Obstructive sleep apnoea: a stand-alone risk factor for chronic kidney disease
Obstructive sleep apnoea: a stand-alone risk factor for chronic kidney disease
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DOI：
10.1093/ndt/gfq821
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发表时间：
2011-07-01
影响因子：
6.1
通讯作者：
Chen, Ning-Hung
中科院分区：
文献类型：
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作者：
Chou, Yu-Ting;Lee, Pei-Hsien;Chen, Ning-Hung
背景以前的研究已经发现阻塞性睡眠呼吸暂停（OSA）和慢性肾脏病（CKD）之间存在关联。但是，未排除有糖尿病和高血压等混杂因素的受试者。本研究的目的是确定不符合糖尿病或高血压标准的阻塞性睡眠呼吸暂停综合征患者是否也会出现慢性肾病的可能性增加。方法。我们前瞻性地招募了以习惯性打鼾为主诉的成年患者。检查夜间多导睡眠图、空腹血甘油三酯、胆固醇、血糖、胰岛素、肌酐、白蛋白和血红蛋白A1 c以及首次排尿白蛋白和肌酐。计算肾小球滤过率（eGFR）、尿白蛋白/肌酐比值（UACR）、胰岛素抵抗（IR）和慢性肾脏病（CKD）。最终分析涉及40名中年患者[44.8（8.6）岁]，主要为男性（83%），肥胖[体重指数，28.2（5.1）kg/m2]和更严重的OSA，呼吸暂停低通气指数（AHI）为51.6（39.2）/h。平均eGFR和UACR分别为85.4（18.3）mL/min/1.73m2和13.4（23.4）mg/g。重度OSA患者中CKD的患病率为18%。多元逐步回归分析显示，AHI和去氧饱和指数分别是UACR（β = 0.26，P = 0.01，R-2 = 0.17）和eGFR（β = 0.32，P < 0.01，R-2 = 0.32）的独立预测因子。无高血压或糖尿病的重度OSA患者中CKD患病率较高。OSA的严重程度与肾功能损害程度呈正相关。
Background. Previous studies have found an association between obstructive sleep apnea (OSA) and chronic kidney disease (CKD). However, subjects with confounding factors such as diabetes and hypertension were not excluded. The purpose of the present study was to determine whether patients with OSA without meeting criteria for diabetes or hypertension would also show increased likelihood of CKD.Methods. We prospectively enrolled adult patients with a chief complaint of habitual snoring. Overnight polysomnography, fasting blood triglyceride, cholesterol, glucose, insulin, creatinine, albumin and hemoglobin A1c, and first voiding urine albumin and creatinine were examined. Estimated glomerular filtration rate (eGFR), urine albumin-to-creatinine ratio (UACR), homeostatic model assessment-insulin resistance and percentage of CKD were calculated.Results. The final analyses involved 40 patients who were middle-aged [44.8 (8.6) years] predominantly male (83%), obese [body mass index, 28.2 (5.1) kg/m(2)] and more severe OSA, with an apnea-hypopnea index (AHI) of 51.6 (39.2)/h. The mean eGFR and UACR were 85.4 (18.3) mL/min/1.73m(2) and 13.4 (23.4) mg/g, respectively. The prevalence of CKD in severe OSA subjects is 18%. With stepwise multivariate linear regression analysis, AHI and desaturation index were the only independent predictor of UACR (beta = 0.26, P = 0.01, R-2 = 0.17) and eGFR (beta = 0.32, P < 0.01, R-2 = 0.32), respectively.Conclusions. High prevalence of CKD is present in severe OSA patients without hypertension or diabetes. Significantly positive correlations were found between severity of OSA and renal function impairment.