睡眠相关呼吸障碍（SRBD）患者中慢性肾脏病的高患病率。

High Prevalence of chronic kidney disease among patients with sleep related breathing disorder (SRBD).

作者信息

Iseki Kunitoshi, Tohyama Kazuyo, Matsumoto Tsuyoshi, Nakamura Hiroshi

机构信息

Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan.

出版信息

Hypertens Res. 2008 Feb;31(2):249-55. doi: 10.1291/hypres.31.249.

DOI:10.1291/hypres.31.249

PMID:18360044

Abstract

Sleep apnea syndrome, a sleep-related breathing disorder (SRBD) of which obstructive sleep apnea syndrome (OSAS) is representative, is often associated with obesity, and therefore patients with SRBD might have a high prevalence of chronic kidney disease (CKD). However, the relationship between obesity and the prevalence of CKD has not yet been investigated in a large cohort of patients with SRBD. The Okinawa Nakamura Clinic Sleep Apnea Syndrome (ONSLEEP) registry contains records for all patients evaluated by full-scale polysomnography (PSG) from September 1990 to the end of 2003 (n=5,651). We studied the total of 4,056 (71.8%) of these patients who had an apnea hypopnea index (AHI) of more than 5 events per hour. The glomerular filtration rate (GFR) was estimated using the abbreviated Modification of Diet in Renal Disease equation in the 1,624 patients for whom serum creatinine data was obtained at the time of the PSG. We defined CKD as a GFR of less than 60 mL/min/1.73 m2. The mean age was 49.9+/-13.5 (mean+/-SD) years; the mean body mass index (BMI) was 28.4+/-5.0 (mean+/-SD) kg/m2. We compared the findings with those from participants in the 1993 general screening registry in Okinawa (n=94,267). From among the total 94,267 screening participants, we selected 7,454 subjects who were age- and sex-matched to the experimental group with SRBD; the ratio of cases to controls was thus approximately 1:4. CKD was detected in 496 (30.5%) patients, with SRBD a higher incidence than that in the screened population (9.1%); the adjusted odds ratio (95% confidence interval) was 4.542 (3.922-5.260, p<0.0001). In contrast to the screened population, the prevalence of CKD decreased as BMI increased (it was 35.7% in SRBD patients with a BMI<25.0 kg/m2, 31.4% in those with a BMI 25.0 to 29.9 kg/m2, and 25.2% in those with a BMI > or =30.0 kg/m2); in the controls the values were 8.1%, 10.5%, and 10.6%, respectively. Taken together, these results suggest that surveillance of CKD is warranted among SRBD patients, particularly those who are not obese.

摘要

睡眠呼吸暂停综合征是一种与睡眠相关的呼吸障碍（SRBD），其中阻塞性睡眠呼吸暂停综合征（OSAS）具有代表性，它常与肥胖相关，因此SRBD患者可能有较高的慢性肾脏病（CKD）患病率。然而，肥胖与CKD患病率之间的关系尚未在一大群SRBD患者中进行研究。冲绳中村诊所睡眠呼吸暂停综合征（ONSLEEP）登记处包含了1990年9月至2003年底通过全面多导睡眠图（PSG）评估的所有患者的记录（n = 5651）。我们研究了其中4056名（71.8%）呼吸暂停低通气指数（AHI）每小时超过5次的患者。在1624名在PSG检查时获得血清肌酐数据的患者中，使用简化的肾脏病饮食改良方程估算肾小球滤过率（GFR）。我们将CKD定义为GFR低于60 mL/min/1.73 m²。平均年龄为49.9±13.5（均值±标准差）岁；平均体重指数（BMI）为28.4±5.0（均值±标准差）kg/m²。我们将这些结果与1993年冲绳一般筛查登记处的参与者（n = 94267）的结果进行了比较。在总共94267名筛查参与者中，我们选择了7454名年龄和性别与SRBD实验组匹配的受试者；病例与对照的比例约为1:4。在496名（30.5%）患者中检测到CKD，SRBD患者的发病率高于筛查人群（9.1%）；调整后的优势比（95%置信区间）为4.542（3.922 - 5.260，p < 0.0001）。与筛查人群不同，CKD的患病率随着BMI的增加而降低（BMI < 25.0 kg/m² 的SRBD患者中为35.7%，BMI为25.0至29.9 kg/m² 的患者中为31.4%，BMI≥30.0 kg/m² 的患者中为25.2%）；对照组中的相应值分别为8.1%、10.5%和10.6%。综上所述，这些结果表明，有必要对SRBD患者，尤其是那些不肥胖的患者进行CKD监测。