Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, 19129, USA.
Department of Internal Medicine, University of Pittsburgh Medical Center Pinnacle, 504 S. Front St, Suite 3C, Harrisburg, PA, 17104, USA.
Int Urol Nephrol. 2020 Dec;52(12):2337-2343. doi: 10.1007/s11255-020-02583-y. Epub 2020 Aug 1.
Sleep apnea (SA) is common in advanced chronic kidney disease (CKD) patients. However, the association between CKD with concomitant SA and overall mortality remains inconclusive.
Ovid MEDLINE, EMBASE, and the Cochrane Library were searched for eligible publications, including non-transplant CKD patients aged > 18 years with co-existing SA. CKD is defined by estimated glomerular filtration rate of < 60 mL/min/1.73 m.
Seven observational studies (n = 186,686) were included in the meta-analyses. 94.2% had end-stage kidney disease (ESKD) requiring hemodialysis (HD), 5.0% had ESKD requiring peritoneal dialysis (PD), and 0.8% had non-dialysis CKD. The mean age was 76.8 ± 2.2 years. Most patients were male (53.4%) and white (76.8%). Up to 39.3% had diabetes. The mean body mass index was 26.0 ± 0.6 kg/m. Among patients with advanced CKD and SA, the pooled estimated odds ratios (OR) for overall mortality and cardiovascular events were 2.092 (95% CI, 1.594-2.744) and 1.020 (95% CI, 0.929-1.119), respectively, compared to patients with CKD alone. The OR was 2.145 (95% CI, 1.563-2.944) when studies with polysomnography-diagnosed SA were examined independently. No potential publication bias was detected. There were no significant differences in odds ratios for overall mortality, based on subgroup analyses.
Co-existence between advanced CKD and SA is associated with increased overall mortality, but not cardiovascular (CV) events when compared with CKD alone. The analysis of CV events requires additional studies to confirm our findings. Moreover, clinical interventions aiming to prevent the progression of SA and CKD are encouraged.
睡眠呼吸暂停（SA）在晚期慢性肾脏病（CKD）患者中很常见。然而，CKD 合并 SA 与总体死亡率之间的关系仍不确定。
在 Ovid MEDLINE、EMBASE 和 Cochrane 图书馆中搜索合格的出版物，包括年龄>18 岁且同时患有 SA 的非移植 CKD 患者。CKD 的定义为估计肾小球滤过率<60mL/min/1.73m。
共有 7 项观察性研究（n=186686）纳入荟萃分析。94.2%的患者患有需要血液透析（HD）的终末期肾病（ESKD），5.0%的患者患有需要腹膜透析（PD）的 ESKD，0.8%的患者患有非透析性 CKD。平均年龄为 76.8±2.2 岁。大多数患者为男性（53.4%）和白人（76.8%）。多达 39.3%的患者患有糖尿病。平均体重指数为 26.0±0.6kg/m。在患有晚期 CKD 和 SA 的患者中，总体死亡率和心血管事件的合并估计优势比（OR）分别为 2.092（95%CI，1.594-2.744）和 1.020（95%CI，0.929-1.119），与单独患有 CKD 的患者相比。当单独检查经多导睡眠图诊断的 SA 的研究时，OR 为 2.145（95%CI，1.563-2.944）。未发现潜在的发表偏倚。根据亚组分析，总体死亡率的优势比无显著差异。
与单独患有 CKD 相比，晚期 CKD 和 SA 的共存与总体死亡率增加有关，但与心血管（CV）事件无关。需要进一步的研究来证实我们的发现。此外，鼓励采取旨在预防 SA 和 CKD 进展的临床干预措施。
