Obstructive sleep apnoea: a stand-alone risk factor for chronic kidney disease

IntroductionObstructive sleep apnoea (OSA) is common in patients with chronic kidney disease (CKD) and may contribute to the progression of kidney disease either through direct effects of hypoxia on the kidney or indirectly through hypoxaemia-induced oxidative stress, endothelial dysfunction, inflammation, activation of the renin–angiotensin and sympathetic nervous systems, and hypertension. Treatment of OSA with continuous positive airway pressure (CPAP) improves many of these physiological abnormalities in patients with normal renal function, though to date there are no trials evaluating the effect of OSA treatment on kidney function in patients with CKD. The purpose of this study is to test the feasibility and efficacy of CPAP therapy in CKD patients with OSA.Methods and analysisThe study is a randomised, controlled, non-blinded, parallel clinical trial in which patients with established CKD are screened for OSA. Patients with OSA are randomised to either conventional medical therapy (control group) or medical therapy and CPAP (CPAP group) and followed for 1 year. The primary outcome is the change in estimated glomerular filtration rate. Secondary outcomes are the change in the urinary albumin/creatinine ratio, the Epworth Sleepiness Scale , Pittsburgh Sleep Quality Index and Kidney Disease Quality of Life questionnaire.Ethics and disseminationEthics approval has been obtained from the Conjoint Health Research Ethics Board (ID: REB15-0055). Results from this study will be disseminated through presentations at scientific conferences and publication in peer-reviewed journals.Trial registration numberNCT02420184; Pre-results.

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Comorbidities Often Associated with Brain Damage in Hypertension: Diabetes, Coronary Artery Disease, Chronic Kidney Disease and Obstructive Sleep Apnoea

Updates in Hypertension and Cardiovascular Protection - Hypertension and Brain Damage ◽

10.1007/978-3-319-32074-8_4 ◽

2016 ◽

pp. 35-46

Author(s):

Athanasios J. Manolis ◽

Manolis S. Kallistratos ◽

Demetrios V. Vlahakos ◽

Asimina Mitrakou ◽

Leonidas E. Poulimenos

Keyword(s):

Coronary Artery Disease ◽

Chronic Kidney Disease ◽

Coronary Artery ◽

Kidney Disease ◽

Brain Damage ◽

Obstructive Sleep Apnoea ◽

Sleep Apnoea ◽

Obstructive Sleep ◽

Artery Disease

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Common Secondary Causes of Resistant Hypertension and Rational for Treatment

International Journal of Hypertension ◽

10.4061/2011/236239 ◽

2011 ◽

Vol 2011 ◽

pp. 1-17 ◽

Cited By ~ 39

Author(s):

Charles Faselis ◽

Michael Doumas ◽

Vasilios Papademetriou

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Obstructive Sleep Apnoea ◽

Resistant Hypertension ◽

Primary Aldosteronism ◽

Salt Intake ◽

Antihypertensive Drugs ◽

Sleep Apnoea ◽

Obstructive Sleep ◽

Secondary Causes

Resistant hypertension is defined as uncontrolled blood pressure despite the use of three antihypertensive drugs, including a diuretic, in optimal doses. Treatment resistance can be attributed to poor adherence to antihypertensive drugs, excessive salt intake, physician inertia, inappropriate or inadequate medication, and secondary hypertension. Drug-induced hypertension, obstructive sleep apnoea, primary aldosteronism, and chronic kidney disease represent the most common secondary causes of resistant hypertension. Several drugs can induce or exacerbate pre-existing hypertension, with non-steroidal anti-inflammatory drugs being the most common due to their wide use. Obstructive sleep apnoea and primary aldosteronism are frequently encountered in patients with resistant hypertension and require expert management. Hypertension is commonly found in patients with chronic kidney disease and is frequently resistant to treatment, while the management of renovascular hypertension remains controversial. A step-by-step approach of patients with resistant hypertension is proposed at the end of this review paper.

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