Effect of Obstructive Sleep Apnea Treatment on Renal Function in Patients with Cardiovascular Disease

Kelly Loffler, Emma Heeley, Ruth Freed, Craig Anderson, Ben Brockway, Alastair Corbett, Catharina Chang, James Douglas, Katherine Ferrier, Neil Graham, Garun Hamilton, Michael Hlavac, Nigel McArdle, John McLachlan, Sutapa Mukherjee, Matthew Naughton, Francis Thien, Alan Young, Ronald Grunstein, Lyle PalmerRichard Woodman, Patrick Hanly, R McEvoy, Investigators SAVE

    Research output: Contribution to journalArticle

    15 Citations (Scopus)

    Abstract

    Rationale: Obstructive sleep apnea (OSA) is associated with impaired renal function, but uncertainty exists over whether OSA treatment can influence renal outcomes. Objectives: To determine the effects of continuous positive airway pressure (CPAP) on renal function in subjects with coexisting OSA and cardiovascular disease. Methods: This was a substudy of the international SAVE (Sleep Apnea Cardiovascular Endpoints) trial, in which 2,717 patients with moderate to severe OSA and established coronary or cerebrovascular disease were randomized to receive either CPAP plus usual care or usual care alone. Renal function and adverse renal events were compared between the CPAP (n = 102) and usual care (n = 98) groups. Glomerular filtration rate was estimated at randomization and at the end of follow-up, and the urinary albumin-to-creatinine ratio was measured at study exit. Measurements and Main Results: In 200 substudy participants (mean age, 64 yr; median, 4% oxygen desaturation index; 20 events/h; mean estimated glomerular filtration rate at baseline, 82 ml/min/ 1.73 m2), the median (interquartile range) changes in estimated glomerular filtration rate (ml/min/1.73 m2/yr) were 21.64 (23.45 to 20.740) in the CPAP group and 22.30 (24.53 to 20.71) in the usual care group (P = 0.21) after a median of 4.4 years. There were no between-group differences in end-of-study urinary albumin-to-creatinine ratio or in the occurrence of serious renal or urinary adverse events during the trial. The level of CPAP adherence did not influence the findings. Conclusions: CPAP treatment of OSA in patients with cardiovascular disease does not alter renal function or the occurrence of renal adverse events.

    Original languageEnglish
    Pages (from-to)1456-1462
    Number of pages7
    JournalAmerican Journal of Respiratory and Critical Care Medicine
    Volume196
    Issue number11
    DOIs
    Publication statusPublished - 1 Dec 2017

    Keywords

    • Albuminuria
    • Continuous positive airway pressure
    • Glomerular filtration rate
    • Obstructive sleep apnea
    • Randomized controlled trial

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  • Cite this

    Loffler, K., Heeley, E., Freed, R., Anderson, C., Brockway, B., Corbett, A., Chang, C., Douglas, J., Ferrier, K., Graham, N., Hamilton, G., Hlavac, M., McArdle, N., McLachlan, J., Mukherjee, S., Naughton, M., Thien, F., Young, A., Grunstein, R., ... SAVE, I. (2017). Effect of Obstructive Sleep Apnea Treatment on Renal Function in Patients with Cardiovascular Disease. American Journal of Respiratory and Critical Care Medicine, 196(11), 1456-1462. https://doi.org/10.1164/rccm.201703-0603OC