Peng Hui-Hui, Hu Chia-Enn, Wu Yueh-Lin, Liu Wen-Te, Tsai Cheng-Yu, Kuan Yi-Chun
School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Department of Medical Education, Taipei Medical University Hospital, Taipei, Taiwan.
Sleep Breath. 2025 Feb 13;29(1):102. doi: 10.1007/s11325-025-03256-9.
Obstructive sleep apnea (OSA) is associated with increased risk of chronic kidney disease (CKD). OSA is highly prevalent among patients with CKD, suggesting a bidirectional link between the two conditions. Recent studies reported that continuous positive airway pressure (CPAP) may benefit renal function in OSA patients; however, uncertainties regarding their effects persist. Therefore, we examined the effects of CPAP treatment on renal function in adults with OSA.
We systematically searched PubMed, EMBASE, Cochrane Library, Web of Science, and ClinicalTrials.gov for relevant studies from their inception until January 2024. Pooled estimates for all outcomes were calculated using a random-effects model. Primary outcome measures were the estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR).
Four randomized controlled trials (RCTs) and seven non-RCTs (NRCTs) (n = 2,660) were included. Compared with the control group, the CPAP group exhibited a significantly minimal alleviation in eGFR decline in NRCT (mean difference [MD] = 1.95, 95% confidence interval [CI] = 0.80 to 3.11, p < 0.001), but not in RCT (MD = 1.42, 95% CI = - 0.99 to 3.82, p = 0.25). No significant associations were found between CPAP therapy and UACR (MD = - 0.05, 95% CI = - 0.41 to 0.30, p = 0.77).
Current research provides a low to moderate certainty of evidence, suggesting that CPAP therapy has little to no effect on alleviating the decline in renal function. However, further RCTs with larger sample sizes and extended follow-up periods are required.
阻塞性睡眠呼吸暂停（OSA）与慢性肾脏病（CKD）风险增加相关。OSA在CKD患者中高度流行，提示这两种情况之间存在双向联系。近期研究报道，持续气道正压通气（CPAP）可能对OSA患者的肾功能有益；然而，其效果仍存在不确定性。因此，我们研究了CPAP治疗对成年OSA患者肾功能的影响。
我们系统检索了PubMed、EMBASE、Cochrane图书馆、科学网和ClinicalTrials.gov，以获取从各数据库创建至2024年1月的相关研究。使用随机效应模型计算所有结局的合并估计值。主要结局指标为估计肾小球滤过率（eGFR）和尿白蛋白与肌酐比值（UACR）。
纳入了四项随机对照试验（RCT）和七项非随机对照试验（NRCT）（n = 2660）。与对照组相比，CPAP组在NRCT中eGFR下降的缓解程度显著最小（平均差值[MD]=1.95，95%置信区间[CI]=0.80至3.11，p<0.001），但在RCT中并非如此（MD = 1.42，95% CI = -0.99至3.82，p = 0.25）。未发现CPAP治疗与UACR之间存在显著关联（MD = -0.05，95% CI = -0.41至0.30，p = 0.77）。
当前研究提供的证据确定性低至中等，表明CPAP治疗对缓解肾功能下降几乎没有效果。然而，需要进一步开展样本量更大、随访期更长的RCT。
