Division of Nephrology, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Clin Sleep Med. 2017 Oct 15;13(10):1145-1152. doi: 10.5664/jcsm.6758.
This retrospective study was conducted to evaluate the associations and interactions among obstructive sleep apnea (OSA), chronic kidney disease (CKD), and metabolic syndrome (MS).
This study included 1,732 subjects (1,482 male and 250 female) in whom OSA was diagnosed by polysomnography. The severity of OSA was defined as mild, moderate, or severe with an apnea-hypopnea index (AHI) score of 5 to < 15, 15 to < 30, and ≥ 30 events/h, respectively. CKD was defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m or albuminuria.
The prevalence of MS was 29.2% (n = 505). One hundred twenty-nine subjects (7.4%) had CKD. In subjects with MS, CKD prevalence increased progressively with OSA severity: 7.4%, 12.5%, and 15.8% in those with mild, moderate, or severe OSA, respectively ( = .025). Each 10-point increment in AHI score was independently associated with a 1.15-fold higher prevalence of CKD [95% confidence interval (CI), 1.036-1.280; = .009] after adjustment for all individual components of MS. On the contrary, in those without MS, AHI was not associated with increased odds for CKD [odds ratio, 1.054; 95% CI, 0.930-1.195].
The independent association between OSA severity and CKD prevalence was observed only in subjects with MS. Further studies are needed to ascertain if OSA contributes to the development of CKD in subjects with MS.
本回顾性研究旨在评估阻塞性睡眠呼吸暂停（OSA）、慢性肾脏病（CKD）和代谢综合征（MS）之间的关联和相互作用。
本研究纳入了 1732 名（1482 名男性和 250 名女性）经多导睡眠图诊断为 OSA 的患者。OSA 的严重程度定义为轻度、中度或重度，其呼吸暂停低通气指数（AHI）分别为 5-<15、15-<30 和≥30 次/小时。CKD 的定义为估计肾小球滤过率<60ml/min/1.73m 或蛋白尿。
MS 的患病率为 29.2%（n=505）。129 名患者（7.4%）患有 CKD。在合并 MS 的患者中，随着 OSA 严重程度的增加，CKD 的患病率逐渐升高：分别为轻度、中度和重度 OSA 的患者中，CKD 的患病率分别为 7.4%、12.5%和 15.8%（P=0.025）。在校正 MS 的所有个体成分后，AHI 评分每增加 10 分，CKD 的患病率增加 1.15 倍（95%置信区间为 1.036-1.280；P=0.009）。相反，在没有 MS 的患者中，AHI 与 CKD 的比值比无显著相关性（比值比，1.054；95%置信区间，0.930-1.195）。
仅在合并 MS 的患者中观察到 OSA 严重程度与 CKD 患病率之间的独立关联。需要进一步的研究来确定 OSA 是否会导致合并 MS 的患者发生 CKD。
