Department of Anesthesiology, The Second Affiliated Hospital of Fujian Medical University, No.950 Donghai Street, Quanzhou, 362000, Fengze District, China.
Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Quanzhou, 362000, Fengze District, China.
Sleep Breath. 2023 Dec;27(6):2155-2163. doi: 10.1007/s11325-023-02811-6. Epub 2023 Mar 20.
Obstructive sleep apnea (OSA) is highly prevalent in patients with chronic kidney disease and may lead to a loss of kidney function. However, it remains unclear whether or not continuous positive airway pressure (CPAP) treatment improves the estimated glomerular filtration rate (eGFR) in patients with OSA. This meta-analysis was designed to investigate the effect of CPAP therapy on eGFR in patients with OSA.
We searched the electronic databases Web of Science, Cochrane Library, PubMed, and Embase through June 1, 2022. Information about patients, CPAP duration, gender distribution, pre- and post-CPAP treatment eGFR, and age of patients were collected for further analysis. We applied the standardized mean difference (SMD) with a 95%confidence interval (CI) to analyze the pooled effects. Both Stata 12.0 software and Review Manager 5.2 software were employed for all statistical analyses.
A sample of 13 studies with 519 patients was included in the meta-analysis. There was no significant change of eGFR levels before and after CPAP usage for patients with OSA (SMD = - 0.05, 95%CI: - 0.30 to 0.19, Z = 0.43, p = 0.67). However, subgroup analysis revealed that the level of eGFR was obviously decreased after CPAP therapy in patients with OSA and CPAP use duration > 6 months (SMD = - 0.30, 95% CI = - 0.49 to - 0.12, z = 3.20, p = 0.001), and elderly patients (> 60 years) (SMD = - 0.32, 95% CI = - 0.52 to - 0.11, z = 3.02, p = 0.002).
Meta-analysis confirmed that OSA treatment with CPAP has no clinically significant effect on eGFR.
阻塞性睡眠呼吸暂停(OSA)在慢性肾脏病患者中发病率很高,可能导致肾功能丧失。然而,持续气道正压通气(CPAP)治疗是否能改善 OSA 患者的估算肾小球滤过率(eGFR)尚不清楚。本荟萃分析旨在探讨 CPAP 治疗对 OSA 患者 eGFR 的影响。
我们通过 Web of Science、Cochrane 图书馆、PubMed 和 Embase 电子数据库检索,截至 2022 年 6 月 1 日。收集患者信息、CPAP 持续时间、性别分布、CPAP 治疗前后 eGFR 以及患者年龄等信息进行进一步分析。我们应用标准化均数差(SMD)和 95%置信区间(CI)分析汇总效应。所有统计分析均采用 Stata 12.0 软件和 Review Manager 5.2 软件。
荟萃分析纳入了 13 项研究的 519 例患者。OSA 患者 CPAP 使用前后 eGFR 水平无显著变化(SMD=-0.05,95%CI:-0.30 至 0.19,Z=0.43,p=0.67)。然而,亚组分析显示,CPAP 治疗后 OSA 患者和 CPAP 使用时间>6 个月(SMD=-0.30,95%CI:-0.49 至-0.12,Z=3.20,p=0.001)和老年患者(>60 岁)(SMD=-0.32,95%CI:-0.52 至-0.11,Z=3.02,p=0.002)的 eGFR 水平明显降低。
荟萃分析证实,CPAP 治疗 OSA 对 eGFR 无临床显著影响。