Effect of 12-month nasal continuous positive airway pressure therapy for obstructive sleep apnea on progression of chronic kidney disease.

backgroundObstructive sleep apnea (OSA) is common among patients with chronic kidney disease (CKD). CKD may increase the risk of OSA, and OSA may increase the risk of renal injury. Nasal continuous positive airway pressure (nCPAP) is the standard treatment for OSA. However, the effect of nCPAP on the progression of CKD is unclear.

methodsA total of 395 patients with stage 3/4 CKD were initially examined, and 269 patients (148 non-OSA cases; 79 mild OSA cases; 42 moderate/severe OSA cases) were analyzed after implementation of the exclusion criteria. The severity of OSA was determined by polysomnography (PSG). Fifty-two OSA patients (32 mild OSA cases; 20 moderate/severe OSA cases) received nCPAP treatment for 12 months. Variables associated with OSA severity and estimated glomerular filtration rate (eGFR) were evaluated before and after the 12-month nCPAP treatment.

resultsAmong all 269 CKD patients, body mass index (BMI), and eGFR had significant associations with OSA severity. Age, BMI, apnea-hypopnea index (AHI), mean SaO2%, and SaO2 <90% monitoring time had independent associations with lower eGFR. The 12-month nCPAP treatment significantly reduced the rate of eGFR decline. Univariate and multivariate analysis indicated that age, BMI, AHI, mean SaO2%, and SaO2 <90% monitoring time were independently associated with reduced eGFR. Furthermore, nCPAP treatment significantly improved eGFR, AHI, mean SaO2, and SaO2 <90% monitoring time in patients with mild OSA, and improved systolic/diastolic blood pressure, urinary protein level, eGFR, AHI, mean SaO2, and SaO2 <90% monitoring time for patients with moderate/severe OSA.

conclusionThis study of patients with CKD and OSA indicated that nCPAP therapy significantly ameliorated CKD progression, especially in those with moderate/severe OSA.