Clin Nephrol. 2021 Apr;95(4):195-200. doi: 10.5414/CN110352.
Sleep apnea (SA) is common in patients with advanced chronic kidney disease. However, its prevalence and clinical significance in kidney transplant patients are unknown.
To demonstrate the clinical impacts of SA on kidney allograft and mortality from current evidence to date.
Ovid -MEDLINE, EMBASE, and the Cochrane Library were searched for eligible publications. Kidney transplant recipients aged ≥ 18 years with SA were included. The outcomes included overall mortality, graft failure, and graft loss. Graft loss was attributed by either 1) graft failure requiring renal replacement therapy (RRT)or 2) death.
Four observational studies (n = 5,259) were included in the meta-analyses. The mean age was 49.6 ± 0.4 years. Most patients were male (58.3%) and white (82.1%). Up to 25.1% had diabetes, 15.2% had SA, and 36.8% had history of smoking. The mean body mass index was 26.9 ± 0.9 kg/m. With the mean follow-up duration of 14.4 ± 4.2 years, the pooled adjusted odds ratios (ORs) for graft failure and mortality among kidney transplant patients with SA were 1.061 (95% CI, 0.851 - 1.322; I = 41.3%) and 1.044 (95% CI, 0.853 - 1.278; I = 0%), respectively. The pooled adjusted OR for graft loss was 0.837 (95% CI, 0.597 - 1.173; I = 0%). On subgroup analyses, the ORs for graft failure were similar after adjusted by study year, country, study design, sample size, ethnicity, and sex. No potential publication bias was detected.
With 14-year follow-up, SA in kidney transplant patients was not associated with worsening clinical and allograft outcomes, such as graft loss, graft failure, and mortality. However, additional observational studies are needed to confirm this finding.
睡眠呼吸暂停（SA）在晚期慢性肾脏病患者中很常见。然而，其在肾移植患者中的患病率和临床意义尚不清楚。
根据现有证据，证明 SA 对肾移植和死亡率的临床影响。
检索 Ovid-MEDLINE、EMBASE 和 Cochrane 图书馆中符合条件的文献。纳入年龄≥18 岁且患有 SA 的肾移植受者。主要结局包括全因死亡率、移植物失败和移植物丢失。移植物丢失归因于 1）需要肾脏替代治疗（RRT）的移植物失败或 2）死亡。
Meta 分析纳入了 4 项观察性研究（n=5259）。平均年龄为 49.6±0.4 岁。大多数患者为男性（58.3%）和白人（82.1%）。多达 25.1%的患者患有糖尿病，15.2%患有 SA，36.8%有吸烟史。平均体重指数为 26.9±0.9kg/m。中位随访时间为 14.4±4.2 年，SA 组与非 SA 组的肾移植患者发生移植物失败和死亡率的调整后比值比（OR）分别为 1.061（95%CI，0.851-1.322；I=41.3%）和 1.044（95%CI，0.853-1.278；I=0%）。SA 组与非 SA 组的移植物丢失的调整后 OR 为 0.837（95%CI，0.597-1.173；I=0%）。在亚组分析中，调整研究年份、国家、研究设计、样本量、种族和性别后，移植物失败的 OR 相似。未发现潜在的发表偏倚。
在 14 年的随访中，肾移植患者的 SA 与移植物丢失、移植物失败和死亡率等临床和移植物结局的恶化无关。然而，需要更多的观察性研究来证实这一发现。
