How Prevalent Was Reduced Egfr In Patients With Osa
The total number of patients with reduced eGFR in the OSA group was 23/240 when the cystatin-C-based calculation was used and 16/240 when the creatinine-based calculation was used. The difference was not statistically significant .
All patients were grouped into categories of eGFR according to the CKD-EPI recommendations. The relative frequency/prevalence of CKD-EPI categories are shown for eGFRcystat and eGFRcreat in Figures 1,2, respectively.
Figure 1Figure 2
Anthropometrics, sleep and breathing characteristics and main blood biochemistry results in patients with OSA grouped according to eGFRcystat and eGFRcreat are shown in Tables 1,2, respectively.
Effects Of Cpap Therapy On Kidney Function
CPAP is the therapy of OSA that more fully prevents occurrence of SDB. Its main limitation is related to variable adherence to its use, which leaves some patients incompletely treated. Its favorable effects on patients symptomatology are undiscussed, whereas benefits on other health aspects, like cardiovascular and metabolic manifestations, are small and still controversial .
CPAP therapy is associated with a reduction in common risk factors for CKD, which could warrant an improvement in kidney function. CPAP prevents nocturnal oxygen desaturations, slightly decreases blood pressure , and reduces renal RAS activity and circulating inflammatory markers including IL-18, a marker of acute kidney injury .
Establish A Bedtime Routine
Many insomnia-sufferers are caught up in bad bedtime habits, such as taking long naps during the day, drinking caffeine too close to bedtime, or engaging in stressful or strenuous activities too close to bedtime. To encourage your body to fall asleep at normal times, choose a bedtime and wake time and stick to it even on the weekends. Limit your naps to no more than 30 minutes, and try not to take any naps after 3 pm. Help your body prepare for sleep by dimming the lights in your home, taking a warm bath, or meditating.
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What Are My Options For Treatment
FSGS is not an easy disease to treat. Anyone with this disease should be seen regularly by a kidney specialist, also called a nephrologist. If it is associated with any of the illnesses mentioned above, treating that particular illness becomes a priority. It is also important for someone with either primary OR secondary FSGS to be on medication that reduces the amount of protein in the urine. These medications are called ACE-inhibitors and ARBs . If urine protein levels are high, the complications of the Nephrotic Syndrome should also be considered. Patients should receive routine cholesterol screening/treatment. Their physicians should always remember their tendency to form clots.
Finally, every patient with FSGS should have their kidney function monitored regularly with both blood and urine studies. As kidney function declines, certain other interventions may become necessary. No ones kidney disease is exactly the same. Your nephrologist can tell you how often your labs need to be checked and what to expect if your kidney function begins to decline.
In addition to the above, many different types of drugs that suppress the immune system are also being used to treat FSGS. The most common of these are steroids. Unfortunately, all of these drugs have significant side effects. Their use must be considered on a patient-by-patient basis.
Avoid Electronics Close To Bedtime
Many studies have shown devices emitting blue light delay the release of melatonin, keeping the user awake past their bedtime. Exposure to blue light during the day is relatively healthy, but when the sun goes down, the body needs warmer light. Avoid looking at any screens at least 2-3 hours before bedtime this includes TVs, e-readers, smartphones, or computer screens.
Sleep Apnea And Kidney Disease
If you snore at night, youre probably aware of how frustrating it can be to your family. They complain that it keeps them awake half the night, but is it really that big of a deal?
If youre curious about your snoring, its generally a good idea to talk to your health care provider. Snoring is only one of the many symptoms of sleep apnea, a disorder known for causing interrupted breathing during the night. While snoring seems benign, sleep apnea is not. Sleep apnea has many deadly adverse effects including the development of kidney disease.
What is Kidney Disease?
Your kidneys are responsible for filtering your blood, producing urine to excrete excess salt and minerals, and also to produce certain hormones. Kidney disease occurs when your kidneys become damaged and are unable to properly filter your blood. This unfiltered blood builds up in your system leading to swelling, breathing problems, and even heart trauma. Kidney disease is separated by stages, each stage growing progressively worse. In many cases, youll need to have a procedure performed called dialysis where the excess fluid accumulated in your body is removed via a catheter in your abdomen or your arm. For most, dialysis is painless but comes with risks of infection or hypovolemia, the removal of too much fluid.
How Does Sleep Apnea Cause Kidney Disease?
What if I Already Have Kidney Disease?
Changes In Sleep Architecture
Patients with ESRD typically exhibit poor sleep architecture as measured objectively on polysomnographic studies. In a comprehensive review, ESRD patients had short, fragmented sleep with total sleep times between 260-360 min. Sleep efficiencies ranged between 66%-85% and time spent awake ranged from 77-135 min. Sleep latencies were reported between 10-30 min and REM latencies between 92-64 min. There was a pattern of increased stage 1 and stage 2 sleep while slow wave sleep and REM sleep were decreased. Daytime sleepiness is a parameter not measured by polysomnographic studies but is still considered an important marker of inadequate sleep. Multiple sleep latency tests objectively measure daytime sleepiness by having the patient take five scheduled naps throughout the day separated by 2-h breaks. Time to onset of sleep, also known as sleep latency, of less than 5 min is considered to be pathological and may be exacerbated by various sleep disorders. A study conducted by Parker et al in 2003 also found that out of 46 ESRD patients, 46% had abnormal MSLTs. Another study conducted by Stepanski et al on peritoneal dialysis patients reported a MSLT of 6.6 ± 3.7 min.
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Chronic Kidney Disease And Sleep
Chronic kidney disease is one of the most prevalent diseases in the United States, affecting an estimated 37 million people. Many of us know about heart disease and cancer, but kidney disease is an under-recognized health crisis currently, kidney disease is the 9th leading cause of death in this country, and many people who have it dont even realize it.
Whats more, 1 in 3 Americans are at risk for developing CKD common precursors to the disease include diabetes, obesity, and high blood pressure. The relationship between Chronic Kidney Disease and sleep has not been fully explored, but studies have shown people with chronic disorders such as CKD experience a high prevalence of sleep disorders compared to the general population including sleep apnea, insomnia, restless leg syndrome, and daytime sleepiness.
Improving sleep hygiene can lead to better overall health, including the health of CKD and ESRD patients. This article will discuss the various connections between chronic kidney disease and sleep disorders, as well as viable treatments to ensure you get a restorative, good nights sleep no matter your health.
Continuous Positive Airway Pressure
is nearly always the first medical treatment for sleep apnea. With CPAP, you use a breathing machine that prevents your airways from closing during sleep.
Research shows that:
- CPAP decreases daytime sleepiness.footnote 4, footnote 5, footnote 6 If you still feel sleepy during the day while using CPAP at night, tell your doctor.
- CPAP can lower daytime and nighttime blood pressure.footnote 7
It may take time for you to be comfortable using CPAP. You may find that you want to take off the mask, or you may find it hard to sleep. If you can’t get used to CPAP, talk to your doctor. You might be able to try another type of mask or make other adjustments.
Some CPAP devices automatically adjust air pressure or use different air pressures when you breathe in or out. They are easier and more comfortable for some people to use.
If you use CPAP to treat sleep apnea, you need to use it every night and while you nap. If you don’t use it, your symptoms will return right away.
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Sleep Apnea And Chronic Kidney Disease
A new sleep apnea study, published in the most recent issue of the journal Respirology, has found that those with sleep apnea have a 59 percent higher risk of developing chronic kidney disease over four years than those who do not suffer from the sleep disorder. Specifically, sleep apnea is connected to the development of chronic kidney disease at the same rate as hypertension.
Osa Study Methods & Results
The study, titled Association of sleep apnea with chronic kidney disease in a large cohort from Taiwan, followed 43,434 patients over the age of 20 in Taiwan from 2000 to 2010. Of the study participants, 8,687 had been diagnosed with sleep apnea and 34,747 did not suffer from sleep apnea.
Researchers corrected for other factors, such as body mass index, diabetes, and age. They found that participants who suffered from sleep apnea were significantly more likely to become diagnosed with chronic kidney disease about as likely as they were to be diagnosed with high blood pressure but not as likely as they were to be diagnosed with type 2 diabetes.
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Data Quality And Management
All data will be stored on a secure network behind a firewall at the University of Calgary. All data will be accessed and analysed solely by the principal investigator and his research team using password-protected computers. Patient identifying information will be replaced with unique identifiers for any data seen by individuals other than the principal investigator and research assistants. Paper copies of unique identifiers are locked in a cabinet in a locked office and all electronic identifiers are behind the Alberta Health Services firewall in a password-protected document.
The trial steering committee consists of PJH, SBA, SRP and TCT. We do not feel that a formal committee for data safety and monitoring is required since the intervention in our trial has minimal risk and our sleep centre and the CPAP providers in the community have extensive experience with this treatment. Furthermore, our exclusion criteria were chosen to avoid recruitment of patients in whom CPAP therapy may not be appropriate.
What Does It Look Like
First, a quick look at the kidney. Most people have two kidneys, one on each side of their lower back. All of the blood in your body passes through your kidneys many times during the day. Each time blood goes through some of it gets cleaned and filtered by the glomeruli . This cleaning is how your body gets impurities out of the blood . Some of the cleaned blood becomes your urine. Urine isnt red like blood because the red blood cells, which give blood its color, are too big to fit through the filters. A glomerulus is just a tiny bag of blood containers through which blood gets filtered, and all of the clean blood runs into tubes which eventually lead to your bladder.
Above are shown two kidney filters, as they look under a microscope. On the left is a normal filter, and on the right is a filter from someone with FSGS. The right half of the filter with FSGS still looks a lot like the normal picture on the left. Again, thats where the Segmental part of the name comes from. A healthy filter can be right next to a diseased filter. The left half of the picture on the right is scarred.
On left, graphic illustration of a normal glomerulus on right graphic illustration of glomerulus with FSGS
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What Influences Egfr In Patients With Osa
We observed a clear correlation between eGFRcystat and eGFRcreat .
A similar good correlation was observed in patients with eGFR < 60 mL/min/1.73 m2 . We tried to assess a link between sleep parameters, such as AHI, ODI, mean SpO2 and lowest SpO2, and eGFR but we did not find any correlations. Significant correlations were found between the eGFRcyst and pro-brain natriuretic peptide and the total cholesterol .
In addition, a weak but statistically significant correlation was found between the ESS score and eGFRcyst .
Epidemiology Of The Association Between Osa And Ckd
Despite unquestionable evidence of risk factors for CKD in OSA, the presence of confounders makes an independent link between the two conditions difficult to demonstrate in human patients. These confounders include advanced age, obesity, and especially comorbidities like arterial hypertension and diabetes mellitus. Therefore, one important requirement for epidemiological studies on OSA and CKD is a large sample of subjects in order to adjust for multiple confounders. In addition, ideally, the sample sizes of subjects with CKD, OSA , and healthy controls should be adequately balanced, which is difficult to obtain. In fact, studies performed in general population samples, while showing little or no selection bias in subjects recruitment, predominantly included healthy subjects, and the few OSA patients in the sample had a mild disease with little nocturnal hypoxemia. Conversely, studies on patients with suspected OSA included subjects with worse risk factors for CKD and more severe hypoxemia, with higher probability to show significant effects of OSA on renal function, but low applicability of results to the general population.
Sleep Apnea Obesity And Heart Disease
Research suggests that obesity may play an important role in the development of both sleep apnea and heart disease. It is important to keep in mind that sleep apnea alone, with or without obesity, can increase the risk for heart disease. Sleep apnea and obesity independently increase the risk of health conditions that negatively affect heart health, like hypertension , unhealthy cholesterol levels, and diabetes.
Obesity is a common cause of sleep apnea, often related to increased deposits of fat in the neck that narrow or block the upper airway during sleep. Researchers have found that even a 10% increase in body weight increases the risk of OSA by six-fold. While 60 to 90% of people with sleep apnea also have obesity, only around 30% of people diagnosed with obesity have sleep apnea.
Ruling Out Other Medical Reasons Or Conditions
Your doctor may order the following tests to help rule out other medical conditions that can cause sleep apnea:
- Blood tests to check the levels of certain hormones and to rule out endocrine disorders that could be contributing to sleep apnea. Thyroid hormone can rule out hypothyroidism. Growth hormone tests can rule out acromegaly. Total testosterone and dehydroepiandrosterone sulphate tests can help rule out polycystic ovary syndrome .
- Pelvic ultrasound to examine the ovaries and detect cysts. This can rule out PCOS.
Your doctor will also want to know whether you are using medicines, such as opioids, that could be affecting your sleep or causing breathing symptoms of sleep apnea. Your doctor may want to know whether you have traveled recently to altitudes greater than 6,000 feet, because these low-oxygen environments can cause symptoms of sleep apnea for a few weeks after traveling.
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How Is Sleep Apnea Diagnosed
Your doctor will probably examine you and ask about your past health. He or she may also ask you or your sleep partner about your snoring and sleep behaviour and how tired you feel during the day.
Your doctor may suggest a sleep study. A sleep study may take place in your home or at a sleep centre, where you will spend the night. Sleep studies find out how often you stop breathing or have too little air flowing into your lungs during sleep. They also find out how much oxygen you have in your blood during sleep. You may have blood tests and X-rays.
Chronobiology Of Melatonin In Ckd Patients
Melatonin, a hormone secreted by the pineal gland, is responsible for the sleep – wake circadian rhythm. It is secreted in small amounts during the daytime but increases during the night, which correlates with the onset of nocturnal sleepiness. In a small cross sectional study comparing 30 ESRD patients undergoing hemodialysis and 20 healthy participants, nocturnal melatonin levels were significantly lower in patients with ESRD. About 22 of the 30 patients also lacked the circadian rhythm in melatonin secretion. HD did not correct or improve melatonin concentrations. In another study by Karasek et al, melatonin concentrations released during the night did not improve with kidney transplantation, despite improvements in renal function. Sleep quality, as measured by actigraphy, did not significantly improve either.
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What Should Ckd Patients Eat
Perhaps youre overwhelmed at all the foods you should avoid if you have CKD or are at risk for developing it. Thats understandable! Thankfully, there are still quite a few things you can eat that will provide you with the energy and nutrients your body needs.
- Spices and herbs with no added salt
- Fresh food
- Rinsed canned foods
- Heart-healthy foods such as salmon, olive oil, berries, and leafy greens
- Foods low in saturated and trans fat
- Low-fat dairy products
If you are in the later stages of CKD or already on dialysis, you should establish an emergency meal plan in case you cannot make it to dialysis for some reason. This diet is very strict to control the buildup of toxins. For a meal plan and emergency checklist, please see Kidney.Org.