Abuyassin Bisher, Sharma Kumar, Ayas Najib T, Laher Ismail
Departments of Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Institute of Metabolomic Medicine and Center for Renal Translational Medicine, University of California, San Diego, La Jolla, CA.
J Clin Sleep Med. 2015 Aug 15;11(8):915-24. doi: 10.5664/jcsm.4946.
Chronic kidney disease (CKD) is associated with high mortality rates and heavy economic and social burdens. Nearly 10% of the United States population suffer from CKD, with fatal outcomes increased by 16-40 times even before reaching end-stage renal disease. The prevalence of obstructive sleep apnea (OSA) is between 3% and 7% in the general population, and has increased dramatically during the last 2 decades along with increased rates of obesity. However, the prevalence of OSA is much greater in patients with CKD. In addition, aggressive dialysis improves OSA. The current literature suggests a bidirectional association between CKD and OSA through a number of potential pathological mechanisms, which increase the possibility of both diseases being possible risk factors for each other. CKD may lead to OSA through a variety of mechanisms, including alterations in chemoreflex responsiveness, pharyngeal narrowing due to fluid overload, and accumulation of uremic toxins. It is also being increasingly recognized that OSA can also accelerate loss of kidney function. Moreover, animals exposed to intermittent hypoxia suffer histopathological renal damage. Potential mechanisms of OSA-associated renal dysfunction include renal hypoxia, hypertension, endothelial dysfunction, activation of the sympathetic nervous system, and increased oxidative stress.
慢性肾脏病(CKD)与高死亡率以及沉重的经济和社会负担相关。近10%的美国人口患有CKD,甚至在进入终末期肾病之前,死亡风险就增加了16至40倍。普通人群中阻塞性睡眠呼吸暂停(OSA)的患病率在3%至7%之间,并且在过去20年中随着肥胖率的上升而急剧增加。然而,CKD患者中OSA的患病率要高得多。此外,积极的透析可改善OSA。当前的文献表明,CKD和OSA之间通过多种潜在的病理机制存在双向关联,这增加了两种疾病互为潜在危险因素的可能性。CKD可能通过多种机制导致OSA,包括化学反射反应性改变、液体过载导致的咽部狭窄以及尿毒症毒素的蓄积。人们也越来越认识到,OSA也会加速肾功能丧失。此外,暴露于间歇性缺氧的动物会出现肾脏组织病理学损伤。OSA相关肾功能障碍的潜在机制包括肾缺氧、高血压、内皮功能障碍、交感神经系统激活以及氧化应激增加。