Iliescu E A, Lam M, Pater J, Munt P W
Queen's University at Kingston, Ontario, Canada.
Clin Nephrol. 2001 Mar;55(3):196-204.
Previous studies report a high prevalence of proteinuria in patients with obstructive sleep apnea syndrome (OSAS). This common syndrome may therefore be an important cause ofproteinuria and renal failure in the general population. This study was undertaken to assess the prevalence of proteinuria among OSAS patients, and to identify the factors associated with urine protein excretion in these patients.
Overnight polysomnography, urine protein to creatinine ratio (PTCR), body mass index (BMI), mean arterial pressure (MAP), and hematocrit were assessed prospectively in 224 patients referred for evaluation of suspected OSAS. Sleep apnea was defined as apnea-hypopnea score (AHS) > or = 5 events/hour. Proteinuria was defined as PTCR > 0.2 mg/mg.
Sleep apnea was present in 143 subjects (63.8%), and proteinuria in 10 (4.5%). The highest PTCR was 0.677 mg/mg. PTCR and AHS were weakly correlated (r = 0.12, p = 0.08). PTCR correlated (alpha = 0.05) with lowest oxygen saturation (r = -0.18, p = < 0.01), time spent with oxygen saturation below 90% (r = 0.19, p = < 0.01), and BMI (r= 0. 17, p = < 0.01). The mean PTCR was similar in subjects with and without sleep apnea. Proteinuria was present in 7 of 143 (4.9%) subjects with AHS > or = 5 and 3 of 81 (3.7%) subjects with AHS < 5, a relative risk of 1.34, 95% CI (0.34, 5.32). Predictors of LogPTCR in multiple linear regression (model R2 - 0.104) were: AHS (< 5 or > or = 5), baseline oxygen saturation, sex, and MAP.
Clinically significant proteinuria is uncommon in OSAS. The prevalence and severity of proteinuria are similar in both OSAS patients and patients without sleep-disordered breathing. Sleep apnea severity is weakly associated with urine protein excretion, related more to hypoxemia than to frequency of apneic events.
既往研究报道阻塞性睡眠呼吸暂停综合征（OSAS）患者中蛋白尿的患病率较高。因此，这种常见综合征可能是普通人群中蛋白尿和肾衰竭的重要原因。本研究旨在评估OSAS患者中蛋白尿的患病率，并确定与这些患者尿蛋白排泄相关的因素。
对224例因疑似OSAS前来评估的患者进行前瞻性的夜间多导睡眠监测、尿蛋白与肌酐比值（PTCR）、体重指数（BMI）、平均动脉压（MAP）和血细胞比容评估。睡眠呼吸暂停定义为呼吸暂停低通气指数（AHS）≥5次/小时。蛋白尿定义为PTCR＞0.2mg/mg。
143例受试者（63.8%）存在睡眠呼吸暂停，10例（4.5%）存在蛋白尿。最高PTCR为0.677mg/mg。PTCR与AHS呈弱相关（r = 0.12，p = 0.08）。PTCR与最低血氧饱和度（r = -0.18，p ＜0.01）、血氧饱和度低于90%的时间（r = 0.19，p ＜0.01）以及BMI（r = 0.17，p ＜0.01）相关（α = 0.05）。有和没有睡眠呼吸暂停的受试者的平均PTCR相似。AHS≥5的143例受试者中有7例（4.9%）存在蛋白尿，AHS＜5的81例受试者中有3例（3.7%）存在蛋白尿，相对危险度为1.34，95%可信区间（0.34，5.32）。多元线性回归（模型R2 = 0.104）中LogPTCR的预测因素为：AHS（＜5或≥5）、基线血氧饱和度、性别和MAP。
临床上有意义的蛋白尿在OSAS中并不常见。OSAS患者和无睡眠呼吸障碍患者的蛋白尿患病率和严重程度相似。睡眠呼吸暂停严重程度与尿蛋白排泄呈弱相关，更多与低氧血症有关而非呼吸暂停事件的频率。
