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Effect of positive airway pressure on glomerular filtration rate in patients with sleep-disordered breathing: a meta-analysis

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Objective

Sleep-disordered breathing (SDB) has been suggested to be associated with chronic kidney disease (CKD). Positive airway pressure (PAP) is an effective treatment for SDB, but the impact of PAP therapy on glomerular filtration rate (GFR) in patients with SDB remains unclear. The present meta-analysis was performed to determine whether PAP therapy could increase GFR.

Design

A systematic search of PubMed, Embase, Web of Science, and Cochrane library was performed for literature published up to January 2016. Standardized mean difference (SMD) was calculated to estimate the treatment effects of pre- and post-PAP therapy.

Results

A total of eight studies with 240 patients were pooled into a meta-analysis. The meta-analysis showed that there was no change of GFR before and after PAP treatment in SDB patients (SMD = 0.010, 95 % confidence interval (CI) = −0.331 to 0.350, z = 0.06, p = 0.956), Subgroup analyses indicated that GFR was significantly increased after PAP treatment in elder patients (≥55 years) (SMD = −0.283, 95 % CI = −0.518 to −0.047, z = 2.35, p = 0.019) and patients with therapeutic duration ≥ 3 months (SMD = −0.276, 95 % CI = −0.522 to −0.031, z = 2.20, p = 0.027).

Conclusion

The present meta-analysis suggested that PAP treatment had no impact on GFR in SDB patients. However, longer PAP usage for SDB patients significantly improved GFR. In elder SDB subjects, PAP was also associated with a statistically significant increase in GFR.

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References

  1. Markou N, Kanakaki M, Myrianthefs P, Hadjiyanakos D, Vlassopoulos D, Damianos A, Siamopoulos K, Vasiliou M, Konstantopoulos S (2006) Sleep-disordered breathing in nondialyzed patients with chronic renal failure. Lung 184:43–49

    Article  PubMed  Google Scholar 

  2. Canales MT, Lui LY, Taylor BC, Ishani A, Mehra R, Stone KL, Redline S, Ensrud KE (2008) Renal function and sleep-disordered breathing in older men. Nephrol Dial Transplant: Off Publ Eur Dial Transplant Assoc Eur Ren Assoc 23:3908–3914

    Article  Google Scholar 

  3. Nicholl DD, Ahmed SB, Loewen AH, Hemmelgarn BR, Sola DY, Beecroft JM, Turin TC, Hanly PJ (2012) Declining kidney function increases the prevalence of sleep apnea and nocturnal hypoxia. Chest 141:1422–1430

    Article  PubMed  Google Scholar 

  4. Chou YT, Lee PH, Yang CT, Lin CL, Veasey S, Chuang LP, Lin SW, Lin YS, Chen NH (2011) Obstructive sleep apnea: a stand-alone risk factor for chronic kidney disease. Nephrol Dial Transplant: Off Publ Eur Dial Transplant Assoc Eur Ren Assoc 26:2244–2250

    Article  Google Scholar 

  5. Stevens LA, Coresh J, Greene T, Levey AS (2006) Assessing kidney function—measured and estimated glomerular filtration rate. N Engl J Med 354:2473–2483

    Article  CAS  PubMed  Google Scholar 

  6. Koga S, Ikeda S, Yasunaga T, Nakata T, Maemura K (2013) Effects of nasal continuous positive airway pressure on the glomerular filtration rate in patients with obstructive sleep apnea syndrome. Intern Med 52:345–349

    Article  PubMed  Google Scholar 

  7. Yoshihisa A, Suzuki S, Owada T, Iwaya S, Yamauchi H, Miyata M, Yamaki T, Sugimoto K, Kunii H, Nakazato K, Suzuki H, Saitoh S, Takeishi Y (2013) Short-term use of adaptive servo ventilation improves renal function in heart failure patients with sleep-disordered breathing. Heart Vessel 28:728–734

    Article  Google Scholar 

  8. Koyama T, Watanabe H, Terada S, Makabe S, Igarashi G, Nobori K, Ito H (2011) Adaptive servo-ventilation improves renal function in patients with heart failure. Respir Med 105:1946–1953

    Article  PubMed  Google Scholar 

  9. Zhang L, Huang X, Li X, Wu Q (1997) Alterations in renal function in patients with obstructive sleep apnea syndrome and effects of continuous positive airway pressure. Chin Med J 110:915–918

    CAS  PubMed  Google Scholar 

  10. Nicholl DD, Hanly PJ, Poulin MJ, Handley GB, Hemmelgarn BR, Sola DY, Ahmed SB (2014) Evaluation of continuous positive airway pressure therapy on renin-angiotensin system activity in obstructive sleep apnea. Am J Respir Crit Care Med 190:572–580

    Article  CAS  PubMed  Google Scholar 

  11. Puckrin R, Iqbal S, Zidulka A, Vasilevsky M, Barre P (2015) Renoprotective effects of continuous positive airway pressure in chronic kidney disease patients with sleep apnea. Int Urol Nephrol 47:1839–1845

    Article  CAS  PubMed  Google Scholar 

  12. Yasar ZA, Ucar ZZ, Demir AU, Kirakli C, Kalenci D, Tibet G (2014) Does CPAP therapy alter urinary albumin level in adult patients with moderate to severe obstructive sleep apnea syndrome? Sleep Breath Schlaf Atmung 18:525–532

    Article  PubMed  Google Scholar 

  13. Krieger J, Imbs JL, Schmidt M, Kurtz D (1988) Renal function in patients with obstructive sleep apnea effects of nasal continuous positive airway pressure. Arch Intern Med 148:1337–1340

    Article  CAS  PubMed  Google Scholar 

  14. Krieger J, Schmidt M, Sforza E, Lehr L, Imbs JL, Coumaros G, Kurtz D (1989) Urinary excretion of guanosine 3′:5′-cyclic monophosphate during sleep in obstructive sleep apnoea patients with and without nasal continuous positive airway pressure treatment. Clin Sci (Lond) 76:31–37

    Article  CAS  Google Scholar 

  15. Owada T, Yoshihisa A, Yamauchi H, Iwaya S, Suzuki S, Yamaki T, Sugimoto K, Kunii H, Nakazato K, Suzuki H, Saitoh S, Takeishi Y (2013) Adaptive servoventilation improves cardiorenal function and prognosis in heart failure patients with chronic kidney disease and sleep-disordered breathing. J Card Fail 19:225–232

    Article  PubMed  Google Scholar 

  16. Kinebuchi S, Kazama JJ, Satoh M, Sakai K, Nakayama H, Yoshizawa H, Narita I, Suzuki E, Gejyo F (2004) Short-term use of continuous positive airway pressure ameliorates glomerular hyperfiltration in patients with obstructive sleep apnoea syndrome. Clin Sci (Lond) 107:317–322

    Article  Google Scholar 

  17. Zhang XB, Jiang XT, Lin QC, Chen X, Zeng HQ (2014) Effect of continuous positive airway pressure on serum cystatin C among obstructive sleep apnea syndrome patients. Int Urol Nephrol 46:1997–2002

    Article  CAS  PubMed  Google Scholar 

  18. Lee YC, Hung SY, Wang HK, Lin CW, Wang HH, Chen SW, Chang MY, Ho LC, Chen YT, Liou HH, Tsai TC, Tseng SH, Wang WM, Lin SH, Chiou YY (2015) Sleep apnea and the risk of chronic kidney disease: a nationwide population-based cohort study. Sleep 38:213–221

    PubMed  PubMed Central  Google Scholar 

  19. Sim JJ, Rasgon SA, Kujubu DA, Kumar VA, Liu IL, Shi JM, Pham TT, Derose SF (2009) Sleep apnea in early and advanced chronic kidney disease: Kaiser Permanente Southern California cohort. Chest 135:710–716

    Article  PubMed  Google Scholar 

  20. Sakaguchi Y, Hatta T, Hayashi T, Shoji T, Suzuki A, Tomida K, Okada N, Rakugi H, Isaka Y, Tsubakihara Y (2013) Association of nocturnal hypoxemia with progression of CKD. Clin J Am Soc Nephrol: CJASN 8:1502–1507

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Fine LG, Orphanides C, Norman JT (1998) Progressive renal disease: the chronic hypoxia hypothesis. Kidney Int Suppl 65:S74–S78

    CAS  PubMed  Google Scholar 

  22. Fine LG, Norman JT (2008) Chronic hypoxia as a mechanism of progression of chronic kidney diseases: from hypothesis to novel therapeutics. Kidney Int 74:867–872

    Article  CAS  PubMed  Google Scholar 

  23. Adeseun GA, Rosas SE (2010) The impact of obstructive sleep apnea on chronic kidney disease. Curr Hypertens Rep 12:378–383

    Article  PubMed  PubMed Central  Google Scholar 

  24. Hanly PJ, Ahmed SB (2014) Sleep apnea and the kidney: is sleep apnea a risk factor for chronic kidney disease? Chest 146:1114–1122

    Article  PubMed  Google Scholar 

  25. Shimizu K, Chin K, Nakamura T, Masuzaki H, Ogawa Y, Hosokawa R, Niimi A, Hattori N, Nohara R, Sasayama S, Nakao K, Mishima M, Ohi M (2002) Plasma leptin levels and cardiac sympathetic function in patients with obstructive sleep apnoea-hypopnoea syndrome. Thorax 57:429–434

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Xie X, Pan L, Ren D, Du C, Guo Y (2013) Effects of continuous positive airway pressure therapy on systemic inflammation in obstructive sleep apnea: a meta-analysis. Sleep Med 14:1139–1150

    Article  PubMed  Google Scholar 

  27. Fava C, Dorigoni S, Dalle Vedove F, Danese E, Montagnana M, Guidi GC, Narkiewicz K, Minuz P (2014) Effect of CPAP on blood pressure in patients with OSA/hypopnea a systematic review and meta-analysis. Chest 145:762–771

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Respiratory Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No 59, Shenglixi road, Xiangcheng district, Zhangzhou, Fujian province, 363000, People’s Republic of China

    Li-Da Chen, Li Lin, Yang-Wu Ou, Zhi Wu, Zhi-Ming Cai, Tie-Zhu Wang & Jian-Nan Liu

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  1. Li-Da Chen
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  2. Li Lin
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  3. Yang-Wu Ou
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  4. Zhi Wu
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Correspondence to Jian-Nan Liu.

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This article does not contain any studies with human participants performed by any of the authors.

Funding

The Fujian Provincial Health Bureau provided financial support in the form of Youth Research Fund (grant 2015–1-98). The sponsor had no role in the design or conduct of this research.

Conflict of interest

The authors declare that they have no conflict of interest.

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Chen, LD., Lin, L., Ou, YW. et al. Effect of positive airway pressure on glomerular filtration rate in patients with sleep-disordered breathing: a meta-analysis. Sleep Breath 21, 53–59 (2017). https://doi.org/10.1007/s11325-016-1364-6

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  • DOI: https://doi.org/10.1007/s11325-016-1364-6

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