1. This study found moderate-to-very high risk of chronic kidney disease progression was greater in patients with more severe obstructive sleep apnea based on eGFR and ACR measurements.
2. Furthermore, many patients with increased risk of chronic kidney disease progression were unaware of their abnormal kidney function.
Evidence Rating Level: 2 (Good)
Chronic Kidney Disease (CKD) affects more than 10% of the global population and has been shown to lead to cardiovascular disease and mortality. While substantial medical literature supports a bi-directional relationship between CKD and obstructive sleep apnea (OSA), significant gaps still exist in our understanding. In this observational cohort study, the prevalence and awareness of CKD progression was assessed in OSA patients.
In this study, 1295 patients (≥18 years old) referred to one of five Canadian academic sleep centers for suspected OSA were included. Patients who were currently on dialysis and/or had a prior kidney transplant were excluded. Patients were further categorized as having, no/mild OSA, moderate OSA, or severe OSA, based on oxygen desaturation index. The patients were asked to complete a sleep questionnaire and a home sleep apnea or in-lab polysomnography test. Blood and urine samples were collected from each patient for albumin:creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) measurements. The risk of CKD progression was determined from heat maps generated from eGFR and ACR levels.
In this study, 13.6% of the no/mild OSA group, 28.9% of the moderate OSA group, and 30.9% of the severe OSA group had a moderate-to-very high risk of CKD progression. Compared to patients with no/mild OSA, the odds ratio for moderate-to-very high risk of CKD progression was 2.63 for moderate OSA and 2.96 for severe OSA patients. Interestingly, 73% of patients with increased risk of CKD progression were unaware they had abnormal kidney function. However, this study was limited in that the results were self-reported by the patients, which may be confounded by poor memory commonly found amongst OSA patients. Nonetheless, this study was significant in suggesting patients with moderate to severe OSA may be at increased risk for CKD progression, which patients may be unaware of.
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