High risk of obstructive sleep apnea is a risk factor of death censored graft loss in kidney transplant recipients: An observational cohort study

Szentkirályi, András; Czira, Maria E.; Molnar, Miklos Z.; Kövesdy, Csaba P.; Remport, Ádám; Szeifert, Lilla; Vámos, Eszter; Juhász, János; Turányi, Csilla Zita; Mucsi, István; Novák, Márta

doi:10.1016/j.sleep.2010.08.012

Cited by 28 publications

(20 citation statements)

References 42 publications

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“…OSA can cause increased renal sympathetic activity, intermittent hypoxia, hypertension, accelerated atherosclerosis, production of proinflammatory cytokines, endothelial dysfunction and proteinuria, which could all contribute to the development and progression of CKD. Previous studies have reported a significant association of OSA with the progression of kidney disease 34 35. In a study comparing 27 patients with OSA with 32 healthy controls, those with OSA had higher filtration fraction suggesting the presence of glomerular hyperfiltration 13.…”

Section: Discussionmentioning

confidence: 94%

Association of incident obstructive sleep apnoea with outcomes in a large cohort of US veterans

Molnar

Mucsi

Novák

et al. 2015

Thorax

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124

122

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Rationale There is a paucity of large cohort studies examining the association of obstructive sleep apnea(OSA) with clinical outcomes including all-cause mortality, coronary heart disease(CHD), strokes and chronic kidney disease(CKD). Objectives We hypothesized that a diagnosis of incident OSA is associated with higher risks of these adverse clinical outcomes. Methods, Measurements In a nationally representative cohort of over 3 million(n=3,079,514) US veterans(93% male) with baseline estimated glomerular filtration rate (eGFR)≥60 ml/min/1.73m2, we examined the association between the diagnosis of incident OSA, treated and untreated with continuous positive airway pressure(CPAP), and: 1) all-cause mortality, 2) incident CHD, 3) incident strokes, 4)incident CKD defined as eGFR<60 ml/min/1.73m2, and 5)slopes of eGFR. Main Results Compared to OSA negative patients, untreated and treated OSA was associated with 86% higher mortality risk,(adjusted hazard ratio and 95% confidence interval: 1.86(1.81-1.91)) and 35% (1.35(1.21-1.51)), respectively. Similarly, untreated and treated OSA was associated with 3.5 times(3.54(3.40-3.69)) and 3 times(3.06(2.62-3.56)) higher risk of incident CHD; 3.5 times higher risk of incident strokes(3.48(3.28-3.64) and 3.50(2.92-4.19)) for untreated and treated OSA, respectively. The risk of incident CKD was also significantly higher in untreated(2.27(2.19-2.36)) and treated(2.79(2.48-3.13)) OSA patients. The median (interquartile range) of the eGFR slope was −0.41(−2.01 - 0.99), −0.61(−2.69 - 0.93) and −0.87(−3.00 - 0.70)ml/min/1.73m2 in OSA negative, untreated and treated OSA positive patients, respectively. Conclusions In this large and contemporary cohort of more than 3 million US veterans, a diagnosis of incident OSA was associated with higher mortality, incident CHD, stroke and CKD and with faster kidney function decline.

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Section: Discussionmentioning

confidence: 94%

Association of incident obstructive sleep apnoea with outcomes in a large cohort of US veterans

Molnar

Mucsi

Novák

et al. 2015

Thorax

Self Cite

124

122

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“…We previously showed that high risk of OSA is an independent predictor of graft loss among female kidney transplant recipients21. However, we used questionnaire to assess the risk of OSA in our patients.…”

Section: Discussionmentioning

confidence: 99%

Sleep apnea is not associated with worse outcomes in kidney transplant recipients

Fornadi

Rónai

Turányi

et al. 2014

Sci Rep

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Obstructive sleep apnea(OSA) is one of the most common sleep disorders in kidney transplant recipients, however its long-term consequences have only rarely been investigated. Here, we hypothesized that the presence of OSA would be associated with higher risk of mortality and faster decline of graft function in kidney transplant recipients. In a prospective cohort study 100 prevalent kidney transplant recipients who underwent one-night polysomnography at baseline and were followed for a median 75 months. Generalized linear mixed-effects models and Cox regression models were used to assess the association between OSA and the rate of progression of chronic kidney disease(CKD) and mortality. The estimated slopes of estimated glomerular filtration rate(eGFR) in patients with and without OSA were compared using a two-stage model of eGFR change including only OSA as a variable. In this model patients with OSA (eGFR versus time was −0.93 ml/min/1.73 m2/yr(95%CI:−1.75 to−0.11) had a similar slope as compared to patients without OSA(eGFR versus time was −1.24 ml/min/1.73 m2/yr(95%CI: −1.67 to −0.81). In unadjusted Cox proportional regression analyses OSA was not associated with higher all-cause mortality risk (Hazard Ratio(HR) = 1.20; 95% Confidence Interval(CI): 0.50–2.85). No association was found between the presence of OSA and the rate of progression of CKD or all-cause mortality in prevalent kidney transplant recipients.

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“…Un estudio que incluyó a 823 pacientes candidatos a trasplante renal a los cuales se les realizó el cuestionario de Berlín, encontrando 28% de riesgo de tener SAOS. Posteriormente, calcularon el riesgo de rechazo renal de los pacientes con SAOS, obteniendo que las mujeres con SAOS tienen un mayor riesgo de rechazo con un RR de 3,05 (CI 1,24-7,51) 49 . Es importante mencionar que no se encontró un mayor riesgo de mortalidad en este estudio.…”

Section: Enfermedad Renal Crónicaunclassified

Compromiso multisistémico en apnea obstructiva del sueño

Labarca

Descalzi

2014

Rev. méd. Chile

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. El diagnóstico se establece mediante la demostración de eventos obstructivos mediante polisomnografía o la poligrafía respiratoria, la que demuestra el índice de apnea e hipoapnea (AHI), indicador de severidad de SAOS. Un AHI < 5 es normal; leve, 5 a 10; moderado, 15 a 30 y severo > 30 [1][2][3] . La terapia se basa en tratamiento conservador e incluyen la pérdida de peso, higiene del sueño, corrección con terapia postural y manejo de factores como la congestión nasal. En aquellos pacientes con SAOS moderado o severo se recomienda el uso de CPAP (continuous positive airway pressure). Este dispositivo es considerado el tratamiento más efectivo demostrado en varios ensayos clínicos de distribución aleatoria 3,4 . La obstrucción de la vía aérea y la fragmentación del sueño tienen como consecuencia una alteración en los ciclos de hipoxia y reoxigenación.Esta alteración produce isquemia transitoria sobre los tejidos, concepto conocido como hipoxia crónica intermitente (HI) 5,6 . La HI aumenta las concentraciones de radicales libre de oxígeno (ROS) que actúan como mediadores de citoquinas pro-inflamatorias, generando un estado de inflamación sistémica, una mayor activación del sistema simpático, disfunción endotelial, desregulación metabólica y un estado de hipercoagulabilidad, mecanismos identificados como patogénicos en distintos sistemas del organismo en modelos clínicos como experimentales 7 (Figura 1). El objetivo de la presente revisión es describir las consecuencias que tiene SAOS sobre los distintos sistemas, así como los riesgos asociados a la patología y estudios que avalan estas asociaciones. Compromiso metabólico en SAOS ObesidadLa obesidad central es el factor de riesgo más prevalente en SAOS, cerca de 40% de los pacientes

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High risk of obstructive sleep apnea is a risk factor of death censored graft loss in kidney transplant recipients: An observational cohort study

Cited by 28 publications

References 42 publications

Association of incident obstructive sleep apnoea with outcomes in a large cohort of US veterans

Association of incident obstructive sleep apnoea with outcomes in a large cohort of US veterans

Sleep apnea is not associated with worse outcomes in kidney transplant recipients

Compromiso multisistémico en apnea obstructiva del sueño

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