Chronic kidney disease and concomitant sleep apnea are associated with increased overall mortality: a meta-analysis
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NEPHROLOGY - ORIGINAL PAPER
Chronic kidney disease and concomitant sleep apnea are associated with increased overall mortality: a meta‑analysis Max M. Puthenpura1 · Panupong Hansrivijit2 · Nasrollah Ghahramani3 · Charat Thongprayoon4 · Wisit Cheungpasitporn5 Received: 4 May 2020 / Accepted: 25 July 2020 © Springer Nature B.V. 2020
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 years), male proportion (≤ 60% vs. > 60%), BMI (≤ 25 vs. > 25 kg/m2) and SA definition (polysomnography-diagnosed vs. other criteria). Publication bias was analyzed by Egger’s regression intercept.
Statistical analysis The Comprehensive Meta-Analysis software version 3.3.070 (Biostat Inc, Englewood, NJ, USA) was used to perform meta-analyses. Statistical heterogeneity of studies was assessed using I2 statistic (≤ 25%, insignificant heterogeneity; 26–50%, low heterogeneity; 51–75%, moderate heterogeneity; and ≥ 75%, high heterogeneity) and Cochran’s Q test [7]. It is noteworthy that I2 is derived from fixed-effects model of analysis. Thus, we analyzed our data using random-effects model or mixed-effects to minimize betweenstudy variance and heterogeneity. Descriptive data were reported in mean ± standard deviation (SD) or percentage. p value less than 0.05 is considered statistically significant.
Results Study characteristics Figure 1 illustrates the PRISMA flowchart of literature search and reference management from all databases. A
International Urology and Nephrology Fig. 1 The PRISMA flowchart of systematic literature search and reference management from all databases
total of eight cohorts from seven studies were identified consisting of 186,686 CKD subjects (94.2% HD, 5.0% PD, 0.8% non-dialysis CKD). The studies dated from 2010 to 2020. All included studies were prospective observational in design. The definition of SA was based on either apnea–hypopnea index criteria [8] or the International Classification of Diseases (ICD)-9 coding system. The mean age of included patients was 76.8 ± 2.2 years. Most patients were male (53.4%) and white (76.8%). Up to 39.3% had diabetes as one of co-morbidities. The mean BMI was 26.0 ± 0.6 kg/ m2. All seven studies (eight cohorts) reported the adjusted OR for overall mortality, while only three studies reported the adjusted OR for cardiovascular events. Table 1 depicts the characteristics of included studies.
when we compared the pooled OR from polysomnographydiagnosed SA vs. other SA criteria (Q = 0.276, p = 0.599).
Odds ratio for overall mortality
Subgroup analyses were performed based on the study year (≤ 2015 vs. > 2015), country (USA vs. others), stages of CKD (non-dialysis vs. dialysis), sample size (≤ 500
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