Division of Pulmonology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Clin Transplant. 2019 Dec;33(12). doi: 10.1111/ctr.13747. Epub 2019 Nov 26.
Obstructive sleep apnea (OSA) is common but underdiagnosed among patients with kidney disease. This study examines whether the diagnosis of OSA in kidney transplant recipients (KTR) affected death, death-censored graft failure (DCGF), and acute rejection (AR). We analyzed the records of KTR who underwent transplant between 2000 and 2015. A total of 4014 kidney transplants were performed during the study period. Of these, 415 (10.3%) had a diagnosis of pretransplant OSA. Pretransplant OSA was associated with a higher risk of death in unadjusted analyses. After adjustment for potential confounders, pretransplant OSA was not associated with risk of death (HR = 1.04, 95% CI: 0.80-1.36). Similarly, pretransplant OSA was associated with a slightly higher incidence of DCGF or AR but neither associations were significant (HR: 1.23, 95% CI: 0.85-1.47 for DCGF; HR 1.10, 95% CI: 0.90-1.36 for AR). A total of 117 (3.3%) were diagnosed with de novo OSA after transplant. Similar to the pretransplant OSA, unadjusted HR for death was significantly higher in the de novo OSA group (HR: 1.48, 95% CI: 1.19-1.84); however, after adjustment, de novo OSA was not significantly associated with risk of death (HR: 1.15, 95% CI: 0.92-1.45). Similarly, DCGF and AR rates were not significantly associated with de novo OSA (HR: 1.10, 95% CI: 0.84-1.44 for DCGF; HR 1.10, 95% CI: 0.90-1.33 for AR). Our work did not detect significant associations between OSA and risk of death, graft failure, and rejection but the estimates might be underestimated due to underdiagnosis of OSA.
阻塞性睡眠呼吸暂停（OSA）在肾病患者中较为常见，但诊断不足。本研究旨在探讨肾移植受者（KTR）中 OSA 的诊断是否会影响死亡、死亡相关移植物失败（DCGF）和急性排斥反应（AR）。我们分析了 2000 年至 2015 年间接受移植的 KTR 记录。在研究期间共进行了 4014 例肾脏移植。其中，415 例（10.3%）在移植前诊断为 OSA。在未调整分析中，移植前 OSA 与死亡风险增加相关。在校正潜在混杂因素后，移植前 OSA 与死亡风险无关（HR=1.04，95%CI：0.80-1.36）。同样，移植前 OSA 与 DCGF 或 AR 的发生率略高相关，但均无统计学意义（HR：1.23，95%CI：0.85-1.47 用于 DCGF；HR 1.10，95%CI：0.90-1.36 用于 AR）。共有 117 例（3.3%）在移植后被诊断为新发 OSA。与移植前 OSA 类似，新发 OSA 组的死亡未调整 HR 显著更高（HR：1.48，95%CI：1.19-1.84）；然而，调整后，新发 OSA 与死亡风险无显著相关性（HR：1.15，95%CI：0.92-1.45）。同样，DCGF 和 AR 发生率与新发 OSA 无显著相关性（HR：1.10，95%CI：0.84-1.44 用于 DCGF；HR 1.10，95%CI：0.90-1.33 用于 AR）。我们的研究未发现 OSA 与死亡、移植物失败和排斥反应风险之间存在显著关联，但由于 OSA 诊断不足，估计值可能被低估。
