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Chronic kidney disease and concomitant sleep apnea are associated with increased overall mortality: a meta-analysis

  • Nephrology - Original Paper
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Abstract

Purpose

Sleep apnea (SA) is common in advanced chronic kidney disease (CKD) patients. However, the association between CKD with concomitant SA and overall mortality remains inconclusive.

Methods

Ovid MEDLINE, EMBASE, and the Cochrane Library were searched for eligible publications, including non-transplant CKD patients aged > 18 years with co-existing SA. CKD is defined by estimated glomerular filtration rate of < 60 mL/min/1.73 m2.

Results

Seven observational studies (n = 186,686) were included in the meta-analyses. 94.2% had end-stage kidney disease (ESKD) requiring hemodialysis (HD), 5.0% had ESKD requiring peritoneal dialysis (PD), and 0.8% had non-dialysis CKD. The mean age was 76.8 ± 2.2 years. Most patients were male (53.4%) and white (76.8%). Up to 39.3% had diabetes. The mean body mass index was 26.0 ± 0.6 kg/m2. Among patients with advanced CKD and SA, the pooled estimated odds ratios (OR) for overall mortality and cardiovascular events were 2.092 (95% CI, 1.594–2.744) and 1.020 (95% CI, 0.929–1.119), respectively, compared to patients with CKD alone. The OR was 2.145 (95% CI, 1.563–2.944) when studies with polysomnography-diagnosed SA were examined independently. No potential publication bias was detected. There were no significant differences in odds ratios for overall mortality, based on subgroup analyses.

Conclusion

Co-existence between advanced CKD and SA is associated with increased overall mortality, but not cardiovascular (CV) events when compared with CKD alone. The analysis of CV events requires additional studies to confirm our findings. Moreover, clinical interventions aiming to prevent the progression of SA and CKD are encouraged.

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References

  1. Parajuli S, Tiwari R, Clark DF, Mandelbrot DA, Djamali A, Casey K (2019) Sleep disorders: serious threats among kidney transplant recipients. Transplant Rev (Orlando) 33(1):9–16. https://doi.org/10.1016/j.trre.2018.09.002

    Article  Google Scholar 

  2. Santos RSS, Motwani SS, Elias RM (2016) Chronic kidney disease and sleeping disordered breathing (SDB). Curr Hypertens Rev 12(1):43–47. https://doi.org/10.2174/1573402112666160114094222

    Article  PubMed  PubMed Central  Google Scholar 

  3. Coniglio AC, Mentz RJ (2020) Sleep breathing disorders in heart failure. Heart Fail Clin 16(1):45–51. https://doi.org/10.1016/j.hfc.2019.08.009

    Article  PubMed  Google Scholar 

  4. United States Renal Data System (USRDS) (2017) Chapter 3: Morbidity and mortality in patients with CKD. Am J Kidney Dis 69(3):S67-S92. https://doi.org/10.1053/j.ajkd.2017.01.012

  5. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097

    Article  PubMed  PubMed Central  Google Scholar 

  6. Sterne JA, Hernan MA, Reeves BC, Savovic J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan AW, Churchill R, Deeks JJ, Hrobjartsson A, Kirkham J, Juni P, Loke YK, Pigott TD, Ramsay CR, Regidor D, Rothstein HR, Sandhu L, Santaguida PL, Schunemann HJ, Shea B, Shrier I, Tugwell P, Turner L, Valentine JC, Waddington H, Waters E, Wells GA, Whiting PF, Higgins JP (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919. https://doi.org/10.1136/bmj.i4919

  7. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560. https://doi.org/10.1136/bmj.327.7414.557

    Article  PubMed  PubMed Central  Google Scholar 

  8. Inami T, Lyons OD, Perger E, Yadollahi A, Floras JS, Chan CT, Bradley TD (2020) Effect of ultrafiltration on sleep apnea and cardiac function in end-stage renal disease. Am J Nephrol 51(2):139–146. https://doi.org/10.1159/000505445

    Article  PubMed  Google Scholar 

  9. Xu J, Yoon IY, Chin HJ (2016) The effect of sleep apnea on all-cause mortality in nondialyzed chronic kidney disease patients. Sleep Med 27–28:32–38. https://doi.org/10.1016/j.sleep.2016.07.026

    Article  PubMed  Google Scholar 

  10. Tuohy CV, Montez-Rath ME, Turakhia M, Chang TI, Winkelman JW, Winkelmayer WC (2016) Sleep disordered breathing and cardiovascular risk in older patients initiating dialysis in the United States: a retrospective observational study using medicare data. BMC Nephrol. https://doi.org/10.1186/s12882-016-0229-3

    Article  PubMed  PubMed Central  Google Scholar 

  11. Gansevoort RT, Correa-Rotter R, Hemmelgarn BR, Jafar TH, Heerspink HJ, Mann JF, Matsushita K, Wen CP (2013) Chronic kidney disease and cardiovascular risk: epidemiology, mechanisms, and prevention. Lancet 382(9889):339–352. https://doi.org/10.1016/s0140-6736(13)60595-4

    Article  PubMed  Google Scholar 

  12. Ryan S, Taylor CT, McNicholas WT (2009) Systemic inflammation: a key factor in the pathogenesis of cardiovascular complications in obstructive sleep apnoea syndrome? Thorax 64(7):631–636. https://doi.org/10.1136/thx.2008.105577

    Article  CAS  PubMed  Google Scholar 

  13. Budhiraja R, Budhiraja P, Quan SF (2010) Sleep-disordered breathing and cardiovascular disorders. Respir Care 55(10):1322–1332 (discussion 1330–1322)

    PubMed  Google Scholar 

  14. Budhiraja R, Parthasarathy S, Quan SF (2007) Endothelial dysfunction in obstructive sleep apnea. J Clin Sleep Med 3(4):409–415

    Article  PubMed  PubMed Central  Google Scholar 

  15. Leon BM, Maddox TM (2015) Diabetes and cardiovascular disease: epidemiology, biological mechanisms, treatment recommendations and future research. World J Diabetes 6(13):1246–1258. https://doi.org/10.4239/wjd.v6.i13.1246

    Article  PubMed  PubMed Central  Google Scholar 

  16. Velagaleti RS, Vasan RS (2007) Heart failure in the twenty-first century: is it a coronary artery disease or hypertension problem? Cardiol Clin 25(4):487–495. https://doi.org/10.1016/j.ccl.2007.08.010

    Article  PubMed  PubMed Central  Google Scholar 

  17. Tang SCW, Lam B, Yao TJ, Leung WS, Chu CM, Ho YW, Ip MSM, Lai KN (2010) Sleep apnea is a novel risk predictor of cardiovascular morbidity and death in patients receiving peritoneal dialysis. Kidney Int 77(11):1031–1038. https://doi.org/10.1038/ki.2010.76

    Article  PubMed  Google Scholar 

  18. Masuda T, Murata M, Honma S, Iwazu Y, Sasaki N, Ogura M, Onishi A, Ando Y, Muto S, Shimada K, Kario K, Kusano E, Asano Y (2011) Sleep-disordered breathing predicts cardiovascular events and mortality in hemodialysis patients. Nephrol Dial Transplant 26(7):2289–2295. https://doi.org/10.1093/ndt/gfq756

  19. Sivalingam M, Chakravorty I, Mouatt S, Farrington K (2013) Obstructive sleep apnea in incremental hemodialysis: Determinants, consequences, and impact on survival. Hemodial Int 17(2):230–239. https://doi.org/10.1111/j.1542-4758.2012.00729.x

    Article  PubMed  Google Scholar 

  20. Kerns ES, Kim ED, Meoni LA, Sozio SM, Jaar BG, Estrella MM, Parekh RS, Bourjeily G (2018) Obstructive sleep apnea increases sudden cardiac death in incident hemodialysis patients. Am J Nephrol 48(2):147–156. https://doi.org/10.1159/000489963

    Article  PubMed  Google Scholar 

  21. Jhamb M, Ran X, Abdalla H, Roumelioti ME, Hou S, Davis H, Patel SR, Yabes J, Unruh M (2020) Association of sleep apnea with mortality in patients with advanced kidney disease. Clin J Am Soc Nephrol 15(2):182–190. https://doi.org/10.2215/CJN.07880719

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgement

There is no institutional or national funding for this research.

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Author notes

  1. Max M. Puthenpura and Panupong Hansrivijit equivalent contribution.

Authors and Affiliations

  1. Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, 19129, USA

    Max M. Puthenpura

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

    Panupong Hansrivijit

  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

Authors
  1. Max M. Puthenpura
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  4. Charat Thongprayoon
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  5. Wisit Cheungpasitporn
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Contributions

PH and WC performed literature search. MP and PH screened all citations and extracted the data. PH analyzed the data. MP and PH drafted the manuscript. CT, NG and WC revised and edited the manuscript for submission.

Corresponding author

Correspondence to Panupong Hansrivijit.

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The authors declared no potential conflicts of interest.

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This study does not involve human participants and/or animals. Thus, ethical approval is not required.

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Puthenpura, M.M., Hansrivijit, P., Ghahramani, N. et al. Chronic kidney disease and concomitant sleep apnea are associated with increased overall mortality: a meta-analysis. Int Urol Nephrol 52, 2337–2343 (2020). https://doi.org/10.1007/s11255-020-02583-y

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  • DOI: https://doi.org/10.1007/s11255-020-02583-y

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