Skip to main content

Advertisement

SpringerLink
Log in

Obstructive sleep apnea as a risk factor for incident end stage renal disease: a nationwide population-based cohort study from Korea

  • Original article
  • Published:
Clinical and Experimental Nephrology Aims and scope Submit manuscript

Abstract

Background

Obstructive sleep apnea (OSA) is known to be associated with metabolic dysregulation and incident cardiovascular diseases. However, its association with end-stage renal disease (ESRD) has not been clarified. This study aimed to evaluate longitudinally whether OSA is an independent risk factor for ESRD.

Methods

This retrospective nationwide population-based cohort study included data on 67,359 patients with OSA and 336,795 age-, sex- and years of the enrollment-matched controls without OSA obtained from the Korean National Health Insurance Service database from 2009 to 2014. The study population was followed up from baseline to the date of ESRD diagnosis or until 2016. A Cox proportional-hazards model with multivariable adjustment was used to evaluate the association between OSA and incident ESRD.

Results

A significantly higher incident ESRD risk (adjusted hazard ratio: 1.29, 95% confidence interval 1.02–1.62) was observed for patients older than 40 years with OSA than for matched controls, when adjusted for age, sex, income status, smoking, alcohol consumption, body mass index, diabetes, hypertension, dyslipidemia, estimated glomerular filtration rate, and proteinuria. The OSA group remained predictive of higher risk of ESRD incidence in subgroups of age ≥ 65 years, female sex, hypertension, dyslipidemia, proteinuria, and chronic kidney disease.

Conclusion

OSA was associated with a higher risk of incident ESRD. Understanding the association between OSA and ESRD might provide further insights to establish national health care policy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Lin CH, Perger E, Lyons OD. Obstructive sleep apnea and chronic kidney disease. Curr Opin Pulmon Med. 2018;24(6):549–54. https://doi.org/10.1097/MCP.0000000000000525.

    Article  Google Scholar 

  2. Mohsenin V. Obstructive sleep apnea and hypertension: a critical review. Curr Hypertens Rep. 2014;16(10):482. https://doi.org/10.1007/s11906-014-0482-4.

    Article  PubMed  Google Scholar 

  3. Jordan AS, McSharry DG, Malhotra A. Adult obstructive sleep apnoea. Lancet. 2014;383(9918):736–47. https://doi.org/10.1016/S0140-6736(13)60734-5.

    Article  PubMed  Google Scholar 

  4. Pien GW, Schwab RJ. Sleep disorders during pregnancy. Sleep. 2004;27(7):1405–17.

    Article  PubMed  Google Scholar 

  5. Leung RS, Bradley TD. Sleep apnea and cardiovascular disease. Am J Respir Crit Care Med. 2001;164(12):2147–65. https://doi.org/10.1164/ajrccm.164.12.2107045.

    Article  CAS  PubMed  Google Scholar 

  6. Budhiraja R, Siddiqi TA, Quan SF. Sleep disorders in chronic obstructive pulmonary disease: etiology, impact, and management. J Clin Sleep Med. 2015;11(3):259–70. https://doi.org/10.5664/jcsm.4540.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353(19):2034–41. https://doi.org/10.1056/NEJMoa043104.

    Article  CAS  PubMed  Google Scholar 

  8. Nicholl DDM, Ahmed SB, Loewen AHS, Hemmelgarn BR, Sola DY, Beecroft JM, et al. Declining kidney function increases the prevalence of sleep apnea and nocturnal hypoxia. Chest. 2012;141(6):1422–30. https://doi.org/10.1378/chest.11-1809.

    Article  PubMed  Google Scholar 

  9. Lee YC, Hung SY, Wang HK, Lin CW, Wang HH, Chen SW, et al. Sleep apnea and the risk of chronic kidney disease: a nationwide population-based cohort study. Sleep. 2015;38(2):213–21. https://doi.org/10.5665/sleep.4400.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kato K, Takata Y, Usui Y, Shiina K, Asano K, Hashimura Y, et al. Severe obstructive sleep apnea increases cystatin C in clinically latent renal dysfunction. Respir Med. 2011;105(4):643–9. https://doi.org/10.1016/j.rmed.2010.11.024.

    Article  PubMed  Google Scholar 

  11. Sakaguchi Y, Shoji T, Kawabata H, Niihata K, Suzuki A, Kaneko T, et al. High prevalence of obstructive sleep apnea and its association with renal function among nondialysis chronic kidney disease patients in Japan: a cross-sectional study. Clin J Am Soc Nephrol. 2011;6(5):995–1000. https://doi.org/10.2215/CJN.08670910.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Markou N, Kanakaki M, Myrianthefs P, Hadjiyanakos D, Vlassopoulos D, Damianos A, et al. Sleep-disordered breathing in nondialyzed patients with chronic renal failure. Lung. 2006;184(1):43–9. https://doi.org/10.1007/s00408-005-2563-2.

    Article  PubMed  Google Scholar 

  13. Drager LF, McEvoy RD, Barbe F, Lorenzi-Filho G, Redline S, Initiative I. Sleep apnea and cardiovascular disease: lessons from recent trials and need for team science. Circulation. 2017;136(19):1840–50. https://doi.org/10.1161/CIRCULATIONAHA.117.029400.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Song SO, Jung CH, Song YD, Park CY, Kwon HS, Cha BS, et al. Background and data configuration process of a nationwide population-based study using the Korean national health insurance system. Diabetes Metabol J. 2014;38(5):395–403. https://doi.org/10.4093/dmj.2014.38.5.395.

    Article  Google Scholar 

  15. Lee SR, Choi EK, Rhee TM, Lee HJ, Lim WH, Kang SH, et al. Evaluation of the association between diabetic retinopathy and the incidence of atrial fibrillation: a nationwide population-based study. Int J Cardiol. 2016;223:953–7. https://doi.org/10.1016/j.ijcard.2016.08.296.

    Article  PubMed  Google Scholar 

  16. Yang HK, Han K, Kwon HS, Park YM, Cho JH, Yoon KH, et al. Obesity, metabolic health, and mortality in adults: a nationwide population-based study in Korea. Sci Rep. 2016;6:30329. https://doi.org/10.1038/srep30329.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Internal Med. 2009;150(9):604–12.

    Article  Google Scholar 

  18. Marshall NS, Wong KK, Phillips CL, Liu PY, Knuiman MW, Grunstein RR. Is sleep apnea an independent risk factor for prevalent and incident diabetes in the Busselton Health Study? J Clin Sleep Med. 2009;5(1):15–20.

    PubMed  PubMed Central  Google Scholar 

  19. Drager LF, Li J, Reinke C, Bevans-Fonti S, Jun JC, Polotsky VY. Intermittent hypoxia exacerbates metabolic effects of diet-induced obesity. Obesity (Silver Spring). 2011;19(11):2167–74. https://doi.org/10.1038/oby.2011.240.

    Article  CAS  Google Scholar 

  20. Polotsky VY, Li J, Punjabi NM, Rubin AE, Smith PL, Schwartz AR, et al. Intermittent hypoxia increases insulin resistance in genetically obese mice. J Physiol. 2003;552(Pt 1):253–64. https://doi.org/10.1113/jphysiol.2003.048173.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Louis M, Punjabi NM. Effects of acute intermittent hypoxia on glucose metabolism in awake healthy volunteers. J Appl Physiol (1985). 2009;106(5):1538–44. https://doi.org/10.1152/japplphysiol.91523.2008.

    Article  CAS  Google Scholar 

  22. Dong R, Dong Z, Liu H, Shi F, Du J. Prevalence, Risk Factors, Outcomes, and treatment of obstructive sleep apnea in patients with cerebrovascular disease: a systematic review. J Stroke Cerebrovasc Dis. 2018. https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.12.048.

    Article  PubMed  Google Scholar 

  23. Ahmed SB, Ronksley PE, Hemmelgarn BR, Tsai WH, Manns BJ, Tonelli M, et al. Nocturnal hypoxia and loss of kidney function. PLoS ONE. 2011;6(4):e19029. https://doi.org/10.1371/journal.pone.0019029.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Sakaguchi Y, Hatta T, Hayashi T, Shoji T, Suzuki A, Tomida K, et al. Association of nocturnal hypoxemia with progression of CKD. Clin J Am Soc Nephrol. 2013;8(9):1502–7. https://doi.org/10.2215/CJN.11931112.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Canales MT, Hagen EW, Barnet JH, Peppard PE, Derose SF. Sleep apnea and kidney function trajectory: results from a 20-year longitudinal study of healthy middle-aged adults. Sleep. 2018. https://doi.org/10.1093/sleep/zsx181.

    Article  PubMed  Google Scholar 

  26. Dempsey JA, Veasey SC, Morgan BJ, O'Donnell CP. Pathophysiology of sleep apnea. Physiol Rev. 2010;90(1):47–112. https://doi.org/10.1152/physrev.00043.2008.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Eckert DJ, Malhotra A. Pathophysiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008;5(2):144–53. https://doi.org/10.1513/pats.200707-114MG.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Zalucky AA, Nicholl DD, Hanly PJ, Poulin MJ, Turin TC, Walji S, et al. Nocturnal hypoxemia severity and renin-angiotensin system activity in obstructive sleep apnea. Am J Respir Crit Care Med. 2015;192(7):873–80. https://doi.org/10.1164/rccm.201502-0383OC.

    Article  CAS  PubMed  Google Scholar 

  29. Nicholl DD, Hanly PJ, Poulin MJ, Handley GB, Hemmelgarn BR, Sola DY, et al. Evaluation of continuous positive airway pressure therapy on renin-angiotensin system activity in obstructive sleep apnea. Am J Respir Crit Care Med. 2014;190(5):572–80. https://doi.org/10.1164/rccm.201403-0526OC.

    Article  CAS  PubMed  Google Scholar 

  30. Punjabi NM, Shahar E, Redline S, Gottlieb DJ, Givelber R, Resnick HE, et al. Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study. Am J Epidemiol. 2004;160(6):521–30. https://doi.org/10.1093/aje/kwh261.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by the Bio & Medical Technology Development Program of the NRF funded by the Korean government, MSIT (NRF-2017M3A9E8023016, NRF-2017M3A9E8023001); Grant (BCRI18024) of Chonnam National University Hospital Biomedical Research Institute; and Grant (CRI18015-1) of Chonnam National University Hospital Biomedical Research Institute.

Author information

Author notes

  1. Hong Sang Choi and Ha Yeon Kim contributed equally

Authors and Affiliations

  1. Department of Internal Medicine, Chonnam National University Medical School, 42 Jebongro, Gwangju, 61469, Korea

    Hong Sang Choi, Ha Yeon Kim, Chang Seong Kim, Eun Hui Bae, Seong Kwon Ma & Soo Wan Kim

  2. Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Korea

    Kyung-Do Han & Jin-Hyung Jung

Authors
  1. Hong Sang Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ha Yeon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kyung-Do Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jin-Hyung Jung
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chang Seong Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eun Hui Bae
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Seong Kwon Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Soo Wan Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Soo Wan Kim.

Ethics declarations

Conflict of interest

All authors declare no competing financial interests.

Ethical approval

Ethical approval was waived in this study by the Institutional Review Board (IRB) of Chonnam National University Hospital (#IRB no. CNUH-EXP-2018-019).

Informed consent

Informed consent was not obtained because patient records and information were anonymized and de-identified prior to analysis.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Choi, H.S., Kim, H.Y., Han, KD. et al. Obstructive sleep apnea as a risk factor for incident end stage renal disease: a nationwide population-based cohort study from Korea. Clin Exp Nephrol 23, 1391–1397 (2019). https://doi.org/10.1007/s10157-019-01779-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10157-019-01779-6

Keywords

Search

Navigation