Obstructive Sleep Apnea and Kidney Disease: A Potential Bidirectional Relationship?

Abuyassin, Bisher; Sharma, Kumar; Ayas, Najib; Laher, Ismail

doi:10.5664/jcsm.4946

Cited by 114 publications

(104 citation statements)

References 124 publications

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“…These findings have led to the contention that sleep apnea and CKD have a bidirectional relationship with both diseases being a risk factor for the other. 279 CKD may lead to sleep apnea by autonomic nerve damage, effected by generalized uremic neuropathy, interfering with baroreceptor activity, pharyngeal narrowing due to fluid overload, and accumulation of uremic toxins. [279][280][281][282][283][284] Sleep apnea likely causes CKD through numerous mechanisms that promote renal hypoxia.…”

Section: Repeated Episodes Of Acute Kidney Injurymentioning

confidence: 99%

“…279 CKD may lead to sleep apnea by autonomic nerve damage, effected by generalized uremic neuropathy, interfering with baroreceptor activity, pharyngeal narrowing due to fluid overload, and accumulation of uremic toxins. [279][280][281][282][283][284] Sleep apnea likely causes CKD through numerous mechanisms that promote renal hypoxia. 285,286 The most obvious mechanism is that apnea causes insufficient or absent ventilation, compromised gas exchange, and, thus, intermittent nocturnal hypoxia.…”

Section: Repeated Episodes Of Acute Kidney Injurymentioning

confidence: 99%

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Hypoxia: The Force that Drives Chronic Kidney Disease

Colgan

Shelley

2016

Clinical Medicine & Research

128

111

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In the United States the prevalence of end-stage renal disease (ESRD) reached epidemic proportions in 2012 with over 600,000 patients being treated. The rates of ESRD among the elderly are disproportionally high. Consequently, as life expectancy increases and the baby-boom generation reaches retirement age, the already heavy burden imposed by ESRD on the US health care system is set to increase dramatically. ESRD represents the terminal stage of chronic kidney disease (CKD). A large body of evidence indicating that CKD is driven by renal tissue hypoxia has led to the development of therapeutic strategies that increase kidney oxygenation and the contention that chronic hypoxia is the final common pathway to end-stage renal failure. Numerous studies have demonstrated that one of the most potent means by which hypoxic conditions within the kidney produce CKD is by inducing a sustained inflammatory attack by infiltrating leukocytes. Indispensable to this attack is the acquisition by leukocytes of an adhesive phenotype. It was thought that this process resulted exclusively from leukocytes responding to cytokines released from ischemic renal endothelium. However, recently it has been demonstrated that leukocytes also become activated independent of the hypoxic response of endothelial cells. It was found that this endothelium-independent mechanism involves leukocytes directly sensing hypoxia and responding by transcriptional induction of the genes that encode the β2-integrin family of adhesion molecules. This induction likely maintains the long-term inflammation by which hypoxia drives the pathogenesis of CKD. Consequently, targeting these transcriptional mechanisms would appear to represent a promising new therapeutic strategy.

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Section: Repeated Episodes Of Acute Kidney Injurymentioning

confidence: 99%

Section: Repeated Episodes Of Acute Kidney Injurymentioning

confidence: 99%

Hypoxia: The Force that Drives Chronic Kidney Disease

Colgan

Shelley

2016

Clinical Medicine & Research

128

111

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“…When compared to controls without hypoxia, patients with nocturnal hypoxia presented with an increased risk for accelerated kidney function loss (reduction in eGFR by ≥4 mL/min/1.73 m 2 per year) with an odds ratio of 2.89 (95% CI: 1.25–6.67) after adjustment for confounding factors [47]. Additional proposed mechanisms include sympathetic hyperactivity, glomerular dysfunction due to arterial hypertension, and endothelial damage caused by oxidative stress and inflammation [48]. Moreover, both OSAS and kidney disease share common risk factors such as obesity, diabetes, and arterial hypertension.…”

Section: Discussionmentioning

confidence: 99%

Cystatin C Levels in Middle-Aged Patients with Obstructive Sleep Apnea Syndrome

et al. 2016

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Background. Obstructive sleep apnea syndrome (OSAS) is associated with systemic inflammation and increased risk of cardiovascular and chronic kidney disease. Cystatin C (Cyst C) is a novel biomarker of both latent renal damage and cardiovascular disease. Aim of the study was to measure serum levels of Cyst C, as well as IL-8 and CRP, in otherwise healthy OSAS patients. Methods. 84 individuals examined with polysomnography for OSAS symptoms without known comorbidities were prospectively recruited. Results. According to apnea hypopnea index (AHI) subjects were divided in two groups: OSAS group (AHI > 5/hour, n = 64) and controls (AHI < 5/hour, n = 20), which were age- and BMI-matched. Cyst C levels were higher in OSAS patients versus controls (1176.13 ± 351.33 versus 938.60 ± 245.83 ng/mL, resp.; p = 0.017) while serum IL-8 and CRP levels did not differ significantly. Positive correlation was found between Cyst C levels and respiratory disturbance index (RDI) (r = 0.240, p = 0.039) and percentage of time with oxygen saturation <90% (r = 0.290, p = 0.02) and negative correlation was found between Cyst C levels and average oxygen saturation during sleep (r = −0.291, p = 0.012). After adjustment for age and BMI, RDI was the only independent predictor of Cyst C levels (β = 0.256, p = 0.039). Conclusion. Cyst C serum levels are increased in OSAS patients without comorbidities, suggesting an increased renal and cardiovascular disease risk.

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“…The review by Abuyassin and colleagues provides a comprehensive account of the literature to date. 10 However, many important questions remain. Central to determining the relevance of OSA in ESRD is to evaluate how OSA impacts clinical outcomes such as sleep quality, daytime function, and cardiovascular morbidity and mortality.…”

Section: Co M M E N Ta Rymentioning

confidence: 99%

Consider the Kidney when Managing Obstructive Sleep Apnea

Hanly

2015

Journal of Clinical Sleep Medicine

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Obstructive Sleep Apnea and Kidney Disease: A Potential Bidirectional Relationship?

Cited by 114 publications

References 124 publications

Hypoxia: The Force that Drives Chronic Kidney Disease

Hypoxia: The Force that Drives Chronic Kidney Disease

Cystatin C Levels in Middle-Aged Patients with Obstructive Sleep Apnea Syndrome

Consider the Kidney when Managing Obstructive Sleep Apnea

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