Effect of continuous positive airway pressure on albuminuria in patients with obstructive sleep apnea: a meta-analysis

Effects of continuous positive airway pressure on renal function in adults with obstructive sleep apnea: a systematic review and meta-analysis

PURPOSE

Obstructive sleep apnea (OSA) is associated with increased risk of chronic kidney disease (CKD). OSA is highly prevalent among patients with CKD, suggesting a bidirectional link between the two conditions. Recent studies reported that continuous positive airway pressure (CPAP) may benefit renal function in OSA patients; however, uncertainties regarding their effects persist. Therefore, we examined the effects of CPAP treatment on renal function in adults with OSA.

METHODS

We systematically searched PubMed, EMBASE, Cochrane Library, Web of Science, and ClinicalTrials.gov for relevant studies from their inception until January 2024. Pooled estimates for all outcomes were calculated using a random-effects model. Primary outcome measures were the estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR).

RESULTS

Four randomized controlled trials (RCTs) and seven non-RCTs (NRCTs) (n = 2,660) were included. Compared with the control group, the CPAP group exhibited a significantly minimal alleviation in eGFR decline in NRCT (mean difference [MD] = 1.95, 95% confidence interval [CI] = 0.80 to 3.11, p < 0.001), but not in RCT (MD = 1.42, 95% CI = - 0.99 to 3.82, p = 0.25). No significant associations were found between CPAP therapy and UACR (MD = - 0.05, 95% CI = - 0.41 to 0.30, p = 0.77).

CONCLUSION

Current research provides a low to moderate certainty of evidence, suggesting that CPAP therapy has little to no effect on alleviating the decline in renal function. However, further RCTs with larger sample sizes and extended follow-up periods are required.

Association between self-reported sleep apnea and albuminuria among middle age and elderly population: Results from National Health and Nutrition Examination Survey

The prevalence of both obstructive sleep apnea (OSA) and albuminuria increase with advanced age. The data on the association between OSA and albuminuria in subjects with advanced age were limited. Hence, the present study aimed to assess the association between sleep apnea (SA) and albuminuria in middle age and elderly population. Data on participants with age ≥ 40 years during 2005 to 2008 and 2015 to 2020 National Health and Nutrition Examination Survey were analyzed. SA was evaluated based on the sleep questionnaire and albuminuria was assessed by albumin-to-creatinine ratio. The independent relationship between SA and albuminuria was explored by using multivariate logistic regression. A total of 13,902 subjects with 11,788 cases of normoalbuminuria and 2114 cases of albuminuria were included for data analysis. The proportion of albuminuria increased as SA severity aggravation. Univariate logistic analysis showed that frequently SA was positively associated with albuminuria (OR = 1.301, 95% CI = 1.089-1.547, P = .003). In multivariate logistic analysis, frequently SA was independently associated with increased risk of albuminuria after adjusting for confounding factors (OR = 1.309, 95% CI = 1.010-1.683, P = .039). The present study suggested that self-reported frequently SA was independently associated with increased risk of albuminuria in middle age and elderly population.

Association between obstructive sleep apnea and 24-h urine protein quantification in patients with hypertension

The association between obstructive sleep apnea (OSA) and proteinuria is undetermined, with few studies on hypertension, a high-risk group for renal impairment. Therefore, we aimed to explore whether OSA is an independent risk factor for proteinuria in patients with hypertension. We investigated the cross-sectional association between OSA and proteinuria. Participants were divided into groups by apnea hypopnea index (AHI) category. Multivariable Logistic regression analysis was used to evaluate the association between OSA severity, objectively measured sleep dimensions, and proteinuria which is mainly defined by 24-h urine protein quantification > 300 mg/24 h. Sensitivity analyses were performed by excluding those with comorbidities (primary aldosteronism and homocysteine ≥ 15 μmol/L). Of the 2106 participants, the mean age was 47.57 ± 10.50 years, 67.2% were men, and 75.9% were OSA patients. In total participants, compared with those without OSA, patients with mild OSA, moderate OSA, and severe OSA showed 1.09 (95% CI 0.80-1.40), 1.24 (95% CI 0.89-1.74) and 1.47 (95% CI 1.04-2.08) fold risk for proteinuria with a trend test P trend < 0.05. Each 10-unit increase in the AHI, oxygen desaturation index (ODI), and time spent with oxygen saturation < 90% (T90) was found to be associated with 13%, 10%, and 2% higher likelihood of proteinuria in the crude model, significant in adjusted models. The more severe the OSA is, the higher the risk of proteinuria. AHI and T90 are independently associated with a higher risk of structural renal damage in the population with hypertension.

The effect of PAP on UACR and metabolic indexes in patients with MS and OSAHS

PURPOSE

To investigate the effects of positive airway pressure (PAP) device on urinary albumin to creatinine ratio (UACR) and metabolic indexes in patients with metabolic syndrome (MS) and obstructive sleep apnea-hypopnea syndrome (OSAHS).

METHODS

This study is a retrospective cohort study. Grouped according to whether to use PAP treatment, there were 25 cases in the PAP group and 44 cases in the no OSAHS treatment group. The PAP group received positive airway pressure device and routine treatment of MS. The no OSAHS treatment group received routine treatment of OSAHS and MS. The treatment period is 3 months.

RESULTS

1. The PAP group demonstrated significant reductions in Body Mass Index (BMI), Waist circumference (WC), Neck circumference (NC), Visceral fat area (VFA), Fasting C peptide (FCP), high-sensitivity C-reactive protein (hs-CRP), and UACR compared to the no OSAHS treatment group, with significant differences (P all <0.05). Among them, the UACR in the PAP group decreased significantly (from 86.05(52.55,131.61)mg/g to 16.76(8.70,25.12)mg/g, P<0.001). 2. Linear regression analysis using the decrease in UACR values as the dependent variable demonstrated a positive linear relationship with the decrease in BMI, VFA, fasting insulin (FINS), and homeostasis model assessment of insulin resistance (HOMA-IR). Furthermore, multiple linear regression analysis indicated that the decrease in VFA (B=0.537 [95% confidence interval, 0.084 to 0.989]; P = 0.021) and HOMA-IR (B=1.000 [95% confidence interval, 0.082 to 1.917]; P = 0.033) values independently correlated with decrease in UACR values.

CONCLUSIONS

PAP treatment can reduce UACR in patients with MS and OSAHS, and has the effect of improving metabolic disorders. The decrease of UACR in patients may be related to the decrease of visceral fat and the improvement of insulin resistance.

Adaptive responses to chronic intermittent hypoxia: contributions from the European Sleep Apnoea Database (ESADA) Cohort

Obstructive sleep apnoea (OSA) is a common disease in the general population, and is associated with increased cardiovascular risk and several comorbidities. Obesity favours upper airway collapsibility, but other pathophysiological traits have been identified, i.e. upper airway muscle activity, modulation of the respiratory drive, and the arousal threshold. OSA causes chronic intermittent hypoxia, inflammatory activation and autonomic imbalance with diurnal and nocturnal sympathetic hyperactivity. Disentangling so many components to investigate the pathogenesis of OSA's consequences is very hard clinically. However, albeit imperfect, clinical medicine constitutes a major source of inspiration for basic research, and a mutual exchange of information is essential between clinicians and physiologists to improve our understanding of disease states. OSA is no exception, and this narrative review will summarize the results of clinical studies performed over the years by the European Sleep Apnoea Database (ESADA) Study Group, to explore the variables linked to markers of intermittent hypoxia as opposed to the traditional assessment of OSA severity based on the frequency of respiratory events during sleep (the Apnoea Hypopnoea Index). The results of the clinical studies indicate that intermittent hypoxia variables are associated with several comorbidities, although evidence of a cause-effect relationship is still missing in many cases. It is also possible that adaptive rather than maladaptive responses could be evoked by intermittent hypoxia. The intensity, duration and frequency of intermittent hypoxia episodes causing adaptive rather than maladaptive responses, and their clinical implications, deserve further investigation.

Lung Dysfunction and Chronic Kidney Disease: A Complex Network of Multiple Interactions

Chronic kidney disease (CKD) is a progressive disease that affects > 10% of the total population worldwide or >800 million people. CKD poses a particularly heavy burden in low- and middle-income countries, which are least able to cope with its consequences. It has become one of the leading causes of death worldwide and is one of the few non-communicable diseases where the number of related deaths has increased over the last two decades. The high number of people affected, and the significant negative impact of CKD should be a reason to increase efforts to improve prevention and treatment. The interaction of lung and kidney leads to highly complex and difficult clinical scenarios. CKD significantly affects the physiology of the lung by altering fluid homeostasis, acid-base balance and vascular tone. In the lung, haemodynamic disturbances lead to the development of alterations in ventilatory control, pulmonary congestion, capillary stress failure and pulmonary vascular disease. In the kidney, haemodynamic disturbances lead to sodium and water retention and the deterioration of renal function. In this article, we would like to draw attention to the importance of harmonising the definitions of clinical events in pneumology and renal medicine. We would also like to highlight the need for pulmonary function tests in routine clinical practise for the management of patients with CKD, in order to find new concepts for pathophysiological based disease-specific management strategies.

A Review of a Recent Meta-Analysis Study on Obstructive Sleep Apnea

This paper summarizes a recent meta-analysis of various topics in obstructive sleep apnea (OSA). In addition to cardiovascular disease and neurocognitive dysfunction, a wide variety of diseases have been associated with OSA, and associations with cancer have also been reported. Although continuous positive airway pressure is a very effective treatment, the results have shown that it does not reduce the incidence of various complications. It has been reported that uvulopalatopharyngoplasty was effective, and robotic surgery for the tongue root and hypoglossal nerve stimulation were also effective. The effectiveness of various medications to reduce daytime sleepiness has also been demonstrated. Although exercise lowered the apnea-hypopnea index, it was not related to changes in body composition, and it was also reported that exercise combined with weight control were effective. Additionally, interesting and clinically meaningful meta-analysis results were summarized and presented.