{"title":"Associations between obstructive sleep apnea and sleep characteristics with chronic kidney disease in rural Pennsylvania","authors":"","doi":"10.1016/j.sleep.2024.09.008","DOIUrl":null,"url":null,"abstract":"<div><h3>Study objectives</h3><p>To examine the association between moderate-severe obstructive sleep apnea (msOSA) and sleep characteristics with chronic kidney disease (CKD) in a population of rural and urban adults in Pennsylvania.</p></div><div><h3>Methods</h3><p>A cross-sectional study of 23,643 adults who underwent polysomnography (PSG) at a rural healthcare system in Pennsylvania between 2009 and 2019. Serum creatinine was abstracted from electronic health records to calculate estimated glomerular filtration rate (eGFR). CKD was defined as an eGFR <60 mL/min/1.73 m<sup>2</sup>. msOSA was defined as an apnea-hypoxia index (AHI) ≥15 events/hour. Poisson regression was performed to estimate the prevalence ratio (PR) of CKD for various sleep measures while adjusting for age, sex, race, smoking (never, former, current), body mass index, diabetes, and hypertension at time of PSG.</p></div><div><h3>Results</h3><p>In this clinically-referred sample comprised of over one-third (35 %) rural individuals, the prevalence of CKD and msOSA was 9.4 % and 32.1 %, respectively. Patients with CKD had more severe OSA based on AHI and intermittent hypoxia profile and presented worse sleep quality across all studied measures. Having OSA was associated with a 13 % higher prevalence of CKD (95%CI: 1.04, 1.22). In addition, for every 5 % increment in sleep efficiency, the prevalence of CKD was 3 % lower (PR = 0.97, 95%CI: 0.96, 0.98). Significant associations that were in the expected direction were observed across most sleep characteristics in adjusted models.</p></div><div><h3>Conclusions</h3><p>Moderate-severe OSA, nocturnal hypoxemia, and disruptions to normal sleep duration, continuity, and architecture are associated with increased CKD prevalence in Pennsylvania adults. Management of OSA and/or sleep disturbances may be an opportunity to improve CKD outcomes. The unique health disparities among vulnerable rural populations are deserving of future study.</p></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":null,"pages":null},"PeriodicalIF":3.8000,"publicationDate":"2024-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1389945724004301/pdfft?md5=bff018f80490a7ce41f8d2eb21293901&pid=1-s2.0-S1389945724004301-main.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Sleep medicine","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1389945724004301","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Study objectives
To examine the association between moderate-severe obstructive sleep apnea (msOSA) and sleep characteristics with chronic kidney disease (CKD) in a population of rural and urban adults in Pennsylvania.
Methods
A cross-sectional study of 23,643 adults who underwent polysomnography (PSG) at a rural healthcare system in Pennsylvania between 2009 and 2019. Serum creatinine was abstracted from electronic health records to calculate estimated glomerular filtration rate (eGFR). CKD was defined as an eGFR <60 mL/min/1.73 m2. msOSA was defined as an apnea-hypoxia index (AHI) ≥15 events/hour. Poisson regression was performed to estimate the prevalence ratio (PR) of CKD for various sleep measures while adjusting for age, sex, race, smoking (never, former, current), body mass index, diabetes, and hypertension at time of PSG.
Results
In this clinically-referred sample comprised of over one-third (35 %) rural individuals, the prevalence of CKD and msOSA was 9.4 % and 32.1 %, respectively. Patients with CKD had more severe OSA based on AHI and intermittent hypoxia profile and presented worse sleep quality across all studied measures. Having OSA was associated with a 13 % higher prevalence of CKD (95%CI: 1.04, 1.22). In addition, for every 5 % increment in sleep efficiency, the prevalence of CKD was 3 % lower (PR = 0.97, 95%CI: 0.96, 0.98). Significant associations that were in the expected direction were observed across most sleep characteristics in adjusted models.
Conclusions
Moderate-severe OSA, nocturnal hypoxemia, and disruptions to normal sleep duration, continuity, and architecture are associated with increased CKD prevalence in Pennsylvania adults. Management of OSA and/or sleep disturbances may be an opportunity to improve CKD outcomes. The unique health disparities among vulnerable rural populations are deserving of future study.
期刊介绍:
Sleep Medicine aims to be a journal no one involved in clinical sleep medicine can do without.
A journal primarily focussing on the human aspects of sleep, integrating the various disciplines that are involved in sleep medicine: neurology, clinical neurophysiology, internal medicine (particularly pulmonology and cardiology), psychology, psychiatry, sleep technology, pediatrics, neurosurgery, otorhinolaryngology, and dentistry.
The journal publishes the following types of articles: Reviews (also intended as a way to bridge the gap between basic sleep research and clinical relevance); Original Research Articles; Full-length articles; Brief communications; Controversies; Case reports; Letters to the Editor; Journal search and commentaries; Book reviews; Meeting announcements; Listing of relevant organisations plus web sites.