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Obstructive sleep apnea and diabetic nephropathy: a cohort study
Abd A Tahrani1, Asad Ali, Neil T Raymond
1Corresponding author: Abd A. Tahrani, a.a.tahrani@bham.ac.uk.
Diabetes Care
|September 25, 2013
Summary
Obstructive sleep apnea (OSA) is linked to diabetic nephropathy (DN) in type 2 diabetes patients, with faster kidney function decline observed in those with OSA. Nitrosative stress may play a role in this association.
Area of Science:
- Nephrology
- Endocrinology
- Sleep Medicine
- Cardiovascular Research
Background:
- Diabetic nephropathy (DN) is a primary cause of end-stage renal disease (ESRD).
- Obstructive sleep apnea (OSA) is prevalent in type 2 diabetes and elevates oxidative stress.
- OSA's potential role in promoting DN development and progression warrants investigation.
Purpose of the Study:
- To investigate the association between obstructive sleep apnea (OSA) and diabetic nephropathy (DN) in adults with type 2 diabetes.
- To assess the impact of OSA on the progression of DN, measured by estimated glomerular filtration rate (eGFR) decline.
- To explore the role of nitrosative stress in the relationship between OSA and DN.
Main Methods:
- A cohort study involving 224 adults with type 2 diabetes, excluding those with known OSA or ESRD.
- DN defined by albuminuria or eGFR <60 mL/min/1.73 m2; progression assessed via eGFR.
- OSA defined by apnea-hypopnea index (AHI) ≥5 events/h; serum nitrotyrosine measured as a marker of nitrosative stress.
Main Results:
- OSA prevalence was 64.3% and DN prevalence was 40.2%.
- DN prevalence was significantly higher in patients with OSA (49.3%) versus without OSA (23.8%) (P < 0.001).
- Adjusted analysis revealed OSA (OR 2.64) independently associated with DN. eGFR decline was greater in OSA+ patients (-6.8%) vs. OSA- (-1.6%) (P = 0.002). Baseline OSA, AHI, and nitrotyrosine levels independently predicted lower study-end eGFR.
Conclusions:
- Obstructive sleep apnea is independently associated with diabetic nephropathy in type 2 diabetes.
- Patients with OSA experience a faster decline in kidney function (eGFR).
- Nitrosative stress may mediate the link between OSA and DN, suggesting a need for interventional studies on OSA treatment's impact on DN.
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