Obstructive sleep apnea and chronic kidney disease : Current Opinion in Pulmonary Medicine (original) (raw)
SLEEP AND RESPIRATORY NEUROBIOLOGY: Edited by Lee Brown and Brian D. Kent
aDepartment of Medicine, University of Toronto, Toronto, Ontario, Canada
bDepartment of Respiratory Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
cAP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil, Paris, France
dDivision of Respirology, Department of Medicine, Women's College Hospital
eSleep Research Laboratory of the Toronto Rehabilitation Institute-UHN, Toronto, Ontario, Canada
Correspondence to Owen D. Lyons, MB BCh BAO MRCPI, Department of Medicine, Women's College Hospital, 76 Grenville Street, Toronto, ON M5S 1B2, Canada. Tel: +1 416 323 6137; fax: +1 416 323 6132; e-mail: [email protected]
Abstract
Purpose of review
Obstructive sleep apnea (OSA) is highly prevalent in patients with chronic kidney disease (CKD). The relationship between OSA and CKD is likely to be bi-directional. On one hand, the presence of OSA leads to intermittent hypoxia, sympathetic nervous system activity, and hypertension, all of which may have deleterious effects on kidney function. On the other hand, in patients with end-stage renal disease (ESRD), intensification of renal replacement therapy has been shown to attenuate sleep apnea severity, suggesting that the renal disease itself contributes to the pathogenesis of OSA. The present review describes our current understanding of the bi-directional relationship between OSA and CKD.
Recent findings
Studies suggest that the presence of OSA and nocturnal hypoxia may lead to worsening of kidney function. One potential mechanism is activation of the renin–angiotensin system by OSA, an effect which may be attenuated by CPAP therapy. In ESRD, fluid overload plays an important role in the pathogenesis of OSA and fluid removal by ultrafiltration leads to marked improvements in sleep apnea severity.
Summary
OSA is associated with accelerated loss of kidney function. In patients with ESRD, fluid overload plays an important role in the pathogenesis of OSA.
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