of the no/mild OSA group, 28.9% of the moderate OSA group, and 30.9% of the severe OSA group had a moderate-to-very high risk of CKD progression (p < .001), which was defined as an eGFR <60 mL/min/1.73 m2, an ACR ≥3 mg/mmol, or both. Compared to those with no/mild OSA, the odds ratio for moderate-to-very high risk of CKD progression was 2.63 (95% CI: 1.79−3.85) for moderate OSA and 2.96 (2.04–4.30) for severe OSA after adjustment for CKD risk factors. Among patients at increased risk of CKD progression, 73% were unaware they had abnormal kidney function. Conclusion Patients with moderate and severe OSA have an increased risk of CKD progression independent of other CKD risk factors; most patients are unaware of this increased risk.