Sleep Apnea and the Kidney
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SLEEP AND SLEEP APNEA AT THE EXTREMES (D GOZAL, SECTION EDITOR)
Sleep Apnea and the Kidney Oreste Marrone 1 & Maria Rosaria Bonsignore 1,2
# The Author(s) 2020
Abstract Purpose of Review There are some uncertainties about the interactions between obstructive sleep apnea (OSA) and chronic kidney disease (CKD). We critically reviewed recent studies on this topic with a focus on experimental and clinical evidence of bidirectional influences between OSA and CKD, as well as the effects of treatment of either disease. Recent Findings Experimental intermittent hypoxia endangers the kidneys, possibly through activation of inflammatory pathways and increased blood pressure. In humans, severe OSA can independently decrease kidney function. Treatment of OSA by CPAP tends to blunt kidney function decline over time, although its effect may vary. OSA may increase cardiovascular complications and mortality in patients with end-stage renal disease (ESRD), while it seems of little harm after renal transplantation. Excessive fluid removal may explain some of the improvements in OSA severity in ESRD and after transplantation. Summary Severe OSA and CKD do interact negatively, mainly through hypoxia and fluid retention. The moderate mutually interactive benefits that treatment of each disease exerts on the other one warrant further studies to improve patient management. Keywords Sleep-disordered breathing . Renal function . Hemodialysis . Kidney transplantation . CPAP
Introduction Both obstructive sleep apnea (OSA) and chronic kidney disease (CKD) are common in the general population [1, 2]. An interrelationship between the two diseases is increasingly recognized, but interdisciplinary approaches to their treatment are highly variable, since both are usually managed by different medical specialists. Despite the fact that the evidence gathered from clinical and epidemiological observations conducted so far still leave some room to uncertainty about independent interrelations between OSA and CKD, there is a large body of biological data that support the plausibility of these interactions. This article is part of the Topical Collection on Sleep and Sleep Apnea at the Extremes * Maria Rosaria Bonsignore [email protected] 1
Istituto per la Ricerca e l’Innovazione Biomedica, National Research Council (CNR) of Italy, Palermo, Italy
2
Respiratory Sleep Clinic, Dipartimento di Promozione Della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy
On the one hand, OSA is associated with intermittent hypoxemia, increased blood pressure and sympathetic activity, obesity, and metabolic alterations [3], all of which may endanger renal integrity and lead to increased albumin excretion and accelerated decline in glomerular filtration rate (GFR) over time. These mechanisms could lead to an increased incidence of CKD and to a more rapid trajectory towards endstage renal disease (ESRD) in OSA patients. On the other h
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