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Obstructive sleep apnea and the kidney

E C Fletcher

    Journal of the American Society of Nephrology : JASN
    |November 1, 1993
    PubMed
    Summary
    This summary is machine-generated.

    Obstructive sleep apnea is linked to kidney disease and hypertension. Treating sleep apnea can improve blood pressure and kidney function, but it

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    Area of Science:

    • Nephrology
    • Pulmonology
    • Cardiology

    Background:

    • Obstructive sleep apnea (OSA) is increasingly recognized for its association with systemic diseases, particularly renal disease and hypertension.
    • Polysomnographic studies reveal a high prevalence of significant sleep apnea (up to 73%) in dialysis patients experiencing daytime fatigue.
    • Potential mechanisms for OSA in renal disease include abnormalities in respiratory control due to chronic hypocarbia, metabolic acidosis, and uremic toxins.

    Discussion:

    • Proteinuria and nephrotic syndrome are observed in obese patients with OSA, with renal biopsies showing glomerulomegaly and focal segmental sclerosis, possibly due to increased glomerular filtration.
    • Elevated urine output, sodium, chloride excretion, and atrial natriuretic peptide in OSA patients normalize with apnea treatment.
    • Both acute and chronic daytime hypertension are common in OSA patients, with occult sleep apnea implicated as a cause of primary hypertension in middle-aged men.

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    Key Insights:

    • Sleep apnea is a significant factor in renal disease and hypertension.
    • Treatment of sleep apnea can lead to improvements in blood pressure and renal parameters.
    • The relationship between OSA and hypertension is complex and may be age-dependent.

    Outlook:

    • While OSA treatment can reverse hypertension in younger individuals, cure is not guaranteed in older patients.
    • Asymptomatic OSA patients may struggle with continuous positive airway pressure (CPAP) therapy adherence.
    • Routine polysomnography for primary hypertension screening is not recommended due to potential treatment intolerance and variable outcomes.