Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary.
Sleep Med. 2011 Mar;12(3):267-73. doi: 10.1016/j.sleep.2010.08.012. Epub 2011 Feb 2.
Obstructive sleep apnea (OSA) is associated with increased risk of cardiovascular morbidity in the general population. The clinical significance of OSA among kidney transplant patients is unknown. Our aim was to investigate the association of "high risk of OSA" with death-censored graft loss and mortality in a large cohort of kidney transplant recipients.
Using the Berlin questionnaire 1067 prevalent kidney transplant recipients were assessed for risk of OSA. Socio-demographic variables, laboratory parameters and data about graft loss and mortality were obtained from the medical records. Multivariable-adjusted associations of OSA risk with graft loss and with all-cause mortality was assessed in competing-risks regression models.
Of the 823 patients who completed the Berlin questionnaire 28% had high risk of OSA (HRO) at baseline. Patients with HRO were older (52±11 vs. 47±13years, p<0.001), had a higher prevalence of diabetes (22 vs. 15%, p=0.018), worse baseline kidney function (estimated glomerular filtration rate: 46±18 vs. 51±19ml/min/1.73m(2), p=0.001) and higher BMI (27±5 vs. 24±4kg/m(2), p<0.001). In multivariate models HRO was an independent predictor of graft loss among females after adjusting for age, comorbidity, hypertension, BMI, kidney function, duration of chronic kidney disease, other laboratory parameters and transplant-related data (HR=3.05; CI: 1.24-7.51; p=0.015), while HRO did not predict graft survival among males. HRO at baseline was not independently associated with all-cause mortality in the sample.
High risk of OSA is an independent predictor of graft loss among female kidney transplant patients.
阻塞性睡眠呼吸暂停（OSA）与普通人群中心血管发病率增加相关。在肾移植患者中，OSA 的临床意义尚不清楚。我们的目的是在一个大型肾移植受者队列中研究“OSA 高危”与死亡相关移植物丢失和死亡率之间的关系。
使用柏林问卷，评估了 1067 例现患肾移植受者的 OSA 风险。从病历中获得社会人口统计学变量、实验室参数以及移植物丢失和死亡率的数据。使用竞争风险回归模型评估 OSA 风险与移植物丢失和全因死亡率的多变量调整关联。
在完成柏林问卷的 823 例患者中，28%（228 例）在基线时存在 OSA 高危（HRO）。HRO 患者年龄更大（52±11 岁 vs. 47±13 岁，p<0.001）、糖尿病患病率更高（22% vs. 15%，p=0.018）、基线肾功能更差（估算肾小球滤过率：46±18 与 51±19ml/min/1.73m(2)，p=0.001）和更高的 BMI（27±5 与 24±4kg/m(2)，p<0.001）。在调整年龄、合并症、高血压、BMI、肾功能、慢性肾脏病持续时间、其他实验室参数和移植相关数据后，HRO 是女性移植物丢失的独立预测因素（HR=3.05；CI：1.24-7.51；p=0.015），而 HRO 并不预测男性的移植物存活率。在该样本中，基线时的 HRO 与全因死亡率无关。
OSA 高危是女性肾移植患者移植物丢失的独立预测因素。
