Obstructive Sleep Apnea and Chronic Kidney Disease

  • Josef YayanEmail author
  • Kurt Rasche
  • Angeliki Vlachou
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1022)


Chronic kidney disease (CKD) often accompanies obstructive sleep apnea (OSA). A causative connection of the two disease entities is uncertain. However, eliminating OSA improves the prognosis of CKD patients. In the present study we examined a possible relationship between OSA and CKD, and whether there would be a mutual enhancing interaction in the severity of the two diseases. The study was of a retrospective nature and encompassed 382 patients over the period of 1 January 2014–30 June 2015. The OSA diagnosis was supported by a polysomnographic examination in 363 (95.0%) patients. Blood samples were taken for the determination of kidney function indices. The influence on OSA and CKD of comorbidities also was examined. We found a high probability of a simultaneous occurrence of OSA and CKD; with the odds ratio of 3.94 (95% CI 1.5–10.3%; p = 0.005). The 363 patients with OSA were stratified into 73 (20.1%) mild, 98 (27.0%) moderate, and 192 (52.9%) severe OSA cases according to the apnea-hypopnea index. CKD was found in 43 (58.9%) patients with mild OSA, 73 (74.5%) with moderate OSA, and 137 (71.4%) with severe OSA. Most OSA patients also suffered from hypertension and obesity. For comparison, CKD was detected in 7 (36.8%) out of the 19 patients without OSA (p < 0.003). We conclude that CKD develops significantly more often in patients with OSA than in those without it, and CKD frequency increases with the severity of OSA.


Apnea-hypopnea index Chronic kidney insufficiency Comorbidities Obstructive sleep apnea Renal function 


Conflicts of Interest

The authors declare no competing interests in relation to this article.


  1. Archontogeorgis K, Nena E, Tsigalou C, Voulgaris A, Xanthoudaki M, Froudarakis M, Steiropoulos P (2016) Cystatin C levels in middle-aged patients with obstructive sleep apnea syndrome. Pulm Med 2016:8081723CrossRefPubMedPubMedCentralGoogle Scholar
  2. Arens R, Marcus CL (2004) Pathophysiology of upper airway obstruction: a developmental perspective. Sleep 27:997–1019CrossRefPubMedGoogle Scholar
  3. Baguet JP, Barone-Rochette G, Pépin JL (2009) Hypertension and obstructive sleep apnoea syndrome: current perspectives. J Hum Hypertens 23:431–443CrossRefPubMedGoogle Scholar
  4. Bayram NA, Ciftçi B, Güven SF, Bayram H, Diker E (2007) Relationship between the severity of obstructive sleep apnea and hypertension. Anadolu Kardiyol Derg 7:378–382. (Article in Turkish)PubMedGoogle Scholar
  5. Chang CP, Li TC, Hang LW, Lin JJ, Chou CY, Tsai JJ, Ko PY, Chang CT (2016) The relationships of sleep apnea, hypertension, and resistant hypertension on chronic kidney disease. Medicine (Baltimore) 95:e3859. doi: 10.1097/MD.0000000000003859 CrossRefGoogle Scholar
  6. Chokorverty S (2010) Overview of sleep and sleep disorders. Indian J Med Res 131:126–140Google Scholar
  7. Chou YT, Lee PH, Yang CT, Lin CL, Veasey S, Chuang LP, Lin SW, Lin YS, Chen NH (2011) Obstructive sleep apnea: a stand-alone risk factor for chronic kidney disease. Nephrol Dial Transplant 26:2244–2250CrossRefPubMedGoogle Scholar
  8. Chu H, Shih CJ, Ou SM, Chou KT, Lo YH, Chen YT (2016) Association of sleep apnoea with chronic kidney disease in a large cohort from Taiwan. Respirology 21:754–760CrossRefPubMedGoogle Scholar
  9. Escourrou P, Grote L, Penzel T, Mcnicholas WT, Verbraecken J, Tkacova R, Riha RL, Hedner J, ESADA Study Group (2015) The diagnostic method has a strong influence on classification of obstructive sleep apnea. J Sleep Res 24:730–738CrossRefPubMedGoogle Scholar
  10. Ezzat H, Mohab A (2015) Prevalence of sleep disorders among ESRD patients. Ren Fail 37:1013–1019CrossRefPubMedGoogle Scholar
  11. Fleischmann G, Fillafer G, Matterer H, Skrabal F, Kotanko P (2010) Prevalence of chronic kidney disease in patients with suspected sleep apnoea. Nephrol Dial Transplant 25:181–186CrossRefPubMedGoogle Scholar
  12. Galbraith LE, Ronksley PE, Barnieh LJ, Kappel J, Manns BJ, Samuel SM, Jun M, Weaver R, Valk N, Hemmelgarn BR (2016) The see kidney disease targeted screening program for CKD. Clin J Am Soc Nephrol 11:964–972CrossRefPubMedPubMedCentralGoogle Scholar
  13. Ho V, Crainiceanu CM, Punjabi NM, Redline S, Gottlieb DJ (2015) Calibration model for apnea-hypopnea indices: impact of alternative criteria for hypopneas. Sleep 38:1887–1892CrossRefPubMedPubMedCentralGoogle Scholar
  14. Inker LA, Astor BC, Fox CH, Isakova T, Lash JP, Peralta CA, Kurella Tamura M, Feldman HI (2014) KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am J Kidney Dis 63:713–735CrossRefPubMedGoogle Scholar
  15. Iseki K, Tohyama K, Matsumoto T, Nakamura H (2008) High prevalence of chronic kidney disease among patients with sleep related breathing disorder (SRBD). Hypertens Res 31:249–255CrossRefPubMedGoogle Scholar
  16. Kalamas AG, Niemann CU (2013) Patients with chronic kidney disease. Med Clin North Am 97:1109–1122CrossRefPubMedGoogle Scholar
  17. Kanbay A, Buyukoglan H, Ozdogan N, Kaya E, Oymak FS, Gulmez I, Demir R, Kokturk O, Covic A (2012) Obstructive sleep apnea syndrome is related to the progression of chronic kidney disease. Int Urol Nephrol 44:535–539CrossRefPubMedGoogle Scholar
  18. KDIGO (2013) Kidney Disease: Improving Global Outcomes. CKD Work Group: Clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 3:1–150CrossRefGoogle Scholar
  19. Knorst MM, Souza FJ, Martinez D (2008) Obstructive sleep apnea-hypopnea syndrome: association with gender, obesity, and sleepiness-related factors. J Bras Pneumol 34:490–496. (Article in Portuguese)CrossRefPubMedGoogle Scholar
  20. Lee YC, Hung SY, Wang HK et al (2015) Sleep apnea and the risk of chronic kidney disease: a nationwide population-based cohort study. Sleep 38:213–221CrossRefPubMedPubMedCentralGoogle Scholar
  21. McClellan WM, Plantinga LC (2013) A public health perspective on CKD and obesity. Nephrol Dial Transplant 28(Suppl 4):iv37-42CrossRefPubMedGoogle Scholar
  22. Meng F, Ma J, Wang W, Lin B (2016) Obstructive sleep apnea syndrome is a risk factor of hypertension. Minerva Med 107:294–299PubMedGoogle Scholar
  23. National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:S1–266Google Scholar
  24. Pagel JF (2007) Obstructive sleep apnea (OSA) in primary care: evidence-based practice. J Am Board Fam Med 20:392–398CrossRefPubMedGoogle Scholar
  25. Sarnak MJ, Levey AS, Schoolwerth AC et al (2003) Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation 108:2154–2169CrossRefPubMedGoogle Scholar
  26. Sim JJ, Rasgon SA, Kujubu DA, Kumar VA, Liu IL, Shi JM, Pham TT, Derose SF (2009) Sleep apnea in early and advanced chronic kidney disease: Kaiser Permanente Southern California cohort. Chest 135:710–716CrossRefPubMedGoogle Scholar
  27. WHO (2016) International Classification of Diseases (ICD). Accessed on 22 Dec 2016

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Department of Internal Medicine, Division of Pulmonary, Allergy and Sleep Medicine, HELIOS Clinic WuppertalWitten/Herdecke UniversityWuppertalGermany

Personalised recommendations