Prevalence of chronic kidney disease in obesity hypoventilation syndrome and obstructive sleep apnoea with severe obesity

Sheila Sivam; Brendon J Yee; Steven J Chadban; Amanda J Piper; Patrick J Hanly; David Wang; Keith K H Wong; Ronald R Grunstein

doi:10.1016/j.sleep.2020.05.017

Prevalence of chronic kidney disease in obesity hypoventilation syndrome and obstructive sleep apnoea with severe obesity

Sleep Med. 2020 Oct:74:73-77. doi: 10.1016/j.sleep.2020.05.017. Epub 2020 May 21.

Authors

Sheila Sivam¹, Brendon J Yee², Steven J Chadban³, Amanda J Piper², Patrick J Hanly⁴, David Wang², Keith K H Wong², Ronald R Grunstein⁵

Affiliations

¹ Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Central Clinical School, University of Sydney, Sydney, NSW, Australia; Sleep and Circadian Research Group CIRUS, Woolcock Institute of Medical Research, Sydney, NSW, Australia. Electronic address: sheila.sivam@sydney.edu.au.
² Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Central Clinical School, University of Sydney, Sydney, NSW, Australia; Sleep and Circadian Research Group CIRUS, Woolcock Institute of Medical Research, Sydney, NSW, Australia.
³ Kidney Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Kidney Node, Charles Perkins Centre, University of Sydney, Australia.
⁴ Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada.
⁵ Central Clinical School, University of Sydney, Sydney, NSW, Australia; Sleep and Circadian Research Group CIRUS, Woolcock Institute of Medical Research, Sydney, NSW, Australia; RPA-Charles Perkins Centre Clinic, Sydney, NSW, Australia.

PMID: 32841847
DOI: 10.1016/j.sleep.2020.05.017

Abstract

Purpose: Chronic kidney disease (CKD) is common in severe obstructive sleep apnoea (OSA), however prevalence in obesity hypoventilation syndrome (OHS) is not known. This study sought to compare prevalence of CKD in OHS and equally obese OSA patients with comparable apnoea hypopnoea indexes (AHI), and secondarily examine the impact of positive airway pressure (PAP) therapy on CKD parameters.

Methods: Estimated Glomerular Filtration Rate (eGFR) and spot urine protein creatinine ratio (PCR) were obtained in patients with OHS (Partial pressure of carbon dioxide, PaCO2 > 45 mmHg) and OSA (AHI > 20 events per hour, PaCO2 < 45 mmHg) with a body mass index (BMI) > 40 kg/m². Samples were obtained at baseline and after three months of PAP in both groups.

Results: Patients with OHS (n = 15, PaCO2 49 mmHg; daytime oxygen saturation, SpO2 94%; total sleep time with SpO2<90%, T90 308min) and OSA (n = 36, PaCO2 40 mmHg, SpO2 96%, T90 140min) were recruited. Stage 1-3 kidney function was present in 7 (46%) and 8 (22%) patients with OHS and OSA respectively (p = 0.08). Mean PCR was higher in OHS than OSA (23 ± 29 v 10 ± 6 mg/mmol; p = 0.03), while the prevalence of proteinuria was not different (40% v 19%, p = 0.19). Proteinuria was not significantly altered by three months of PAP. Moderate associations were demonstrated between eGFR, PaCO2, awake SpO2 and/or HbA1c (r > 0.5, p < 0.05) in OHS.

Conclusion: The prevalence of CKD, primarily early-stage with proteinuria, is at least as frequent in OHS as it is in OSA, if not worse. Markers of CKD were not significantly impacted by PAP therapy.

Keywords: Continuous positive airway pressure; Creatinine; Glomerular filtration rate; Urine protein creatinine ratio.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Humans
Obesity Hypoventilation Syndrome* / complications
Obesity Hypoventilation Syndrome* / epidemiology
Obesity Hypoventilation Syndrome* / therapy
Obesity, Morbid* / complications
Obesity, Morbid* / epidemiology
Polysomnography
Prevalence
Renal Insufficiency, Chronic* / complications
Renal Insufficiency, Chronic* / epidemiology