Department of Medicine, Women's College Hospital, Toronto, ON, Canada; Department of Respiratory Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Department of Medicine, Women's College Hospital, Toronto, ON, Canada.
Chest. 2020 Mar;157(3):673-685. doi: 10.1016/j.chest.2019.09.004. Epub 2019 Sep 19.
Patients with chronic kidney disease have increased morbidity and mortality, mainly due to cardiovascular disease. Compared with the general population, patients with chronic kidney disease have an increased prevalence of both OSA and central sleep apnea, and the presence of sleep apnea in this population has been associated with an increased risk of cardiovascular events and mortality. Although OSA can lead to an increase in the rate of kidney function decline, there is also evidence that the presence of end-stage renal disease can lead to worsening of sleep apnea, indicating a bidirectional relation between sleep apnea and chronic kidney disease. The objective of this review was to describe the epidemiology of sleep apnea in chronic kidney disease, understand the pathophysiological mechanisms by which OSA can lead to progression of chronic kidney disease, and consider the role of treatment with CPAP in this regard. The review also explores the pathophysiological mechanism by which end-stage renal disease can lead to sleep apnea and considers how intensification of renal replacement therapy or extra fluid removal by ultrafiltration may attenuate the degree of sleep apnea severity in this population.
慢性肾脏病患者的发病率和死亡率较高，主要与心血管疾病有关。与一般人群相比，慢性肾脏病患者 OSA 和中枢性睡眠呼吸暂停的患病率均增加，该人群中睡眠呼吸暂停的存在与心血管事件和死亡率的增加相关。虽然 OSA 可导致肾功能下降速度加快，但也有证据表明终末期肾病的存在可导致睡眠呼吸暂停恶化，表明睡眠呼吸暂停与慢性肾脏病之间存在双向关系。本综述的目的是描述慢性肾脏病中睡眠呼吸暂停的流行病学，了解 OSA 导致慢性肾脏病进展的病理生理机制，并考虑 CPAP 治疗在此方面的作用。本综述还探讨了终末期肾病导致睡眠呼吸暂停的病理生理机制，并考虑了强化肾脏替代治疗或超滤去除额外液体是否可以减轻该人群中睡眠呼吸暂停严重程度。
