Department of Pulmonary Medicine, Erciyes University School of Medicine, Kayseri, Turkey.
Int Urol Nephrol. 2012 Apr;44(2):535-9. doi: 10.1007/s11255-011-9927-8. Epub 2011 Mar 3.
Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for the development of cardiovascular events and hypertension. The possible causes are oxygen desaturation due to hypopnea, increased cytokine levels and insulin resistance. All these risk factors also have a role in the progression of chronic kidney disease (CKD). The aim of this study was to determine the relationship between OSAS and the severity of CKD.
We retrospectively evaluated the medical records of 175 subjects who were admitted for the polysomnography study. OSAS was diagnosed by polysomnography if Apnea-Hypopnea Index (AHI) > 5 and glomerular filtration rate (GFR) was calculated with Cockcroft-Gault formula. According to AHI, individuals with AHI < 5 were recruited as group 1 (OSAS negative group), those with AHI = 5-15 group 2 (mild OSAS group), those with AHI = 15-30 group 3 (moderate OSAS group), and those with AHI > 30 group 4 (severe OSAS group).
Of the subjects, 117 (67%) were men, 58 (33%) were women and the mean age was 54.0 ± 12.1 years. There were 28 (14.3%), 18 (10.3%), 35 (20.0%) and 97 (55.4%) patients in groups 1, 2, 3 and 4 respectively. The prevalence of diabetes mellitus and hypertension and body mass index was significantly higher in severe OSAS group (P < 0.05). A significant decrease in GFR was detected when the severity of OSAS increased (group 1 = 50.0 ± 11.8, group 2 = 44.8 ± 15.9, group 3 = 40.8 ± 14.7, group 4 = 38.8 ± 16.0; P for trend < 0.001).
In the light of the present study, we speculate that OSAS is an independent risk factor for the progression of chronic kidney disease, which is a growing health problem. Further randomized-multicenter prospective studies are warranted to evaluate this relationship.
阻塞性睡眠呼吸暂停综合征（OSAS）是心血管事件和高血压发展的独立危险因素。可能的原因是呼吸暂停引起的氧饱和度下降、细胞因子水平升高和胰岛素抵抗。所有这些危险因素在慢性肾脏病（CKD）的进展中也起作用。本研究旨在确定 OSAS 与 CKD 严重程度之间的关系。
我们回顾性评估了 175 名因多导睡眠图研究而住院的患者的病历。如果呼吸暂停-低通气指数（AHI）> 5，则通过多导睡眠图诊断为 OSAS，肾小球滤过率（GFR）用 Cockcroft-Gault 公式计算。根据 AHI，将 AHI < 5 的个体纳入第 1 组（OSAS 阴性组），将 AHI = 5-15 的个体纳入第 2 组（轻度 OSAS 组），将 AHI = 15-30 的个体纳入第 3 组（中度 OSAS 组），将 AHI > 30 的个体纳入第 4 组（重度 OSAS 组）。
在研究对象中，117 名（67%）为男性，58 名（33%）为女性，平均年龄为 54.0 ± 12.1 岁。第 1、2、3 和 4 组分别有 28（14.3%）、18（10.3%）、35（20.0%）和 97（55.4%）名患者。在重度 OSAS 组中，糖尿病和高血压的患病率以及体重指数显著升高（P < 0.05）。随着 OSAS 严重程度的增加，GFR 显著下降（第 1 组=50.0 ± 11.8，第 2 组=44.8 ± 15.9，第 3 组=40.8 ± 14.7，第 4 组=38.8 ± 16.0；趋势 P < 0.001）。
根据本研究，我们推测 OSAS 是慢性肾脏病进展的独立危险因素，这是一个日益严重的健康问题。需要进一步进行随机、多中心的前瞻性研究来评估这种关系。
