Reduced renal function and sleep-disordered breathing in community-dwelling elderly men.
Reduced renal function and sleep-disordered breathing in community-dwelling elderly men.
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DOI：
10.1016/j.sleep.2007.08.021
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发表时间：
2008-08
期刊：
影响因子：
4.8
通讯作者：
Ensrud, Kristine E.
中科院分区：
文献类型：
--
作者：
Canales, Muna T.;Taylor, Brent C.;Ishani, Areef;Mehra, Reena;Steffes, Michael;Stone, Katie L.;Redline, Susan;Ensrud, Kristine E.
关键词：
睡眠呼吸障碍（SDB）可能会增加心血管疾病（CVD）和慢性肾脏疾病（CKD）死亡的风险。然而，肾功能轻度降低与SDB之间的相关性尚不确定。我们研究了508名年龄≥67岁（平均76.0 ± 5.3岁）的社区居住男性，他们在明尼苏达州研究中心参加了老年男性睡眠障碍结局（MrOS）睡眠研究，并在夜间多导睡眠图中同时测量了血清胱抑素C和肌酐。CKD定义为使用Cockcroft-Gault（CG）、肾脏疾病饮食改良（MDRD）和马约诊所公式估计的肾小球滤过率（eGFR）<60 ml/min/1.73 m2。SDB定义为呼吸紊乱指数（RDI）≥15起事件/h。平均胱抑素C为1.21 ± 0.30 mg/L，平均肌酐为1.09 ± 0.23 mg/dL。中位RDI为7.0起事件/小时（范围0-73）。胱抑素-C的四分位数越高，平均RDI越高（趋势p = 0.007）。在调整年龄和种族后，这种相关性仍然存在（趋势p = 0.03），但在调整体重指数后，这种相关性不存在（BMI，趋势p = 0.34）。在调整年龄、种族、BMI、糖尿病、高血压和CVD后，由马约诊所公式定义的CKD与SDB的更高几率相关，而CG或MDRD与SDB的更高几率无关[比值比（OR）1.95，95%置信区间（CI）1.04-3.65，p = 0.04]。肾功能降低的老年男性（定义为胱抑素C浓度较高）的平均RDI较高。这种效应可以通过具有较高胱抑素-C的男性的较高BMI来解释。由马约诊所公式定义的CKD与SDB的两倍高几率独立相关。因此，肾功能下降可能与老年男性的SDB有关。
Sleep-disordered breathing (SDB) may increase the risk of cardiovascular disease (CVD) and death in chronic kidney disease (CKD). However, the association between mild reductions in renal function and SDB is uncertain. We studied 508 community-dwelling men aged ≥67 years (mean 76.0 ± 5.3) who were enrolled at the Minnesota site for the Minneapolis center of the Outcomes of Sleep Disorders in Older Men (MrOS) sleep study and had serum cystatin-C and creatinine measured coincident with overnight polysomnography. CKD was defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 using Cockcroft-Gault (CG), modification of diet in renal disease (MDRD) and Mayo Clinic formulae. SDB was defined by a respiratory disturbance index (RDI) ≥15 events/h. Mean cystatin-C was 1.21 ± 0.30 mg/L, and mean creatinine was 1.09 ± 0.23 mg/dL. Median RDI was 7.0 events/h (range 0-73). Higher quartiles of cystatin-C were associated with higher mean RDI (p for trend = 0.007). This association persisted after adjustment for age and race (p for trend = 0.03), but not after adjustment for body mass index (BMI, p for trend = 0.34). After adjusting for age, race, BMI, diabetes, hypertension, and CVD, CKD defined by the Mayo Clinic formula, but not CG or MDRD, was associated with a higher odds of SDB [odds ratio (OR) 1.95, 95% confidence interval (CI) 1.04-3.65, p = 0.04]. Older men with reduced renal function as defined by higher cystatin-C concentration have higher average RDI. This effect is explained by higher BMI in men with higher cystatin-C. CKD defined by the Mayo Clinic formula is independently associated with twofold higher odds for SDB. Therefore, reduced renal function may be associated with SDB in older men.
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