Effect of Obstructive Sleep Apnea Treatment on Renal Function in Patients with Cardiovascular Disease

Loffler, Kelly A.; Heeley, Emma; Freed, Ruth S.; Anderson, Craig S.; Brockway, Ben; Corbett, Alastair; Chang, Catherina L.; Douglas, James; Ferrier, Katherine; Graham, Neil M.H.; Hamilton, Garun S.; Hlavac, Michael; McArdle, Nigel; McLachlan, J. D.; Mukherjee, Sutapa; Naughton, Matthew T.; Thien, Francis; Young, Alan; Grunstein, Ronald R.; Palmer, Lyle J.; Woodman, Richard; Hanly, Patrick J.; McEvoy, R. Doug

doi:10.1164/rccm.201703-0603oc

Cited by 36 publications

(25 citation statements)

References 28 publications

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“…Two small studies [101,102] Only one randomised controlled study has been published so far on long-term effects of CPAP on kidney function, which was a sub-study of the SAVE trial [106] on 200 patients without severe nocturnal hypoxemia followed up for a median period of In summary, despite a few studies support that treatment of OSA by CPAP has beneficial effects on the kidneys, some controversy still exists, and further stronger evidence is required to better clarify this issue. Large randomized trials are urgently needed and one has already been planned [111].…”

Section: Effect Of Treatment With Cpap On Renal Functionmentioning

confidence: 99%

Chronic kidney disease in patients with obstructive sleep apnea. A narrative review

Voulgaris

Marrone

Bonsignore

et al. 2019

Sleep Medicine Reviews

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Prevalence of both chronic kidney disease (CKD) and obstructive sleep apnea (OSA) is continuously increasing. Moreover, the prevalence of OSA increases as kidney function declines and is higher among patients with end-stage renal disease (ESRD). In addition, OSA is recognized as a potential nontraditional risk factor for development and progression of CKD. Continuous positive airway pressure (CPAP) plays a pivotal role in the management of OSA, eliminating patients' symptoms and improving their quality of life. Recent studies suggested that CPAP treatment may have beneficial effects on kidney function among patients with OSA. This narrative review summarizes the existing knowledge on the association between CKD and OSA, with emphasis on the epidemiology, the pathophysiology of the development of CKD in OSA and vice versa, as well as the effect of CPAP on renal function.

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Section: Effect Of Treatment With Cpap On Renal Functionmentioning

confidence: 99%

Chronic kidney disease in patients with obstructive sleep apnea. A narrative review

Voulgaris

Marrone

Bonsignore

et al. 2019

Sleep Medicine Reviews

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“…OSA is the most common kind of sleep apnea characterized by upper airway collapse during sleep with repeated episodes of apneas and hypopneas leading to oxygen desaturations [5][6][7][8][9][10][11]. OSA is related to congestive heart failure, hypertension, stroke, arrhythmias, and worsens the prognosis of coronary artery disease [12][13][14][15][16][17]. The organ damage is related to intermittent hypoxia, inducing oxidative stress, inflammatory state, hemodynamic instability, and increased sympathetic activity; all of these factors contribute to tissue injury that can be mainly ascribed to endothelial dysfunction [18].…”

Section: Introductionmentioning

confidence: 99%

“…It was estimated that more than 17% of the general population suffers from OSA [12][13][14][15][16][17][18][19], but the prevalence of OSA in CKD patients has been reported to be even greater than 40% [5].…”

Section: Introductionmentioning

confidence: 99%

Interrelationship among Obstructive Sleep Apnea, Renal Function and Survival: A Cohort Study

Pochetti

Azzolina

Ragnoli

et al. 2020

IJERPH

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Previous studies showed a bidirectional relationship between renal function decline and obstructive sleep apnea (OSA) syndrome. Continuous Positive Airway Pressure (C-PAP) treatment was shown to preserve the kidney function in OSA patients. This study aims to investigate the progression of long-term renal function in OSA patients treated with different PAP strategies (patients were divided into two groups, fixed C-PAP or other PAP—automatic and bilevel pressure). Comorbidities and 10-years survival were also evaluated. We performed a retrospective, observational, single-center, cohort study, including the first 40 consecutive patients enrolled from 2009 in the Respiratory disease Unit at the Vercelli University Hospital database. The patient inclusion criteria were: age ≥ 18 years with OSA syndrome according to AASM (American Academy of Sleep Medicine) guidelines. Creatinine serum levels (mg/dL) and the estimated Glomerular Filtration Rate (eGFR, mL/min calculated by CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration equation)) were measured at 3 different time points: at baseline, 3 years and 8 years after PAP treatment. The Kaplan–Meier survival curves stratified according to PAP treatment and compliance have been reported together with log-rank test estimation. In our study, we found a significant creatinine serum level reduction after 3 years of fixed C-PAP treatment (p value = 0.006) when compared to baseline values. However, we observed that the long-term C-PAP benefit was not significant (p value = 0.060). Our data confirmed the progressive renal function decline in OSA patients, especially in those using other-PAP treatments; nevertheless, OSA treatment with a fixed C-PAP device has shown, in the short term, a significant improvement in renal function. By contrast, in our study, long-term benefits after 8 years are not been demonstrated probably because of the lack of compliance of the patients and the aging effect.

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“…A retrospective, observational cohort study23 reported that treatment of OSA with CPAP improved kidney function in patients with CKD. More recently, a randomised controlled trial to evaluate the impact of CPAP on cardiovascular outcomes failed to show any benefit on kidney function24 but the vast majority of the patients had normal kidney function and the study was not adequately powered to investigate renal outcomes. The purpose of this trial is to evaluate the feasibility and efficacy of CPAP treatment for OSA to slow the loss of kidney function in patients with coexisting CKD, using a randomised, controlled design.…”

Section: Introductionmentioning

confidence: 99%

Effect of CPAP therapy on kidney function in patients with obstructive sleep apnoea and chronic kidney disease: a protocol for a randomised controlled clinical trial

et al. 2019

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IntroductionObstructive sleep apnoea (OSA) is common in patients with chronic kidney disease (CKD) and may contribute to the progression of kidney disease either through direct effects of hypoxia on the kidney or indirectly through hypoxaemia-induced oxidative stress, endothelial dysfunction, inflammation, activation of the renin–angiotensin and sympathetic nervous systems, and hypertension. Treatment of OSA with continuous positive airway pressure (CPAP) improves many of these physiological abnormalities in patients with normal renal function, though to date there are no trials evaluating the effect of OSA treatment on kidney function in patients with CKD. The purpose of this study is to test the feasibility and efficacy of CPAP therapy in CKD patients with OSA.Methods and analysisThe study is a randomised, controlled, non-blinded, parallel clinical trial in which patients with established CKD are screened for OSA. Patients with OSA are randomised to either conventional medical therapy (control group) or medical therapy and CPAP (CPAP group) and followed for 1 year. The primary outcome is the change in estimated glomerular filtration rate. Secondary outcomes are the change in the urinary albumin/creatinine ratio, the Epworth Sleepiness Scale , Pittsburgh Sleep Quality Index and Kidney Disease Quality of Life questionnaire.Ethics and disseminationEthics approval has been obtained from the Conjoint Health Research Ethics Board (ID: REB15-0055). Results from this study will be disseminated through presentations at scientific conferences and publication in peer-reviewed journals.Trial registration numberNCT02420184; Pre-results.

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Effect of Obstructive Sleep Apnea Treatment on Renal Function in Patients with Cardiovascular Disease

Abstract: CPAP treatment of OSA in patients with cardiovascular disease does not alter renal function or the occurrence of renal adverse events. Clinical trial registered with www.clinicaltrials.gov (NCT00738179).

Cited by 36 publications

References 28 publications

Chronic kidney disease in patients with obstructive sleep apnea. A narrative review

Chronic kidney disease in patients with obstructive sleep apnea. A narrative review

Interrelationship among Obstructive Sleep Apnea, Renal Function and Survival: A Cohort Study

Effect of CPAP therapy on kidney function in patients with obstructive sleep apnoea and chronic kidney disease: a protocol for a randomised controlled clinical trial

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