Sleep and Breathing

, Volume 23, Issue 1, pp 161–169 | Cite as

Serum levels of NGAL and cystatin C as markers of early kidney dysfunction in patients with obstructive sleep apnea syndrome

  • Athanasios Voulgaris
  • Kostas Archontogeorgis
  • Evangelia Nena
  • Christina Tsigalou
  • Maria Xanthoudaki
  • Maria Kouratzi
  • Grigorios Tripsianis
  • Marios Froudarakis
  • Paschalis SteiropoulosEmail author
Sleep Breathing Physiology and Disorders • Original Article



Obstructive sleep apnea syndrome (OSAS) has been recently proposed as an independent risk factor for chronic kidney disease. Cystatin C (Cyst C) and neutrophil gelatinase-associated lipocalin (NGAL) are novel biomarkers for the earlier detection of latent kidney disease. The aim of the study was to assess serum Cyst C and NGAL levels in otherwise healthy OSAS patients and to explore possible associations with sleep parameters.


Consecutive subjects (n = 96, 79.2% males), without known comorbidities, with symptoms suggestive of OSAS were included. All of them underwent polysomnography (PSG) and blood examination for the measurement of serum Cyst C and NGAL levels.


Based on apnea-hypopnea index (AHI), subjects were classified into two groups: 32 controls and 64 OSAS patients, with no significant differences in terms of age (50.1 ± 11.7 vs 51 ± 12.2 years, p = 0.747) and BMI (33.9 ± 8.8 vs 35.9 ± 13.1 kg/m2, p = 0.449). Serum Cyst C and NGAL mean levels were higher in OSAS patients compared to those in controls (1155.2 ± 319.3 vs 966.8 ± 173 ng/ml, p = 0.001, and 43.7 ± 23.2 vs 35.6 ± 13.8 ng/ml, p = 0.035, respectively). After adjustment for age and BMI in OSAS patients, serum NGAL levels were associated with AHI (β = 0.341, p = 0.015) and minimum oxyhemoglobin saturation during sleep (β = − 0.275, p = 0.032), while serum Cyst C levels were associated with percentage of time with oxyhemoglobin saturation < 90% (β = 0.270, p = 0.043), average (β = − 0.308, p = 0.018), and minimum (β = − 0.410, p = 0.001) oxyhemoglobin saturation during sleep.


Higher risk for latent kidney disease in otherwise healthy OSAS patients is indicated. Sleep hypoxia seems to be a significant contributor in the pathogenetic process of renal dysfunction in OSAS.


Cystatin C NGAL Kidney injury Kidney dysfunction Obstructive sleep apnea syndrome 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Athanasios Voulgaris
    • 1
    • 2
  • Kostas Archontogeorgis
    • 1
  • Evangelia Nena
    • 1
    • 3
  • Christina Tsigalou
    • 4
  • Maria Xanthoudaki
    • 2
  • Maria Kouratzi
    • 2
  • Grigorios Tripsianis
    • 5
  • Marios Froudarakis
    • 2
  • Paschalis Steiropoulos
    • 1
    • 2
    Email author
  1. 1.MSc Programme in Sleep Medicine, Medical SchoolDemocritus University of ThraceAlexandroupolisGreece
  2. 2.Department of Pneumonology, Medical SchoolDemocritus University of Thrace and University General HospitalAlexandroupolisGreece
  3. 3.Laboratory of Hygiene and Environmental Protection, Medical SchoolDemocritus University of ThraceAlexandroupolisGreece
  4. 4.Laboratory of Microbiology, Medical SchoolDemocritus University of ThraceAlexandroupolisGreece
  5. 5.Laboratory of Medical Statistics, Medical SchoolDemocritus University of ThraceAlexandroupolisGreece

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