Hwang Juen-Haur, Yu Ben-Hui, Chen Yi-Chun
Department of Otolaryngology-Head and Neck Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 622, Taiwan.
School of Medicine, Tzu Chi University, Hualien 970, Taiwan.
J Clin Med. 2022 Jul 29;11(15):4411. doi: 10.3390/jcm11154411.
The association between surgical treatment for obstructive sleep apnea (OSA) in chronic kidney disease (CKD) patients and end-stage renal disease (ESRD) and survival outcomes is not established, and this study aimed to evaluate this association. A retrospective cohort analysis was conducted from 2001 to 2015, including 32,220 eligible CKD patients with incident OSA. By 1:3 propensity score matching, 1078 CKD patients with incident OSA who received surgery (treated cohort) and 3234 untreated cohort who never received surgery were analyzed. The risk of ESRD in the competing mortality was significantly lower in the treated cohort than in the untreated cohort, with an adjusted hazard ratio (aHR) of 0.38 (95% confidence interval (CI0, 0.15−0.97; p = 0.043). In addition, the adjusted HRs of overall, cardiovascular, and non-cardiovascular mortality in the treated and untreated cohorts were 2.54 (95% CI, 1.79−3.59; p < 0.0001), 1.46 (95% CI, 0.29−7.22; p = 0.64), and 2.62 (95% CI, 1.83−3.75; p < 0.0001), respectively. Furthermore, the risks of overall and non-cardiovascular mortality for the treated cohort primarily occurred during a 3-month follow-up. In conclusion, surgical treatment for incident OSA in CKD patients was associated with decreased ESRD risk, but with increased non-cardiovascular mortality risk, especially within 3 months after surgical treatment.
慢性肾脏病（CKD）患者阻塞性睡眠呼吸暂停（OSA）的手术治疗与终末期肾病（ESRD）及生存结局之间的关联尚未明确，本研究旨在评估这种关联。对2001年至2015年进行了一项回顾性队列分析，纳入32220例符合条件的新发OSA的CKD患者。通过1:3倾向评分匹配，分析了1078例接受手术的新发OSA的CKD患者（治疗队列）和3234例未接受手术的未治疗队列。在竞争死亡率中，治疗队列中ESRD的风险显著低于未治疗队列，调整后的风险比（aHR）为0.38（95%置信区间（CI），0.15 - 0.97；p = 0.043）。此外，治疗队列和未治疗队列中总体、心血管和非心血管死亡的调整后风险比分别为2.54（95%CI，1.79 - 3.59；p < 0.0001）、1.46（95%CI，0.29 - 7.22；p = 0.64）和2.62（95%CI，1.83 - 3.75；p < 0.0001）。此外，治疗队列的总体和非心血管死亡风险主要发生在3个月的随访期间。总之，CKD患者新发OSA的手术治疗与ESRD风险降低相关，但与非心血管死亡风险增加相关，尤其是在手术治疗后的3个月内。
