Predictors of chronic kidney disease in obstructive sleep apnea patients

Introduction: Obstructive sleep apnea (OSA) is a common condition in patients with chronic kidney disease (CKD). It may worsen renal function in CKD patients and is associated with uncontrolled blood pressure. Although OSA is found in up to 80% of CKD patients, there are limited data available on its clinical features in patients with and without CKD. Objective: This study aimed to identify the differences in the clinical characteristics of OSA between CKD and non-CKD OSA patients and determine the clinical predictors for CKD in OSA patients. Methods: This was a retrospective study conducted at Khon Kaen University's Srinagarind Hospital in Thailand between July and December 2018. The inclusion criteria were diagnosis with OSA via polysomnography and having undergone laboratory tests for CKD. Obstructive sleep apnea is diagnosed according to the apnea-hypopnea index (AHI) as experiencing >5 events/hour, while CKD diagnosed based on the KDOQI guidelines. Eligible patients were divided into two groups: OSA with CKD and OSA without CKD. Predictors of CKD in OSA patients were analyzed using multivariate logistic regression analysis. Results: During the study period, there were 178 OSA patients who met the study criteria, 88 (49.44%) of whom were in the OSA with CKD group. Both age and body mass index were comparable between OSA patients with CKD and those without (age: 59 and 57 years, respectively; body mass index: 30 and 29 kg/m2, respectively. There were three significant factors that differed between those with and without CKD group including systolic blood pressure (147 vs 135 mmHg), proportion of patients with diabetes (55% vs 34%), and proportion of patients with Mallampati scores of 3-4 (73% vs 39%). There were three independent predictors for OSA in patients with CKD: female sex, high systolic blood pressure, and Mallampati score of 3 or 4, with adjusted odds ratios (95% confidence interval) of 4.624 (1.554, 13.757), 1.060 (1.020, 1.101), and 2.816 (1.356, 5.849), respectively. The Hosmer-Lemeshow chi square statistic of the predictive model was 6.06 (p 0.640). Systolic blood pressure of more than 130 and 150 mmHg resulted in sensitivity of 84.21% and specificity of 81.40%, respectively. Conclusions: Female sex, high systolic blood pressure, and Mallampati score of 3-4 were suggestive of OSA with CKD. Obstructive sleep apnea patients with one or more of these predictors may have a high risk of CKD.

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Nocturnal blood pressure decrease in patients with chronic kidney disease and in healthy controls – significance of obstructive sleep apnea and renal function

International Journal of Nephrology and Renovascular Disease ◽

10.2147/ijnrd.s176606 ◽

2018 ◽

Vol Volume 11 ◽

pp. 279-290

Author(s):

Bodil G Hornstrup ◽

Pia H Gjoerup ◽

Jost Wessels ◽

Thomas G Lauridsen ◽

Erling B Pedersen ◽

...

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Obstructive Sleep Apnea ◽

Renal Function ◽

Sleep Apnea ◽

Kidney Disease ◽

Healthy Controls ◽

Blood Pressure Decrease ◽

Nocturnal Blood Pressure ◽

Obstructive Sleep

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Hypertensive crisis in patients with obstructive sleep apnea-induced hypertension

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02119-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sittichai Khamsai ◽

Apichart Chootrakool ◽

Panita Limpawattana ◽

Jarin Chindaprasirt ◽

Wattana Sukeepaisarnjaroen ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Systolic Blood Pressure ◽

Hypertensive Crisis ◽

Multivariate Logistic Regression Analysis ◽

Secondary Hypertension ◽

High Systolic Blood Pressure ◽

Obstructive Sleep

Abstract Background Hypertensive crisis is an urgent/emergency condition. Although obstructive sleep apnea (OSA) in resistant hypertension has been thoroughly examined, information regarding the risk factors and prevalence of hypertensive crisis in co-existing OSA and hypertension is limited. This study thus aimed to determine prevalence of and risk factors for hypertensive crisis in patients with hypertension caused by OSA. Methods The inclusion criteria were age of 18 years or over and diagnosis of co-existing OSA and hypertension. Those patients with other causes of secondary hypertension were excluded. Patients were categorized by occurrence of hypertensive crisis. Factors associated with hypertensive crisis were calculated using multivariate logistic regression analysis. Results There were 121 patients met the study criteria. Of those, 19 patients (15.70%) had history of hypertensive crisis. Those patients in hypertensive crisis group had significant higher systolic and diastolic blood pressure at regular follow-ups than those without hypertensive crisis patients (177 vs. 141 mmHg and 108 vs. 85 mmHg; p value < 0.001 for both factors). After adjusted for age, sex, and Mallampati classification, only systolic blood pressure was independently associated with hypertensive crisis with adjusted odds ratio (95% CI) of 1.046 (1.012, 1.080). Conclusions The prevalence of hypertensive crisis in co-existing OSA and hypertension was 15.70% and high systolic blood pressure or uncontrolled blood pressure associated with hypertensive crisis in patients with OSA-associated hypertension.

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