Diabetic kidney disease and obstructive sleep apnea

Mawed, Saleem Al; Unruh, Mark

doi:10.1097/mcp.0000000000000230

Cited by 16 publications

(5 citation statements)

References 56 publications

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“…In addition to promoting the development of hypertension 33 , which seems not to be related to the renal function of our patients, this can also lead to tubulointerstitial injury 32,34 and renal fibrosis 35 , causing proteinuria and decreased eGFR 31 . Moreover, sympathetic activation may also increase angiotensin II, leading to efferent arteriolar vasoconstriction and hyperfiltration, which is a key pathway for the progression of chronic kidney disease 36 . Second, OSA with concurrent type 2 diabetes is associated with increased oxidative and nitrosative stress and activation of the inflammatory pathways, impairing microvascular and endothelial regulation 32 .…”

Section: Discussionmentioning

confidence: 99%

Obstructive sleep apnea is associated with impaired renal function in patients with diabetic kidney disease

Zamarrón

Oriol

García‐Sánchez

et al. 2021

Sci Rep

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Obstructive sleep apnea (OSA) is a recognized risk factor for the development of diabetic kidney disease (DKD). Our objectives were to compare the urinary albumin–creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) of patients with DKD according to OSA severity, and to evaluate the contribution of sleep parameters to their renal function. In a multicenter, observational, cross-sectional study, 214 patients with DKD were recruited. After a sleep study, UACR and eGFR were measured, as well as serum creatinine, fasting glucose, glycated hemoglobin, insulin resistance, lipid profile and C-reactive protein. UACR was higher in severe OSA patients (920 ± 1053 mg/g) than in moderate (195 ± 232 mg/g, p < 0.001) or mild OSA/non-OSA subjects (119 ± 186 mg/g, p < 0.001). At the same time, eGFR showed an OSA severity-dependent reduction (48 ± 23 vs. 59 ± 21 vs. 73 ± 19 ml/min per 1.73 m2, respectively; p < 0.001). Apnea–hypopnea index (AHI and desaturation index (ODI) were identified as independent predictors for UACR and eGFR, respectively. Therefore, in patients with DKD under optimized treatment, severe OSA is associated with a higher UACR and a lower eGFR, reflecting an additional contribution to the impairment of their renal function, although no causality can be inferred.

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Section: Discussionmentioning

confidence: 99%

Obstructive sleep apnea is associated with impaired renal function in patients with diabetic kidney disease

Zamarrón

Oriol

García‐Sánchez

et al. 2021

Sci Rep

View full text Add to dashboard Cite

show abstract

“…OSAS is a sleep disorder, commonly characterized by interrupted sleep rhythm and sudden pauses of breathing [124]. It affects nearly 1 billion people worldwide and is an important and independent cardiovascular risk factor tightly associated with obesity, IR, T2D, NAFLD, CAD, stroke, CKD, heart failure, and all-cause mortality [13,[125][126][127]. Obesity is the most important risk factor, because OSAS is described in approximately 40% of adults with BMI ≥ 30 kg/m 2 [128].…”

Section: Osasmentioning

confidence: 99%

Empagliflozin therapy and insulin resistance-associated disorders: effects and promises beyond a diabetic state

Papaetis¹

2021

Arch Med Sci Atheroscler Dis

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Empagliflozin is a SGLT2 inhibitor that has shown remarkable cardiovascular and renal activities in patients with type 2 diabetes (T2D). Preclinical and clinical studies of empagliflozin in T2D population have demonstrated significant improvements in body weight, waist circumference, insulin sensitivity, and blood pressure -effects beyond its antihyperglycaemic control. Moreover, several studies suggested that this drug possesses significant anti-inflammatory and antioxidative stress properties. This paper explores extensively the main preclinical and clinical evidence of empagliflozin administration in insulin resistance-related disorders beyond a diabetic state. It also discusses its future perspectives, as a therapeutic approach, in this high cardiovascular-risk population.

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“…In simple words endeavor to find out a "sleepy snorer" should be honestly made. This becomes extremely relevant particularly in obese subset 32 and in patients with chronic kidney disease 33 as the incidence of OSA is significantly higher in these cohorts. Those suspected to be having OSA can be subjected to the further pre-test probability tests and depending on the results of the same triaged for a PSG.…”

Section: Role Of Screeningmentioning

confidence: 99%

Obstructive Sleep Apnea and Diabetes Mellitus: A Bitter Combo

2018

Indian Journal of Sleep Medicine

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Obstructive sleep apnea (OSA) is a sleep-related breathing disorder (SRBD) hallmarked by upper airway collapsibility and obstruction leading to nocturnal hypoxia and sleep arousals. Diabetes mellitus (DM) is a chronic medical malady which stems from an aberration in the glucose metabolism leading to multisystemic complications and eventually ends organ damage. Both these disorders are independently major public health concerns by virtue of their momentous morbidity, mortality and healthcare albatross. The liaison between these two leviathans is enigmatic and multifarious. Prima facie they share a common predisposing factor of obesity. OSA is associated with impairment of glucose metabolism and predisposes the individual to the development of DM.Moreover DM serves as a risk factor for OSA in conjunction with the other components of the metabolic syndrome. Untreated DM leads to aggravation of the severity of OSA while untreated OSA leads to suboptimal glycemic control and propagates complications of DM. This intricate relationship between DM and OSA is a fertile and deficiently fathomed terrain for contemplative research. We hereby make a humble endeavor to decipher and simplify the Daedalean association.

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Diabetic kidney disease and obstructive sleep apnea

Abstract: Clinicians should have a low threshold for evaluating diabetic patients with CKD for OSA. Further studies examining if treatment of OSA would improve the outcomes of CKD patients in general and diabetic CKD patients in particular are needed.

Cited by 16 publications

References 56 publications

Obstructive sleep apnea is associated with impaired renal function in patients with diabetic kidney disease

Obstructive sleep apnea is associated with impaired renal function in patients with diabetic kidney disease

Empagliflozin therapy and insulin resistance-associated disorders: effects and promises beyond a diabetic state

Obstructive Sleep Apnea and Diabetes Mellitus: A Bitter Combo

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