Skip to main content

Advertisement

SpringerLink
Log in

Reversibility of microalbuminuria with continuous positive airway pressure treatment in obstructive sleep apnea syndrome

  • Nephrology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Introduction

Microalbuminuria is an early marker of kidney damage and an early predictor and risk factor for cardiovascular diseases. We aimed to evaluate the association between albuminuria levels in different severity obstructive sleep apnea syndrome (OSAS) cases and to find out the efficacy of CPAP treatment on microalbuminuria.

Materials and methods

We conducted a prospective study on subjects who underwent polysomnography. The polysomnographic data were recorded to establish the presence and severity of OSAS. The blood and urine samples were taken both at the time of diagnosis and 3 months after CPAP therapy. The relationship between the severity of OSAS and microalbuminuria and the effect of CPAP treatment on microalbuminuria were evaluated.

Results

The study population consisted of 449 subjects. Better compliance to CPAP was associated with significantly reduced levels of microlbuminuria. Urinary albumin/creatinine was increased in severe cases, but the difference was not statistically significant. In the non-compliant group, microalbumin/creatinine ratio was 25.24 prior to initiation of CPAP treatment and 28.36 at the third month control visit (p = 0.25). In the compliant group, microalbumin/creatinine ratio was 49.71 prior to initiation of CPAP treatment and 22.30 at the third month control visit (p = 0.04).

Conclusion

Our study demonstrated that good compliance to CPAP therapy is associated with a decrease in microalbuminuria. Patients who used CPAP regularly had a significant decline in albumin/creatinine ratio after 3 months of CPAP therapy.

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

Similar content being viewed by others

References

  1. Unruh ML (2007) Sleep apnea and dialysis therapies: things that go bump in the night? Hemodial Int 11(4):369–378

    Article  Google Scholar 

  2. Fletcher EC, Bao G, Li R (1999) Renin activity and blood pressure in response to chronic episodic hypoxia. Hypertension 34:309–314

    Article  CAS  Google Scholar 

  3. Vonend O, Oberhauser V, von Kugelgen I et al (2002) ATP release in human kidney cortex and its mitogenic effects in visceral glomerular epithelial cells. Kidney Int 61:1617–1626

    Article  CAS  Google Scholar 

  4. Brukamp K, Jim B, Moeller MJ et al (2007) Hypoxia and podocytespecific Vhlh deletion confer risk of glomerular disease. Am J Physiol Ren Physiol 293:F1397–F1407

    Article  CAS  Google Scholar 

  5. Brezis M, Rosen S (1995) Hypoxia of the renal medulla—its implications for disease. N Engl J Med 332:647–655

    Article  CAS  Google Scholar 

  6. Lydia AB, Khan Z, Reynold K et al (2007) Effect of nocturnal nasal continuous positive airway pressure on blood pressure in obstructive sleep apnea. Hypertension 50(2):417–423

    Article  Google Scholar 

  7. Buchner NJ, Wissing KR, Stegbauer J, Quack I, Weiner SM, Krämer BK, Rump LC (2011) The renal resistance index is increased in mild-to-moderate obstructive sleep apnoea and is reduced under continuous positive airway pressure. Nephrol Dial Transplant 26(3):914–920

    Article  Google Scholar 

  8. Shah NA, Yaggi HK, Concato J, Mohsenin V (2010) Obstructive sleep apnea as a risk factor for coronary events or cardiovascular death. Sleep Breath 14(2):131–136

    Article  Google Scholar 

  9. Shamsuzzaman AS, Gersh BJ, Somers VK (2003) Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA 290:1906–1914

    Article  CAS  Google Scholar 

  10. Agrawal V, Vanhecke TE, Rai B et al (2009) Albuminuria and renal function in obese adults evaluated for obstructive sleep apnea. Nephron Clin Pract 113:c140–c147

    Article  Google Scholar 

  11. Krieger J, Imbs JL, Schmidt M, Kurtz D (1988) Renal function in patients with obstructive sleep apnea. Effects of nasal continuous positive airway pressure. Arch Intern Med 148(6):1337–1340

    Article  CAS  Google Scholar 

  12. Ruggenenti P, Remuzzi G (2006) Time to abandon microalbuminuria? Kidney Int 70(7):121422

    Article  Google Scholar 

  13. Ozol D, Carlıoğlu A, Karamanlı H, Akgedik R, Karakurt F, Yıldırım Z (2011) Influence of snoring on microalbuminuria in diabetic patients. Sleep Breath 15(3):295–300

    Article  Google Scholar 

  14. Tsioufis C, Thomopoulos C, Dimitriadis K et al (2008) Association of obstructive sleep apnea with urinary albumin excretion in essential hypertension: a cross-sectional study. Am J Kidney Dis 52:285–293

    Article  Google Scholar 

  15. Kushida CA, Littner MR, Morgenthaler M, Alessi CA, Bailey D, Coleman J, Friedman L et al (2005) Practice parameters fort he indications for polysomnography and related procedures: an update for 2005. Sleep 28(4):499–521

    Article  Google Scholar 

  16. Grig-Damberger M (2012) The AASM scoring manuel four years later. J Clin Sleep Med 8:323–332

    Article  Google Scholar 

  17. American Academy of Sleep Medicine (2014) International classification of sleep disorders, Third Edition (ICSD-3): diagnostic and coding manual. American Academy of Sleep Medicine, Westchester

    Google Scholar 

  18. Flemons WW, Buysee D, Redline S et al (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 22:667–689

    Article  Google Scholar 

  19. Koopman MG, Koomen GC, Krediet RT, de Moor EA, Hoek FJ, Arisz L (1989) Circadian rhythm of glomerular filtration rate in normal individuals. Clin Sci (Lond) 77:105–111

    Article  CAS  Google Scholar 

  20. Denton KM, Shweta A, Anderson WP (2002) Preglomerular and postglomerular resistance responses to different levels of sympathetic activation by hypoxia. J Am Soc Nephrol 13:27–34

    PubMed  Google Scholar 

  21. Fletcher E (2001) Physiological consequences of intermittent hypoxia: systemic blood pressure. J Appl Physiol 90:1600–1605

    Article  CAS  Google Scholar 

  22. Kinebuchi S, Kazama JJ, Satoh M et al (2004) Short-term use of continuous positive airway pressure ameliorates glomerular hyperfiltration patients with obstructive sleep apnoea syndrome. Clin Sci (Lond) 107:317–322

    Article  Google Scholar 

  23. Jørgensen L, Jenssen T, Heuch I, Jacobsen BK (2008) The combined effect of albuminuria and inflammation on all cause and cardiovascular mortality in non diabetic persons. J Intern Med 264:493–501

    Article  Google Scholar 

  24. Buchner NJ, Henning BF, Hagele KF et al (2004) Renal function in hypertensive patients with obstructive sleep apnea. Dtsch Med Wocherschr 129:305–309

    Article  CAS  Google Scholar 

  25. Casserly LF, Chow N, Ali S, Gottlieb DJ, Epstein LJ, Kaufman JS (2001) Proteinuria in obstructive sleep apnea. Kidney Int 60:1484–1489

    Article  CAS  Google Scholar 

  26. Daskalopoulou EG, Liavvas C, Nakas CT, Vlachogiannis EG, Bouros D, Dombros NV (2011) Obstructive sleep apnoea syndrome promotes reversal albuminuria during sleep. Sleep Breath 15:589–597

    Article  Google Scholar 

  27. Chaudhary BA, Sklar AH, Chaudhary TK et al (1988) Sleep apnea, proteinuria, and nephrotic syndrome. Sleep 11:69–74

    Article  CAS  Google Scholar 

  28. Serra A, Romero R, Lopez D et al (2008) Renal injury in the extremely obese patients with normal renal function. Kidney Int 73:947–955

    Article  CAS  Google Scholar 

  29. Faulx MD, Storfer-Isser A, Kircher HL, Jenny NS, Tracy RP, Redline S (2007) Obstructoive sleep apnea is associated with increased urınary albumin excretion. Sleep 30:923–929

    Article  Google Scholar 

  30. Bulcun E, Ekici M, Ekici A et al (2015) Microalbuminuria obstructive sleep apnea syndrome. Sleep Breath. https://doi.org/10.1007/s11325-015-1136-8

    Article  PubMed  Google Scholar 

  31. Casserly LF, Chow N, Ali S, Gottlieb DJ, Epstein LJ (2001) Kaufman JS Proteinuria in obstructive sleep apnea. Kidney Int 60(4):1484–1489

    Article  CAS  Google Scholar 

  32. Adeseun A, Rosas SE (2010) The impact of obstructive sleep apnea on chronic kidney disease. Curr Hypertens Rep 12(5):378–383

    Article  Google Scholar 

  33. Zoccali C (2009) Overweight, obesity and metabolic alterations in chronic kidney disease. Prilozi 30:17–31

    CAS  PubMed  Google Scholar 

  34. Sklar AH, Chaudhary BA, Harp R (1989) Nocturnal urinary protein excretion rates in patients with sleep apnea. Nephron 51:35–38

    Article  CAS  Google Scholar 

  35. Reuben DB, Wachtel TJ, Brown PC, Driscoll JL (1982) Transient proteinüria in emergency medical admissions. N Eng J Med 306:1031–1033

    Article  CAS  Google Scholar 

  36. Masuda T, Honm S, Sasaki N et al (2012) Effect of continuous positive airway pressure on proteinuria in obstructive sleep apnea. Clin Kidney J 5:257–260

    Article  Google Scholar 

  37. Basile DP, Donohoe DL, Roethe K et al (2003) Chronic renal hypoxia after acute ischemic injury: effects of L-arginine on hypoxia and secondary damage. Am J Physiol Renal Physiol 284:F338–F348

    Article  CAS  Google Scholar 

  38. Yaşar Z, Uçar Z, Demir A et al (2014) Does CPAP therapy alter urinary albumin level in adult patients with moderate to severe obstructive sleep apnea syndrome? Sleep Breath 18:525–532

    Article  Google Scholar 

  39. Chen N, Chou Y, Lee P et al (2016) Reversibility of albuminuria and continuous positive airway pressure compliance in patients of obstructive sleep apnea syndrome. Medicine 95:26

    Article  Google Scholar 

  40. Dorkova Z, Petrasova D, Molcanyiova A et al (2008) Effects of continuous positive pressure airway pressure on cardiovascular risk profile in patients with severe obstructive sleep apnea and metabolic syndrome. Chest 134:686–692

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Nephrology Clinic, Istanbul Kartal Dr. Lütfi Kirdar Training and Research Hospital, Kartal, Istanbul, Turkey

    Ergün Parmaksız

  2. Department of Chest Diseases, Istanbul Kartal Dr. Lütfi Kirdar Training and Research Hospital, Istanbul, Turkey

    Elif Torun Parmaksız

Authors
  1. Ergün Parmaksız
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elif Torun Parmaksız
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ergün Parmaksız.

Ethics declarations

Conflict of interest

The writers have no conflict of interest.

Additional information

Publisher's Note

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Parmaksız, E., Torun Parmaksız, E. Reversibility of microalbuminuria with continuous positive airway pressure treatment in obstructive sleep apnea syndrome. Int Urol Nephrol 52, 1719–1724 (2020). https://doi.org/10.1007/s11255-020-02519-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-020-02519-6

Keywords

Search

Navigation