Zhang L, Huang X, Li X, Wu Q
Medical Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Chin Med J (Engl). 1997 Dec;110(12):915-8.
To assess renal function in patients with obstructive sleep apnea syndrome (OSAS) during two nights when they were untreated and treated with continuous positive airway pressure (CPAP).
Tubular function was estimated on the basis of the renal lithium clearance and its derived formulae, urinary osmolality, osmolal clearance and free water clearance; while glomerular function was evaluated by endogenous creatinine clearance. Twenty patients with OSAS and sixteen normal controls were studied.
The untreated patients with OSAS had significantly lower fractional proximal tubular sodium reabsorption (59.1% +/- 7.1%, P < 0.001 vs controls), lower fractional distal tubular sodium reabsorption (93.8% +/- 1.7%, P < 0.05 vs controls) and urinary osmolality (573.0 +/- 107.9 mosm.kg-1, P < 0.05 vs controls). The absolute distal tubular reabsorption rate of sodium and osmolal clearance in the untreated patients were higher 47.0 +/- 26.0 mmol.L-1 and 25.0 +/- 4.1 ml.L-1; P < 0.01 and P < 0.05 respectively vs controls). During CPAP-treated nights all abnormal renal function indexes in the OSAS patients restored to normal control values (P > 0.05).
The natriuresis and diuresis of OSAS patients were due to the decrease in proximal and distal tubular sodium reabsorption and in tubular concentration ability during their nocturnal sleep and were returned to normal by CPAP therapy.
评估阻塞性睡眠呼吸暂停综合征（OSAS）患者在未经治疗及接受持续气道正压通气（CPAP）治疗的两个夜间的肾功能。
根据肾锂清除率及其衍生公式、尿渗透压、渗透清除率和自由水清除率评估肾小管功能；通过内生肌酐清除率评估肾小球功能。对20例OSAS患者和16例正常对照者进行了研究。
未经治疗的OSAS患者近端肾小管钠重吸收率显著降低（59.1%±7.1%，与对照组相比P<0.001），远端肾小管钠重吸收率降低（93.8%±1.7%，与对照组相比P<0.05），尿渗透压降低（573.0±107.9 mosm.kg-1，与对照组相比P<0.05）。未经治疗的患者钠的绝对远端肾小管重吸收率和渗透清除率较高，分别为47.0±26.0 mmol.L-1和25.0±4.1 ml.L-1；与对照组相比分别为P<0.01和P<0.05）。在接受CPAP治疗的夜间，OSAS患者所有异常的肾功能指标均恢复至正常对照值（P>0.05）。
OSAS患者夜间睡眠期间的利钠和利尿是由于近端和远端肾小管钠重吸收及肾小管浓缩能力降低所致，CPAP治疗可使其恢复正常。
