Reversibility of microalbuminuria with continuous positive airway pressure treatment in obstructive sleep apnea syndrome
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NEPHROLOGY - ORIGINAL PAPER
Reversibility of microalbuminuria with continuous positive airway pressure treatment in obstructive sleep apnea syndrome Ergün Parmaksız1 · Elif Torun Parmaksız2 Received: 21 January 2020 / Accepted: 25 May 2020 © Springer Nature B.V. 2020
Abstract Introduction Microalbuminuria is an early marker of kidney damage and an early predictor and risk factor for cardiovascular diseases. We aimed to evaluate the association between albuminuria levels in different severity obstructive sleep apnea syndrome (OSAS) cases and to find out the efficacy of CPAP treatment on microalbuminuria. Materials and methods We conducted a prospective study on subjects who underwent polysomnography. The polysomnographic data were recorded to establish the presence and severity of OSAS. The blood and urine samples were taken both at the time of diagnosis and 3 months after CPAP therapy. The relationship between the severity of OSAS and microalbuminuria and the effect of CPAP treatment on microalbuminuria were evaluated. Results The study population consisted of 449 subjects. Better compliance to CPAP was associated with significantly reduced levels of microlbuminuria. Urinary albumin/creatinine was increased in severe cases, but the difference was not statistically significant. In the non-compliant group, microalbumin/creatinine ratio was 25.24 prior to initiation of CPAP treatment and 28.36 at the third month control visit (p = 0.25). In the compliant group, microalbumin/creatinine ratio was 49.71 prior to initiation of CPAP treatment and 22.30 at the third month control visit (p = 0.04). Conclusion Our study demonstrated that good compliance to CPAP therapy is associated with a decrease in microalbuminuria. Patients who used CPAP regularly had a significant decline in albumin/creatinine ratio after 3 months of CPAP therapy. Keywords Albuminuria · Sleep apnoea · Microalbuminuria
Background and aim Obstructive sleep apnea syndrome (OSAS) is a highly prevalant disease characterized by repetitive upper airway collapse during sleep. This temporary partial or complete upper airway obstruction and reopening causes intermittent hypoxemia and hypercapnia. The repetitive episodes of hypoxemia, arousals and intrathoracic pressure changes in OSAS lead to sympathetic activation, endothelial dysfunction, oxidative stress and inflammation [1]. Episodic hypoxia is the main feature of OSAS, enhancing renal sympathetic nervous system and angiotensin 2 activity [2]. Nocturnal hypoxia was found * Ergün Parmaksız [email protected] 1
Nephrology Clinic, Istanbul Kartal Dr. Lütfi Kirdar Training and Research Hospital, Kartal, Istanbul, Turkey
Department of Chest Diseases, Istanbul Kartal Dr. Lütfi Kirdar Training and Research Hospital, Istanbul, Turkey
2
to be associated with increased urinary albumin excretion. Increased renin angiotensin aldosterone and renal sympathetic nervous system activity have been shown to induce proliferative structural renal damage [3]. It has been shown that the hypoxic state increase
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