Department of Medicine, Malcom Randall VA Medical Center, University of Florida, Gainesville, FL.
Department of Population Health Sciences, University of Wisconsin - Madison, Madison, WI.
Sleep. 2018 Jan 1;41(1). doi: 10.1093/sleep/zsx181.
To determine whether sleep apnea, defined by polysomnography, accelerates kidney function decline in generally healthy adults not selected for sleep apnea or kidney disease.
We performed a retrospective cohort study in 855 participants from the Wisconsin Sleep Cohort Study, a large 20-year population-based study of sleep apnea, who had at least one polysomnogram and serial measurements of serum creatinine over time. Sleep apnea was defined as an apnea-hypopnea index ≥ 15 or positive airway pressure (PAP) use at baseline. We compared the slope of estimated glomerular filtration rate (eGFR) change and odds of rapid eGFR decline (>2.2 mL/minute/1.73 m2/year) for those with and without sleep apnea.
The mean follow-up was 13.9 ± 3.4 years. The cohort was 50.4 ± 7.6 years, 55% male, and 97% white. The mean eGFR was 89.3 ± 13.8 mL/minute/1.73 m2 and 11% had sleep apnea. Overall, the mean eGFR change was -0.88 ± 1.12 mL/minute/1.73 m2/year. Compared with those without sleep apnea, participants with sleep apnea had a 0.2 mL/minute/1.73 m2/year slower eGFR decline though this was not statistically significant (95% CI [-0.06-0.45], p = .134). When we excluded those on PAP therapy (n = 17), eGFR decline was even slower among those with sleep apnea (0.36 mL/minute/1.73 m2/year slower, 95% CI [0.08-063], p = .012). Those with sleep apnea had lower odds of rapid eGFR decline but this was not statistically significant, even after excluding PAP users.
Among healthy middle-aged adults, the presence of sleep apnea at baseline did not accelerate kidney function decline compared with those without sleep apnea over time.
确定通过多导睡眠图定义的睡眠呼吸暂停是否会加速未选择睡眠呼吸暂停或肾脏疾病的一般健康成年人的肾功能下降。
我们对来自威斯康星州睡眠队列研究（一项大型的 20 年人群睡眠呼吸暂停研究）的 855 名参与者进行了回顾性队列研究，这些参与者至少进行了一次多导睡眠图检查，并随着时间的推移进行了多次血清肌酐测量。睡眠呼吸暂停的定义为呼吸暂停低通气指数≥15 或基线时使用正压通气（PAP）。我们比较了睡眠呼吸暂停患者和无睡眠呼吸暂停患者的估算肾小球滤过率（eGFR）变化斜率和快速 eGFR 下降（>2.2ml/min/1.73m2/年）的几率。
平均随访时间为 13.9±3.4 年。队列的平均年龄为 50.4±7.6 岁，55%为男性，97%为白人。平均 eGFR 为 89.3±13.8ml/min/1.73m2，11%的患者患有睡眠呼吸暂停。总体而言，平均 eGFR 变化为-0.88±1.12ml/min/1.73m2/年。与无睡眠呼吸暂停的患者相比，睡眠呼吸暂停患者的 eGFR 下降速度较慢，为 0.2ml/min/1.73m2/年，但无统计学意义（95%CI[-0.06-0.45]，p=0.134）。当我们排除使用 PAP 治疗的患者（n=17）时，睡眠呼吸暂停患者的 eGFR 下降速度甚至更慢（慢 0.36ml/min/1.73m2/年，95%CI[0.08-0.63]，p=0.012）。尽管排除了 PAP 使用者，但睡眠呼吸暂停患者快速 eGFR 下降的几率较低，但无统计学意义。
在健康的中年成年人中，与无睡眠呼吸暂停的患者相比，基线时存在睡眠呼吸暂停并不会随时间加速肾功能下降。
