Sleep and Breathing

, Volume 12, Issue 3, pp 217–222 | Cite as

Low-grade urinary albumin excretion in normotensive/non-diabetic obstructive sleep apnea patients

  • Ahmet Ursavas
  • Mehmet Karadag
  • Mustafa Gullulu
  • Ezgi Demirdogen
  • Funda Coskun
  • Selcuk Onart
  • R. Oktay Gozu
Original Article

Abstract

Previous studies have indicated that high levels of urinary albumin excretion (UAE) are associated with an increased incidence of cardiovascular morbidity and mortality. This study examined the association between UAE and obstructive sleep apnea syndrome (OSAS). The study included 35 newly diagnosed OSAS patients and 11 nonapneic controls. Subjects with diabetes mellitus, hypertension, a history of renal failure, cardiac failure, coronary heart disease, collagen tissue disease, high serum creatinine, and urinary infection, and who use angiotensin-converting enzyme inhibitors and were women were excluded from the study. A single void morning urine sample at the baseline examination was used to measure UAE. There were no significant differences in the age, body mass index (BMI), and smoking habits of the OSAS patients and controls. UAE of the OSAS group was significantly higher than that of the control group (23.3 ± 6.1 μg/min vs. 6.5 ± 2.1 μg/min, respectively; P = 0.002). UAE was positively correlated to length of time spent at an oxygen saturation of <90% (r = 0.503, P = 0.002) and BMI (r = 0.361, P = 0.033). Regression analyses (r2 = 0.504, P < 0.0001) showed that the length of time spent at an oxygen saturation of <90% (P < 0.0001) was risk factor for UAE, independent of age and BMI. Our study supports the notion that low-grade UAE is associated with non-hypertensive/non-diabetic OSAS, independent of age and BMI. Low-grade UAE may be a marker for subclinical vascular damage that predisposes OSAS patients to future cardiovascular disease.

Keywords

Urine albumin Sleep apnea Cardiovascular disease 

References

  1. 1.
    ASDA-Diagnostic Classification Steering Committee (1997) The international classification of sleep disorders. Diagnostic and coding manual, 2nd edn. Allen, Lawrence, KSGoogle Scholar
  2. 2.
    Roux F, D’Ambrosio C, Mohsenin V (2000) Sleep-related breathing disorders and cardiovascular disease. Am J Med 108:396–402PubMedCrossRefGoogle Scholar
  3. 3.
    Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea–hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365:1046–1053PubMedGoogle Scholar
  4. 4.
    Bixler EO, Vgontzas AN, Lin H-M et al (2001) Prevalence of sleep disorders breathing in women; effects of gender. Am J Respir Crit Care Med 163:608–613PubMedGoogle Scholar
  5. 5.
    Peker Y, Hedner J, Norum J et al (2002) Increased incidence of cardiovascular disease in middle-aged men with obstructive sleep apnea: a 7-year follow-up. Am J Respir Crit Care Med 166:159–165PubMedCrossRefGoogle Scholar
  6. 6.
    Nieto FJ, Young TB, Lind BK et al (2000) Association of sleep-disordered breathing, sleep apnea, and hypertension in large community based study. JAMA 283:1829–1836PubMedCrossRefGoogle Scholar
  7. 7.
    Mooe T, Rabben T, Wiklund U et al (1996) Sleep-disordered breathing in men with coronary artery disease. Chest 109:659–663PubMedCrossRefGoogle Scholar
  8. 8.
    Arias MA, Garcia-RIO F, Alonso-Fernandez A et al (2006) Pulmonary hypertension in obstructive sleep apnoea: effects of continuous positive airway pressure: a randomized, controlled cross-over study. Eur Heart J 27:1106–1113PubMedCrossRefGoogle Scholar
  9. 9.
    American Diabetes Association (2001) Clinical recommendations 2001: diabetic nephropathy. Diabetes Care 24(suppl 1):S69–S72Google Scholar
  10. 10.
    Klausen K, Borch-Johnsen K, Feldt-Rasmussen B et al (2004) Very low levels of microalbuminuria are associated with increased risk of coronary heart disease and death independently of renal function, hypertension and diabetes. Circulation 110:32–35PubMedCrossRefGoogle Scholar
  11. 11.
    Bigazzi R, Bianchi S, Baldari D, Campese VM (1998) Microalbuminuria predicts cardiovascular events and renal insufficiency in patients with essential hypertension. J Hypertens 16:1325–1333PubMedCrossRefGoogle Scholar
  12. 12.
    Jensen JS, Feldt-Rasmussen B, Strandgaard S, Schroll M, Borch-Johnsen K (2000) Arterial hypertension, microalbuminuria and risk of ischemic heart disease. Hypertension 35:898–903PubMedGoogle Scholar
  13. 13.
    Deckert T, Feldt-Rasmussen B, Borch-Johnsen K, Jensen T, Kofoed-Enevoldsen A (1989) Albuminuria reflects widespread vascular damage: the steno hypothesis. Diabetologia 32:219–226PubMedCrossRefGoogle Scholar
  14. 14.
    Agewall S, Bjorn F (2002) Microalbuminuria and intima–media thickness of the carotid artery in clinically healthy men. Atherosclerosis 164:161–166PubMedCrossRefGoogle Scholar
  15. 15.
    Chaudhary BA, Rehman OU, Brown TM (1995) Proteinuria in patients with sleep apnea. J Fam Pract 40:139–141PubMedGoogle Scholar
  16. 16.
    Iliescu EA, Lam M, Pater J et al (2001) Do patients with obstructive sleep apnea have clinically significant proteinuria. Clin Nephrol 55:196–204PubMedGoogle Scholar
  17. 17.
    Casserly LF, Chow N, Ali S et al (2001) Proteinuria in obstructive sleep apnea. Kidney Int 60:1484–1489PubMedCrossRefGoogle Scholar
  18. 18.
    Rechtschaffen A, Kales A (1973) (Eds). A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. 3. Edition. Los Angeles: Brain Research Institute, 1–13Google Scholar
  19. 19.
    Bonnet M, Charley D, Carskadon MA (1992) EEG arousals scoring rules and examples. Sleep 15:174–184Google Scholar
  20. 20.
    Dincer HE, O’Neill W (2006) Deleterious effect of sleep breathing disorders on the heart and vascular system. Respiration 73:124–130PubMedCrossRefGoogle Scholar
  21. 21.
    Gerstein HC, Mann JF, Yi Q et al (2001) Albuminuria and risk of cardiovascular events, death and heart failure in diabetic and nondiabetic individuals. JAMA 286:421–426PubMedCrossRefGoogle Scholar
  22. 22.
    Zenere BM, Arcaro G, Saggiani F, Rossi L, Muggeo M, Lechi A (1995) Noninvasive detection of functional alterations of the arterial wall in IDDM patients with and without microalbuminuria. Diabetes Care 18:975–982PubMedCrossRefGoogle Scholar
  23. 23.
    Clausen P, Jensen JS, Jensen G, Borch-Johnsen K, Feldt-Rasmussen B (2001) Elevated urinary albumin excretion is associated with impaired arterial dilatory capacity in clinically healthy subjects. Circulation 103:1869–1874PubMedGoogle Scholar
  24. 24.
    Wang TJ, Evans JC, Meigs JB et al (2005) Low-grade albuminuria and the risk of hypertension and blood pressure progression. Circulation 111:1370–1376PubMedCrossRefGoogle Scholar
  25. 25.
    Hillege HL, Fidler V, Diercks GFH et al (2002) Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population. Circulation 106:1777–1782PubMedCrossRefGoogle Scholar
  26. 26.
    Ibsen H, Wachtell K, Olsen MH et al (2004) Does albuminuria predict cardiovascular outcome on treatment with losartan versus atenolol in hypertension with left ventricular hypertrophy? A LIFE substudy. J Hypertens 22:1805–1811PubMedCrossRefGoogle Scholar
  27. 27.
    Schnohr P, Jensen G, Lange P, Scharling H, Appleyard M (2001) The Copenhagen City Heart Study. Eur Heart J 3(Suppl):H1–83Google Scholar
  28. 28.
    Ärnlöv J, Evans JC, Meigs Jb et al (2005) Low-grade albuminuria and incidence of cardiovascular disease events in nonhypertensive and nondiabetic individuals. The Framingham Heart Study. Circulation 112:969–975PubMedCrossRefGoogle Scholar
  29. 29.
    Kramer H, Jacobs DR, Bild DJ et al (2005) Urine albumin excretion and subclinical cardiovascular disease. The multi-ethnic study of atherosclerosis. Hypertension 46:38–43PubMedCrossRefGoogle Scholar
  30. 30.
    Lieb W, Mayer B, Stritzke J et al (2006) Association of low-grade urinary albumin excretion with left ventricular hypertrophy in the general population. The MONICA/KORA Augsburg echocardiographic substudy. Nephrol Dial Transplant 21:2780–1787PubMedCrossRefGoogle Scholar
  31. 31.
    Mello P, Franger M, Boujaoude Zi et al (2004) Night and day proteinuria in patients with sleep apnea. Am J Kidney Dis 44:636–641PubMedCrossRefGoogle Scholar
  32. 32.
    Kvenild K, Romundstad S, Midthjell K et al (2006) Microalbuminuria in treated hypertensives: only a mirror image of cardiovascular risk. Scand J Prim Health Care 24:145–153PubMedCrossRefGoogle Scholar
  33. 33.
    Jensen JS (1995) Intra-individual variation of overnight urinary albumin excretion in clinically healthy middle-aged individuals. Clin Chim Acta 243:95–99PubMedCrossRefGoogle Scholar
  34. 34.
    Eknoyan G, Hostetter T, Bakris GL et al (2003) Proteinuria and other markers of chronic kidney disease: a position statement of the National Kidney Foundation (NKF) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Am J Kidney Dis 42:616–622CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Ahmet Ursavas
    • 1
    • 4
  • Mehmet Karadag
    • 1
  • Mustafa Gullulu
    • 2
  • Ezgi Demirdogen
    • 1
  • Funda Coskun
    • 1
  • Selcuk Onart
    • 3
  • R. Oktay Gozu
    • 1
  1. 1.Department of Pulmonary Medicine, School of MedicineUniversity of UludağBursaTurkey
  2. 2.Department of Nephrology, School of MedicineUniversity of UludağBursaTurkey
  3. 3.Department of Otolaryngology–Head and Neck Surgery, School of MedicineUniversity of UludağBursaTurkey
  4. 4.Uludağ Üniversitesi Tıp Fakültesi, Göğüs Hastalıkları ve Tüberküloz ADBursaTurkey

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