Sleep and Biological Rhythms

, Volume 16, Issue 2, pp 151–167 | Cite as

The relation and mechanism of kidney injury in obstructive sleep apnea: a literature review

  • Neha Devi Poonit
  • Xiao Hong Cai
Review Article


Up to date, it is found that the presence of obstructive sleep apnea (OSA) contributes to the development of structural, ultra-structural, functional, and proteomics changes in the kidney. These changes are based on pathological processes, such as increased production of free radicals, disruption of mediated NO vasodilation reactions, activation of the sympathetic autonomic nervous system, the renin–angiotensin–aldosterone system, dysfunction of endothelium, the development of renal venous hypertension, and stimulation of atrial natriuretic peptide production. All this in turn contributes to an increase in intra-glomerular pressure, the occurrence of glomerular hyperfiltration, nocturnal polyuria, renal functional changes, proteinuria and renal tubular dysfunction. Kidney injury in OSA patients can also be caused by pathological conditions associated with OSA, such as cor pulmonale, erythrocytosis, diabetes mellitus, metabolic syndrome, hypertension, coronary heart diseases, and atherosclerosis, which in isolated conditions can lead to development of kidney damage, and co-occurring with OSA can even aggravate the course of the latter. There is a bidirectional relationship between kidney diseases and OSA through a number of potential pathological mechanisms, which suggests the possibility of both diseases to be a possible risk factor for each other. Moreover, kidney diseases may lead to OSA through a multifarious of mechanisms, including chemoreflex responsiveness, pharyngeal narrowing due to fluid overload, and accumulation of uremic toxins.


Obstructive sleep apnea syndrome Kidney injury Sympathetic autonomic nervous system Renin–angiotensin–aldosterone system Endothelial dysfunction Atrial natriuretic peptide 



Obstructive sleep apnea syndrome


Chronic renal failure


Continuous positive airway pressure


Reactive oxygen species


Sympathetic autonomic nervous system


Nitric oxide


Endothelial dysfunction


Vascular endothelial growth factor


Hypoxia inducible factor-1α


Nuclear factor κ B


Activator protein1


Nuclear factor (erythroid-derived 2)-like2


Renin–angiotensin system

Ang II

Angiotensin II


Atrial natriuretic peptide


End-stage renal disease


Pulmonary embolism


Apnea–hypoapnea index


Bi-level positive airway pressure


Deep vein thrombosis


Venous thromboembolism.



This work was supported by Zhejiang Provincial Natural Science Foundation Grant (LY17H010004), Scientific Research Foundation of Health Bureau of Zhejiang Province (2018ZD010), Wenzhou City Science and Technology Bureau Grant (Y20170133), National Science-technology Support Program (2015BAI12B09), and Project of Key Innovative Disciplines of Children Sleep Medicine of Zhejiang.

Compliance with ethical standards

Conflict of interest

The authors Dr. Poonit and Dr. Cai certify that there is no conflict of interest.

Ethical approval

This article does not contain any studies with animals performed by any of the authors. This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Guillot M, Sforza E, Achour-Crawford E, Maudoux D, Saint-Martin M, Barthelemy JC, Roche F. Association between severe obstructive sleep apnea and incident arterial hypertension in the older people population. Sleep Med. 2013;14(9):838–42. Scholar
  2. 2.
    Goyal SK, Sharma A. Atrial fibrillation in obstructive sleep apnea. World J Cardiol. 2013;5(6):157–63. Scholar
  3. 3.
    Fava C, Montagnana M, Favaloro EJ, Guidi GC, Lippi G. Obstructive sleep apnea syndrome and cardiovascular diseases. Semin Thromb Hemost. 2011;37(3):280–97. Scholar
  4. 4.
    Barone DA, Krieger AC. Stroke and obstructive sleep apnea: a review. Curr Atheroscler Rep. 2013;15(7):334. Scholar
  5. 5.
    Becker HF, Jerrentrup A, Ploch T, Grote L, Penzel T, Sullivan CE, Peter JH. Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea. Circulation. 2003;107(1):68–73.CrossRefPubMedGoogle Scholar
  6. 6.
    Schober AK, Neurath MF, Harsch IA. Prevalence of sleep apnoea in diabetic patients. Clin Respir J. 2011;5(3):165–72. Scholar
  7. 7.
    Levy P, Tamisier R, Arnaud C, Monneret D, Baguet JP, Stanke-Labesque F, Dematteis M, Godin-Ribuot D, Ribuot C, Pepin JL. Sleep deprivation, sleep apnea and cardiovascular diseases. Front Biosci (Elite Ed). 2012;4:2007–21.Google Scholar
  8. 8.
    Punjabi NM, Sorkin JD, Katzel LI, Goldberg AP, Schwartz AR, Smith PL. Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir Crit Care Med. 2002;165(5):677–82. Scholar
  9. 9.
    Badran M, Golbidi S, Devlin A, Ayas N, Laher I. Chronic intermittent hypoxia causes endothelial dysfunction in a mouse model of diet-induced obesity. Sleep Med. 2014;15(5):596–602. Scholar
  10. 10.
    Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Nieto FJ, O’Connor GT, Boland LL, Schwartz JE, Samet JM. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001;163(1):19–25. Scholar
  11. 11.
    Mehra R, Benjamin EJ, Shahar E, Gottlieb DJ, Nawabit R, Kirchner HL, Sahadevan J, Redline S, Sleep Heart Health S. Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study. Am J Respir Crit Care Med. 2006;173(8):910–6. Scholar
  12. 12.
    Lau EY, Eskes GA, Morrison DL, Rajda M, Spurr KF. The role of daytime sleepiness in psychosocial outcomes after treatment for obstructive sleep apnea. Sleep Disord.2013;2013:140725. Scholar
  13. 13.
    Vernet C, Redolfi S, Attali V, Konofal E, Brion A, Frija-Orvoen E, Pottier M, Similowski T, Arnulf I. Residual sleepiness in obstructive sleep apnoea: phenotype and related symptoms. Eur Respir J. 2011;38(1):98–105. Scholar
  14. 14.
    Papalia L, Goldoni M, Spaggiari MC, Roscelli F, Corradi M, Mutti A. Sleep disorders, risk of accidents and traffic accidents in a group of drivers of public transport. G Ital Med Lav Ergon. 2012;34(3 Suppl):353–6.PubMedGoogle Scholar
  15. 15.
    Sanna A. Obstructive sleep apnoea, motor vehicle accidents, and work performance. Chron Respir Dis. 2013;10(1):29–33. Scholar
  16. 16.
    Karimi M, Eder DN, Eskandari D, Zou D, Hedner JA, Grote L. Impaired vigilance and increased accident rate in public transport operators is associated with sleep disorders. Accid Anal Prev. 2013;51:208–14. Scholar
  17. 17.
    Verhulst SL, Van Hoeck K, Schrauwen N, Haentjens D, Rooman R, Van Gaal L, De Backer W, Desager KN. Sleep-disordered breathing and proteinuria in overweight and obese children and adolescents. Horm Res. 2008;70(4):224–9. Scholar
  18. 18.
    Krishna J, Shah ZA, Merchant M, Klein JB, Gozal D. Urinary protein expression patterns in children with sleep-disordered breathing: preliminary findings. Sleep Med. 2006;7(3):221–7. Scholar
  19. 19.
    Poonit ND, Zhang YC, Ye CY, Cai HL, Yu CY, Li T, Cai XH. Chronic intermittent hypoxia exposure induces kidney injury in growing rats. Sleep Breath. 2017. Scholar
  20. 20.
    Ding W, Cai Y, Wang W, Ji L, Dong Y, Zhang X, Su M, Liu J, Lu G, Zhang X. Adiponectin protects the kidney against chronic intermittent hypoxia-induced injury through inhibiting endoplasmic reticulum stress. Sleep Breath. 2016;20(3):1069–74. Scholar
  21. 21.
    Sun W, Yin X, Wang Y, Tan Y, Cai L, Wang B, Cai J, Fu Y. Intermittent hypoxia-induced renal antioxidants and oxidative damage in male mice: hormetic dose response. Dose Response. 2012;11(3):385–400. Scholar
  22. 22.
    Abuyassin B, Sharma K, Ayas NT, Laher I. Obstructive sleep apnea and kidney disease: a potential bidirectional relationship? J Clin Sleep Med. 2015;11(8):915–24. Scholar
  23. 23.
    Turek NF, Ricardo AC, Lash JP. Sleep disturbances as nontraditional risk factors for development and progression of CKD: review of the evidence. Am J Kidney Dis. 2012;60(5):823–33. Scholar
  24. 24.
    Mirrakhimov AE. Obstructive sleep apnea and kidney disease: is there any direct link? Sleep Breath. 2012;16(4):1009–16. Scholar
  25. 25.
    Uyar M, Davutoglu V. Obstructive sleep apnoea: a stand-alone risk factor for chronic kidney disease. Nephrol Dial Transplant. 2011;26(8):2718. (author reply 2718–2719).CrossRefPubMedGoogle Scholar
  26. 26.
    Faulx MD, Storfer-Isser A, Kirchner HL, Jenny NS, Tracy RP, Redline S. Obstructive sleep apnea is associated with increased urinary albumin excretion. Sleep. 2007;30(7):923–9.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Fletcher EC. Obstructive sleep apnea and the kidney. J Am Soc Nephrol. 1993;4(5):1111–21.PubMedGoogle Scholar
  28. 28.
    Sklar AH, Chaudhary BA. Reversible proteinuria in obstructive sleep apnea syndrome. Arch Intern Med. 1988;148(1):87–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Chaudhary BA, Sklar AH, Chaudhary TK, Kolbeck RC, Speir WA Jr. Sleep apnea, proteinuria, and nephrotic syndrome. Sleep. 1988;11(1):69–74.CrossRefPubMedGoogle Scholar
  30. 30.
    Bailey RR, Lynn KL, Burry AF, Drennan C. Proteinuria, glomerulomegaly and focal glomerulosclerosis in a grossly obese man with obstructive sleep apnea syndrome. Aust N Z J Med. 1989;19(5):473–4.CrossRefPubMedGoogle Scholar
  31. 31.
    Chaudhary BA, Rehman OU, Brown TM. Proteinuria in patients with sleep apnea. J Fam Pract. 1995;40(2):139–41.PubMedGoogle Scholar
  32. 32.
    Zibar L, Kristic A, Krnjeta D, Dogas Z. [Risk for sleep apnea syndrome and excessive daily sleepiness in chronic hemodialysis patients]. Acta Med Croatica. 2011;65(Suppl 3):30–5.PubMedGoogle Scholar
  33. 33.
    Kimmel PL, Miller G, Mendelson WB. Sleep apnea syndrome in chronic renal disease. Am J Med. 1989;86(3):308–14.CrossRefPubMedGoogle Scholar
  34. 34.
    Wali SO, Alkhouli A, Howladar M, Ahmad I, Alshohaib S, Al-Ghamdi S, Krayem A. Risk of obstructive sleep apnea among Saudis with chronic renal failure on hemodialysis. Ann Thorac Med. 2015;10(4):263–8. Scholar
  35. 35.
    Roumelioti ME, Buysse DJ, Sanders MH, Strollo P, Newman AB, Unruh ML. Sleep-disordered breathing and excessive daytime sleepiness in chronic kidney disease and hemodialysis. Clin J Am Soc Nephrol. 2011;6(5):986–94. Scholar
  36. 36.
    Mendelson WB, Wadhwa NK, Greenberg HE, Gujavarty K, Bergofsky E. Effects of hemodialysis on sleep apnea syndrome in end-stage renal disease. Clin Nephrol. 1990;33(5):247–51.PubMedGoogle Scholar
  37. 37.
    Kinebuchi S, Kazama JJ, Satoh M, Sakai K, Nakayama H, Yoshizawa H, Narita I, Suzuki E, Gejyo F. Short-term use of continuous positive airway pressure ameliorates glomerular hyperfiltration in patients with obstructive sleep apnoea syndrome. Clin Sci (Lond). 2004;107(3):317–22. Scholar
  38. 38.
    Sklar AH, Chaudhary BA, Harp R. Nocturnal urinary protein excretion rates in patients with sleep apnea. Nephron. 1989;51(1):35–8.CrossRefPubMedGoogle Scholar
  39. 39.
    Praga M, Hernandez E, Andres A, Leon M, Ruilope LM, Rodicio JL. Effects of body-weight loss and captopril treatment on proteinuria associated with obesity. Nephron. 1995;70(1):35–41.CrossRefPubMedGoogle Scholar
  40. 40.
    Reuter S, Gupta SC, Chaturvedi MM, Aggarwal BB. Oxidative stress, inflammation, and cancer: how are they linked? Free Radic Biol Med. 2010;49(11):1603–16. Scholar
  41. 41.
    Lavie L. Oxidative stress in obstructive sleep apnea and intermittent hypoxia–revisited–the bad ugly and good: implications to the heart and brain. Sleep Med Rev. 2015;20:27–45. Scholar
  42. 42.
    Cortelli P, Parchi P, Sforza E, Contin M, Pierangeli G, Barletta G, Lugaresi E. Cardiovascular autonomic dysfunction in normotensive awake subjects with obstructive sleep apnoea syndrome. Clin Auton Res. 1994;4(1–2):57–62.CrossRefPubMedGoogle Scholar
  43. 43.
    Lai CJ, Yang CC, Hsu YY, Lin YN, Kuo TB. Enhanced sympathetic outflow and decreased baroreflex sensitivity are associated with intermittent hypoxia-induced systemic hypertension in conscious rats. J Appl Physiol (1985). 2006;100(6):1974–82. Scholar
  44. 44.
    Phillips BG, Narkiewicz K, Pesek CA, Haynes WG, Dyken ME, Somers VK. Effects of obstructive sleep apnea on endothelin-1 and blood pressure. J Hypertens. 1999;17(1):61–6.CrossRefPubMedGoogle Scholar
  45. 45.
    Greenberg DA, Chan J, Sampson HA. Endothelins and the nervous system. Neurology. 1992;42(1):25–31.CrossRefPubMedGoogle Scholar
  46. 46.
    Marasciulo FL, Montagnani M, Potenza MA. Endothelin-1: the yin and yang on vascular function. Curr Med Chem. 2006;13(14):1655–65.CrossRefPubMedGoogle Scholar
  47. 47.
    Haight JS, Djupesland PG. Nitric oxide (NO) and obstructive sleep apnea (OSA). Sleep Breath. 2003;7(2):53–62. Scholar
  48. 48.
    Ip MS, Lam KS, Ho C, Tsang KW, Lam W. Serum leptin and vascular risk factors in obstructive sleep apnea. Chest. 2000;118(3):580–6.CrossRefPubMedGoogle Scholar
  49. 49.
    Zhao HY, Chen BY, Cao J, Feng J, Guo MN. Effects of obstructive sleep apnea style intermittent hypoxia on endothelin-1, nitric oxide, and nitric oxide synthase in endothelium: experiment with human umbilical vein endothelial cells. Zhonghua Yi Xue Za Zhi. 2007;87(31):2189–92.PubMedGoogle Scholar
  50. 50.
    Krieger J, Imbs JL, Schmidt M, Kurtz D. Renal function in patients with obstructive sleep apnea. Effects of nasal continuous positive airway pressure. Arch Intern Med. 1988;148(6):1337–40.CrossRefPubMedGoogle Scholar
  51. 51.
    Schurek HJ, Jost U, Baumgartl H, Bertram H, Heckmann U. Evidence for a preglomerular oxygen diffusion shunt in rat renal cortex. Am J Physiol. 1990;259(6 Pt 2):F910-915.Google Scholar
  52. 52.
    Brezis M, Rosen S, Silva P, Epstein FH. Renal ischemia: a new perspective. Kidney Int. 1984;26(4):375–83.CrossRefPubMedGoogle Scholar
  53. 53.
    Fine LG, Norman JT. Chronic hypoxia as a mechanism of progression of chronic kidney diseases: from hypothesis to novel therapeutics. Kidney Int. 2008;74(7):867–72. Scholar
  54. 54.
    Mello P, Franger M, Boujaoude Z, Adaimy M, Gelfand E, Kass J, Weisberg LS. Night and day proteinuria in patients with sleep apnea. Am J Kidney Dis. 2004;44(4):636–41.CrossRefPubMedGoogle Scholar
  55. 55.
    Nangaku M. Chronic hypoxia and tubulointerstitial injury: a final common pathway to end-stage renal failure. J Am Soc Nephrol. 2006;17(1):17–25. Scholar
  56. 56.
    Eckardt KU, Rosenberger C, Jurgensen JS, Wiesener MS. Role of hypoxia in the pathogenesis of renal disease. Blood Purif. 2003;21(3):253–7.CrossRefPubMedGoogle Scholar
  57. 57.
    Bratel T, Ljungman S, Runold M, Stenvinkel P. Renal function in hypoxaemic chronic obstructive pulmonary disease: effects of long-term oxygen treatment. Respir Med. 2003;97(4):308–16.CrossRefPubMedGoogle Scholar
  58. 58.
    Dempsey JA, Veasey SC, Morgan BJ, O’Donnell CP. Pathophysiology of sleep apnea. Physiol Rev. 2010;90(1):47–112. Scholar
  59. 59.
    Freet CS, Stoner JF, Tang X. Baroreflex and chemoreflex controls of sympathetic activity following intermittent hypoxia. Auton Neurosci. 2013;174(1–2):8–14. Scholar
  60. 60.
    Chouchou F, Pichot V, Pepin JL, Tamisier R, Celle S, Maudoux D, Garcin A, Levy P, Barthelemy JC, Roche F, Group PS. Sympathetic overactivity due to sleep fragmentation is associated with elevated diurnal systolic blood pressure in healthy elderly subjects: the PROOF-SYNAPSE study. Eur Heart J. 2013;34(28):2122–31, 2131a. Scholar
  61. 61.
    Morgan BJ, Crabtree D, Skatrud JB. Chemoreflex sensitization augments sympathetic vasomotor outflow in awake humans. Adv Exp Med Biol. 1994;360:269–71.CrossRefPubMedGoogle Scholar
  62. 62.
    Fletcher EC, Miller J, Schaaf JW, Fletcher JG. Urinary catecholamines before and after tracheostomy in patients with obstructive sleep apnea and hypertension. Sleep. 1987;10(1):35–44.CrossRefPubMedGoogle Scholar
  63. 63.
    Xie A, Skatrud JB, Puleo DS, Morgan BJ. Exposure to hypoxia produces long-lasting sympathetic activation in humans. J Appl Physiol (1985). 2001;91(4):1555–62.CrossRefGoogle Scholar
  64. 64.
    Cutler MJ, Swift NM, Keller DM, Wasmund WL, Smith ML. Hypoxia-mediated prolonged elevation of sympathetic nerve activity after periods of intermittent hypoxic apnea. J Appl Physiol (1985). 2004;96(2):754–61. Scholar
  65. 65.
    Greenberg HE, Sica A, Batson D, Scharf SM. Chronic intermittent hypoxia increases sympathetic responsiveness to hypoxia and hypercapnia. J Appl Physiol (1985). 1999;86(1):298–305.CrossRefGoogle Scholar
  66. 66.
    Fletcher EC, Orolinova N, Bader M. Blood pressure response to chronic episodic hypoxia: the renin-angiotensin system. J Appl Physiol (1985). 2002;92(2):627–33. Scholar
  67. 67.
    Narkiewicz K, van de Borne PJ, Montano N, Dyken ME, Phillips BG, Somers VK. Contribution of tonic chemoreflex activation to sympathetic activity and blood pressure in patients with obstructive sleep apnea. Circulation. 1998;97(10):943–5.CrossRefPubMedGoogle Scholar
  68. 68.
    Mills PJ, Kennedy BP, Loredo JS, Dimsdale JE, Ziegler MG. Effects of nasal continuous positive airway pressure and oxygen supplementation on norepinephrine kinetics and cardiovascular responses in obstructive sleep apnea. J Appl Physiol (1985). 2006;100(1):343–8. Scholar
  69. 69.
    Grote L, Kraiczi H, Hedner J. Reduced alpha- and beta(2)-adrenergic vascular response in patients with obstructive sleep apnea. Am J Respir Crit Care Med. 2000;162(4 Pt 1):1480–7. Scholar
  70. 70.
    Stadtman ER. Role of oxidant species in aging. Curr Med Chem. 2004;11(9):1105–12.CrossRefPubMedGoogle Scholar
  71. 71.
    Qian J, Fulton D. Post-translational regulation of endothelial nitric oxide synthase in vascular endothelium. Front Physiol. 2013;4:347. Scholar
  72. 72.
    Li H, Forstermann U. Uncoupling of endothelial NO synthase in atherosclerosis and vascular disease. Curr Opin Pharmacol. 2013;13(2):161–7. Scholar
  73. 73.
    Jordan W, Cohrs S, Degner D, Meier A, Rodenbeck A, Mayer G, Pilz J, Ruther E, Kornhuber J, Bleich S. Evaluation of oxidative stress measurements in obstructive sleep apnea syndrome. J Neural Transm (Vienna). 2006;113(2):239–54. Scholar
  74. 74.
    Lavie L. Obstructive sleep apnoea syndrome–an oxidative stress disorder. Sleep Med Rev. 2003;7(1):35–51.CrossRefPubMedGoogle Scholar
  75. 75.
    Calcerrada P, Peluffo G, Radi R. Nitric oxide-derived oxidants with a focus on peroxynitrite: molecular targets, cellular responses and therapeutic implications. Curr Pharm Des. 2011;17(35):3905–32.CrossRefPubMedGoogle Scholar
  76. 76.
    Kanagy NL, Walker BR, Nelin LD. Role of endothelin in intermittent hypoxia-induced hypertension. Hypertension. 2001;37(2 Pt 2):511–5.CrossRefPubMedGoogle Scholar
  77. 77.
    Bruno RM, Rossi L, Fabbrini M, Duranti E, Di Coscio E, Maestri M, Guidi P, Frenzilli G, Salvetti A, Taddei S, Bonanni E, Ghiadoni L. Renal vasodilating capacity and endothelial function are impaired in patients with obstructive sleep apnea syndrome and no traditional cardiovascular risk factors. J Hypertens. 2013;31(7):1456–64. (discussion 1464).CrossRefPubMedGoogle Scholar
  78. 78.
    Cohen RA. The role of nitric oxide and other endothelium-derived vasoactive substances in vascular disease. Prog Cardiovasc Dis. 1995;38(2):105–28.CrossRefPubMedGoogle Scholar
  79. 79.
    Carlson JT, Rangemark C, Hedner JA. Attenuated endothelium-dependent vascular relaxation in patients with sleep apnoea. J Hypertens. 1996;14(5):577–84.CrossRefPubMedGoogle Scholar
  80. 80.
    Kato M, Roberts-Thomson P, Phillips BG, Haynes WG, Winnicki M, Accurso V, Somers VK. Impairment of endothelium-dependent vasodilation of resistance vessels in patients with obstructive sleep apnea. Circulation. 2000;102(21):2607–10.CrossRefPubMedGoogle Scholar
  81. 81.
    Moller DS, Lind P, Strunge B, Pedersen EB. Abnormal vasoactive hormones and 24-hour blood pressure in obstructive sleep apnea. Am J Hypertens. 2003;16(4):274–80.CrossRefPubMedGoogle Scholar
  82. 82.
    Foster GE, Poulin MJ, Hanly PJ. Intermittent hypoxia and vascular function: implications for obstructive sleep apnoea. Exp Physiol. 2007;92(1):51–65. Scholar
  83. 83.
    Bulcun E, Ekici M, Ekici A, Cimen DA, Kisa U. Microalbuminuria in obstructive sleep apnea syndrome. Sleep Breath. 2015;19(4):1191–7. Scholar
  84. 84.
    Deanfield J, Donald A, Ferri C, Giannattasio C, Halcox J, Halligan S, Lerman A, Mancia G, Oliver JJ, Pessina AC, Rizzoni D, Rossi GP, Salvetti A, Schiffrin EL, Taddei S, Webb DJ. Working Group on E, Endothelial Factors of the European Society of H. (2005) Endothelial function and dysfunction. Part I: methodological issues for assessment in the different vascular beds: a statement by the working group on endothelin and endothelial factors of the european society of hypertension. J Hypertens 23 (1):7–17.CrossRefPubMedGoogle Scholar
  85. 85.
    Seif F, Patel SR, Walia H, Rueschman M, Bhatt DL, Gottlieb DJ, Lewis EF, Patil SP, Punjabi NM, Babineau DC, Redline S, Mehra R. Association between obstructive sleep apnea severity and endothelial dysfunction in an increased background of cardiovascular burden. J Sleep Res. 2013;22(4):443–51. Scholar
  86. 86.
    Dyugovskaya L, Lavie P, Lavie L. Increased adhesion molecules expression and production of reactive oxygen species in leukocytes of sleep apnea patients. Am J Respir Crit Care Med. 2002;165(7):934–9. Scholar
  87. 87.
    Clausen P, Jensen JS, Jensen G, Borch-Johnsen K, Feldt-Rasmussen B. Elevated urinary albumin excretion is associated with impaired arterial dilatory capacity in clinically healthy subjects. Circulation. 2001;103(14):1869–74.CrossRefPubMedGoogle Scholar
  88. 88.
    Schulz R, Hummel C, Heinemann S, Seeger W, Grimminger F. Serum levels of vascular endothelial growth factor are elevated in patients with obstructive sleep apnea and severe nighttime hypoxia. Am J Respir Crit Care Med. 2002;165(1):67–70. Scholar
  89. 89.
    Lavie L, Kraiczi H, Hefetz A, Ghandour H, Perelman A, Hedner J, Lavie P. Plasma vascular endothelial growth factor in sleep apnea syndrome: effects of nasal continuous positive air pressure treatment. Am J Respir Crit Care Med. 2002;165(12):1624–8. Scholar
  90. 90.
    Reuben DB, Wachtel TJ, Brown PC, Driscoll JL. Transient proteinuria in emergency medical admissions. N Engl J Med. 1982;306(17):1031–3. Scholar
  91. 91.
    Faustinella F, Uzoh C, Sheikh-Hamad D, Truong LD, Olivero JJ. Glomerulomegaly and proteinuria in a patient with idiopathic pulmonary hypertension. J Am Soc Nephrol. 1997;8(12):1966–70.PubMedGoogle Scholar
  92. 92.
    Lin YS, Liu PH, Lin SW, Chuang LP, Ho WJ, Chou YT, Juan KC, Lo MT, Chu PH, Chen NH. Simple obstructive sleep apnea patients without hypertension or diabetes accelerate kidney dysfunction: a population follow-up cohort study from Taiwan. Sleep Breath. 2017;21(1):85–91. Scholar
  93. 93.
    Peach MJ. Renin-angiotensin system: biochemistry and mechanisms of action. Physiol Rev. 1977;57(2):313–70.CrossRefPubMedGoogle Scholar
  94. 94.
    Ohtake PJ, Walker JK, Jennings DB. Renin-angiotensin system stimulates respiration during acute hypotension but not during hypercapnia. J Appl Physiol (1985). 1993;74(3):1220–8.CrossRefGoogle Scholar
  95. 95.
    Zhang W, Si LY. Obstructive sleep apnea syndrome (OSAS) and hypertension: pathogenic mechanisms and possible therapeutic approaches. Ups J Med Sci. 2012;117(4):370–82. Scholar
  96. 96.
    Fletcher EC, Bao G, Li R. Renin activity and blood pressure in response to chronic episodic hypoxia. Hypertension. 1999;34(2):309–14.CrossRefPubMedGoogle Scholar
  97. 97.
    Bostrom KB, Hedner J, Melander O, Grote L, Gullberg B, Rastam L, Groop L, Lindblad U. Interaction between the angiotensin-converting enzyme gene insertion/deletion polymorphism and obstructive sleep apnoea as a mechanism for hypertension. J Hypertens. 2007;25(4):779–83. Scholar
  98. 98.
    Wang HL, Wang Y, Zhang Y, Chen YD, Wang XC, Liu ZX, Jing GL, Tong HF, Tian Y, Liu QZ. Changes in plasma angiotensin II and circadian rhythm of blood pressure in hypertensive patients with sleep apnea syndrome before and after treatment. Chin Med Sci J. 2011;26(1):9–13.CrossRefPubMedGoogle Scholar
  99. 99.
    Millman RP, Redline S, Carlisle CC, Assaf AR, Levinson PD. Daytime hypertension in obstructive sleep apnea. Prevalence and contributing risk factors. Chest. 1991;99(4):861–6.CrossRefPubMedGoogle Scholar
  100. 100.
    Kraiczi H, Hedner J, Peker Y, Carlson J. Increased vasoconstrictor sensitivity in obstructive sleep apnea. J Appl Physiol (1985). 2000;89(2):493–8.CrossRefGoogle Scholar
  101. 101.
    Ljunggren M, Lindahl B, Theorell-Haglow J, Lindberg E. Association between obstructive sleep apnea and elevated levels of type B natriuretic peptide in a community-based sample of women. Sleep. 2012;35(11):1521–7. Scholar
  102. 102.
    Krieger J, Follenius M, Sforza E, Brandenberger G, Peter JD. Effects of treatment with nasal continuous positive airway pressure on atrial natriuretic peptide and arginine vasopressin release during sleep in patients with obstructive sleep apnoea. Clin Sci (Lond). 1991;80(5):443–9.CrossRefGoogle Scholar
  103. 103.
    Krieger J, Schmidt M, Sforza E, Lehr L, Imbs JL, Coumaros G, Kurtz D. Urinary excretion of guanosine 3′:5′-cyclic monophosphate during sleep in obstructive sleep apnoea patients with and without nasal continuous positive airway pressure treatment. Clin Sci (Lond). 1989;76(1):31–7.CrossRefGoogle Scholar
  104. 104.
    Krieger J, Laks L, Wilcox I, Grunstein RR, Costas LJ, McDougall JG, Sullivan CE. Atrial natriuretic peptide release during sleep in patients with obstructive sleep apnoea before and during treatment with nasal continuous positive airway pressure. Clin Sci (Lond). 1989;77(4):407–11.CrossRefGoogle Scholar
  105. 105.
    Beecroft J, Duffin J, Pierratos A, Chan CT, McFarlane P, Hanly PJ. Enhanced chemo-responsiveness in patients with sleep apnoea and end-stage renal disease. Eur Respir J. 2006;28(1):151–8. Scholar
  106. 106.
    Kara T, Narkiewicz K, Somers VK. Chemoreflexes–physiology and clinical implications. Acta Physiol Scand. 2003;177(3):377–84. Scholar
  107. 107.
    Eckert DJ, Jordan AS, Merchia P, Malhotra A. Central sleep apnea: pathophysiology and treatment. Chest. 2007;131(2):595–607. Scholar
  108. 108.
    Burgess KR, Burgess EE, Whitelaw WA. Impaired ventilatory response to carbon dioxide in patients with chronic renal failure: implications for the intensive care unit. Crit Care Med. 1994;22(3):413–9.CrossRefPubMedGoogle Scholar
  109. 109.
    Pierratos A, Hanly PJ. Sleep disorders over the full range of chronic kidney disease. Blood Purif. 2011;31(1–3):146–50. Scholar
  110. 110.
    Perl J, Unruh ML, Chan CT. Sleep disorders in end-stage renal disease: ‘markers of inadequate dialysis’? Kidney Int. 2006;70(10):1687–93. Scholar
  111. 111.
    Tang SC, Lam B, Lai AS, Pang CB, Tso WK, Khong PL, Ip MS, Lai KN. Improvement in sleep apnea during nocturnal peritoneal dialysis is associated with reduced airway congestion and better uremic clearance. Clin J Am Soc Nephrol. 2009;4(2):410–8. Scholar
  112. 112.
    Jensen D, Wolfe LA, O’Donnell DE, Davies GA. Chemoreflex control of breathing during wakefulness in healthy men and women. J Appl Physiol (1985). 2005;98(3):822–8. Scholar
  113. 113.
    Isono S, Remmers JE, Tanaka A, Sho Y, Sato J, Nishino T. Anatomy of pharynx in patients with obstructive sleep apnea and in normal subjects. J Appl Physiol (1985). 1997;82(4):1319–26.CrossRefGoogle Scholar
  114. 114.
    Beecroft JM, Hoffstein V, Pierratos A, Chan CT, McFarlane PA, Hanly PJ. Pharyngeal narrowing in end-stage renal disease: implications for obstructive sleep apnoea. Eur Respir J. 2007;30(5):965–71. Scholar
  115. 115.
    Beecroft JM, Hoffstein V, Pierratos A, Chan CT, McFarlane P, Hanly PJ. Nocturnal haemodialysis increases pharyngeal size in patients with sleep apnoea and end-stage renal disease. Nephrol Dial Transplant. 2008;23(2):673–9. Scholar
  116. 116.
    Mavanur M, Sanders M, Unruh M. Sleep disordered breathing in patients with chronic kidney disease. Indian J Med Res. 2010;131:277–84.PubMedGoogle Scholar
  117. 117.
    Chiu KL, Ryan CM, Shiota S, Ruttanaumpawan P, Arzt M, Haight JS, Chan CT, Floras JS, Bradley TD. Fluid shift by lower body positive pressure increases pharyngeal resistance in healthy subjects. Am J Respir Crit Care Med. 2006;174(12):1378–83. Scholar
  118. 118.
    Arzt M, Luigart R, Schum C, Luthje L, Stein A, Koper I, Hecker C, Dumitrascu R, Schulz R,, Sleep M. Circulation, Sleep” working group of the German Society of Sleep R. Sleep-disordered breathing in deep vein thrombosis and acute pulmonary embolism. Eur Respir J. 2012;40(4):919–24. Scholar
  119. 119.
    Arnulf I, Merino-Andreu M, Perrier A, Birolleau S, Similowski T, Derenne JP. Obstructive sleep apnea and venous thromboembolism. JAMA. 2002;287(20):2655–6.CrossRefPubMedGoogle Scholar
  120. 120.
    Epstein MD, Segal LN, Ibrahim SM, Friedman N, Bustami R. Snoring and the risk of obstructive sleep apnea in patients with pulmonary embolism. Sleep. 2010;33(8):1069–74.CrossRefPubMedPubMedCentralGoogle Scholar
  121. 121.
    Bosanquet JP, Bade BC, Zia MF, Karo A, Hassan O, Hess BT, Dabbagh O. Patients with venous thromboembolism appear to have higher prevalence of obstructive sleep apnea than the general population. Clin Appl Thromb Hemost. 2011;17(6):E119-124. Scholar
  122. 122.
    Ambrosetti M, Lucioni A, Ageno W, Conti S, Neri M. Is venous thromboembolism more frequent in patients with obstructive sleep apnea syndrome? J Thromb Haemost. 2004;2(10):1858–60. Scholar
  123. 123.
    Hasegawa R, Shiomi T, Sasanabe R, Otake K, Banno K, Oki Y, Maekawa M, Kobayashi T, Ito A, Taniguchi A, Ozeki K. Sleep apnea syndrome in patients with pulmonary thromboembolism. Psychiatry Clin Neurosci. 2000;54(3):342–3. Scholar
  124. 124.
    Ghiasi F, Ahmadpoor A, Amra B. Relationship between obstructive sleep apnea and 30-day mortality among patients with pulmonary embolism. J Res Med Sci. 2015;20(7):662–7. Scholar
  125. 125.
    Kaneko Y, Floras JS, Usui K, Plante J, Tkacova R, Kubo T, Ando S, Bradley TD. Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea. N Engl J Med. 2003;348(13):1233–41. Scholar
  126. 126.
    Kita H, Ohi M, Chin K, Noguchi T, Otsuka N, Tsuboi T, Itoh H, Nakao K, Kuno K. The nocturnal secretion of cardiac natriuretic peptides during obstructive sleep apnoea and its response to therapy with nasal continuous positive airway pressure. J Sleep Res. 1998;7(3):199–207.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Sleep Research 2018

Authors and Affiliations

  1. 1.Department of PediatricsThe Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical UniversityWenzhouPeople’s Republic of China
  2. 2.The Second School Of MedicineWenzhou Medical UniversityWenzhouPeople’s Republic of China

Personalised recommendations