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Bidirectional association between chronic kidney disease and sleep apnea: a systematic review and meta-analysis

  • Nephrology - Original Paper
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Abstract

Background

Previous data have suggested a link between chronic kidney disease (CKD) and sleep apnea (SA). However, the prevalence and risk association of both disease entities are not uniformly described.

Methods

Ovid MEDLINE, EMBASE, and the Cochrane Library were searched for eligible publications that included patients aged ≥ 18 years diagnosed with CKD or SA. Included studies were divided into two cohorts: (1) a cohort of CKD or end-stage kidney disease (ESKD) patients reporting the prevalence of SA or odds ratio (OR) for SA (CKD cohort) and (2) a cohort of SA patients reporting the prevalence of CKD/ESKD or OR for CKD/ESKD (SA cohort).

Results

CKD cohort: Of 16 studies (n = 340,587), the pooled estimated prevalence of SA among CKD/ESKD patients was 47.5% (95% CI 28.8–66.9). The pooled adjusted OR for SA among CKD/ESKD patients was 1.961 (95% CI 1.702–2.260). Male sex, history of diabetes, and lower BMI were associated with increased prevalence of SA. SA cohort: Of 12 studies (n = 3,103,074), the pooled prevalence of CKD/ESKD among patients with SA was 8.2% (95% CI 4.7–13.7), whereas the pooled adjusted OR for CKD/ESKD among patients with SA was 2.088 (95% CI 1.777–2.452). Increasing age, higher BMI, male sex, white race, and history of diabetes were associated with higher prevalence of CKD/ESKD.

Conclusion

There was a bidirectional association between CKD/ESKD and SA. Interventions aiming to prevent the progression of either CKD or SA are important.

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Author notes

  1. Panupong Hansrivijit, Max M. Puthenpura contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine, University of Pittsburgh Medical Center Pinnacle, 504 S. Front St, Suite 3C, Harrisburg, PA, 17104, USA

    Panupong Hansrivijit

  2. Drexel University College of Medicine, Philadelphia, PA, 19129, USA

    Max M. Puthenpura

  3. Division of Nephrology, Department of Medicine, Penn State University College of Medicine, Hershey, PA, 17033, USA

    Nasrollah Ghahramani

  4. Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, 55905, USA

    Charat Thongprayoon

  5. Division of Nephrology, University of Mississippi Medical Center, Jackson, MS, 39216, USA

    Wisit Cheungpasitporn

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Contributions

P.H. and W.C. performed literature search. P.H. and M.P. screened all citations and extracted the data. P.H. analyzed the data. P.H. constructed the figures and tables. P.H. and M.P. drafted the manuscript. N.G., C.T. and W.C. revised and edited the manuscript for submission. P.H. revised the manuscript prior to publication.

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Correspondence to Panupong Hansrivijit.

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Hansrivijit, P., Puthenpura, M.M., Ghahramani, N. et al. Bidirectional association between chronic kidney disease and sleep apnea: a systematic review and meta-analysis. Int Urol Nephrol 53, 1209–1222 (2021). https://doi.org/10.1007/s11255-020-02699-1

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