Chen Ning-Hung, Chou Yu-Ting, Lee Pei-Hsien, Lin Shih-Wei, Chuang Li-Pang, Lin Yu-Sheng, Yang Cheng-Ta
aSleep Center and Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan bRespiratory Therapy, Chang Gung University, Taoyuan cSleep Center and Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi dGraduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University eChang Gung Technology University fDepartment of nephrology, Chiayi gHealth Examination Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Medicine (Baltimore). 2016 Jun;95(26):e4045. doi: 10.1097/MD.0000000000004045.
A positive correlation between albuminuria and severity of obstructive sleep apnea syndrome (OSAS) has been demonstrated, as indexed by urine albumin-to-creatinine ratios (UACRs). However, the effect of continuous positive airway pressure (CPAP) treatment on albuminuria in OSAS patients has not been established.Sixty subjects, with apnea-hypopnea indices >15 events per hour and no other diagnoses associated with albuminuria, underwent overnight polysomnography for sleep apnea and were examined for UACR at baseline and after 6 months of CPAP therapy. CPAP compliance rates were also recorded.Significant improvement in UACR was found in OSAS patients with good compliance to CPAP treatment after 6 months of therapy (baseline vs 6-month follow-up, 32.0 ± 9.5 vs 19.2 ± 6.5 mg/g, respectively, P = 0.007), whereas slight worsening in UACRs was noted in patients with poor compliance to CPAP treatment (baseline vs 6-month follow-up, respectively, 16.7 ± 4.4 vs 19.1 ± 6.3 mg/g, respectively, P = 0.39). Change in UACR was significant between poor compliance versus good compliance groups (2.4 ± 2.7 vs -12.8 ± 4.4 mg/g, respectively, t = 2.9, P = 0.005). A significant correlation between improvement in UACR and CPAP compliance rates was also noted (Spearman's correlation coefficient: -0.37, P = 0.007). Baseline UACR, good CPAP compliance, and body mass index were independent predictors of changes in UACR.Adequate CPAP treatment improves albuminuria in OSAS patients. In addition to monitoring CPAP adherence and subjective sleepiness, UACR may offer an objective physiological index of CPAP therapeutic effectiveness.
尿白蛋白与肌酐比值（UACR）已表明蛋白尿与阻塞性睡眠呼吸暂停综合征（OSAS）严重程度之间存在正相关。然而，持续气道正压通气（CPAP）治疗对OSAS患者蛋白尿的影响尚未明确。60名呼吸暂停低通气指数每小时大于15次且无其他与蛋白尿相关诊断的受试者接受了睡眠呼吸暂停的夜间多导睡眠图检查，并在基线和CPAP治疗6个月后检测UACR。同时记录CPAP依从率。治疗6个月后，CPAP治疗依从性良好的OSAS患者UACR有显著改善（基线与6个月随访时分别为32.0±9.5与19.2±6.5mg/g，P = 0.007），而CPAP治疗依从性差的患者UACR略有恶化（基线与6个月随访时分别为16.7±4.4与19.1±6.3mg/g，P = 0.39）。依从性差与依从性好的组间UACR变化显著（分别为2.4±2.7与 -12.8±4.4mg/g，t = 2.9，P = 0.005）。UACR改善与CPAP依从率之间也存在显著相关性（Spearman相关系数：-0.37，P = 0.00）。基线UACR、良好的CPAP依从性和体重指数是UACR变化的独立预测因素。充分的CPAP治疗可改善OSAS患者的蛋白尿。除了监测CPAP依从性和主观嗜睡外，UACR可能提供CPAP治疗效果的客观生理指标。
