The relationships of sleep apnea, hypertension, and resistant hypertension on chronic kidney disease.
Hypertension, blood pressure variation, and resistant hypertension have close relations to sleep apnea, which lead to target organ damage, including the kidney. The complex relationships between sleep apnea and blood pressure cause their interactions with chronic kidney disease ambiguous. The aim of the study was to elucidate the separate and joint effects of sleep apnea, hypertension, and resistant hypertension on chronic kidney disease. A cross-sectional study was done to see the associations of sleep apnea, hypertension, and resistant hypertension with chronic kidney disease in 998 subjects underwent overnight polysomnography without device-therapy or surgery for their sleep-disordered breathing. Multivariate logistic regression was used to analyze the severity of SA, hypertension stage, resistant hypertension, and their joint effects on CKD. The multivariable relative odds (95% CI) of chronic kidney disease for the aged (age ≥65 years), severe sleep apnea, stage III hypertension, and resistant hypertension were 3.96 (2.57-6.09) (P < 0.001), 2.28 (1.13-4.58) (P < 0.05), 3.55 (1.70-7.42) (P < 0.001), and 9.42 (4.22-21.02) (P < 0.001), respectively. In subgroups analysis, the multivariable relative odds ratio of chronic kidney disease was highest in patients with both resistant hypertension and severe sleep apnea [13.42 (4.74-38.03)] (P < 0.001). Severe sleep apnea, stage III hypertension, and resistant hypertension are independent risk factors for chronic kidney disease. Patients with both severe sleep apnea and resistant hypertension have the highest risks.
Division of Cardiology College of Medicine, China Medical University Department of Healthcare Administration, College of Health Science, Asia University Graduate institute of Biostatics, College of Public Health, China Medical University Sleep Center Division of Nephrology, China Medical University Hospital Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.
Chih-Ping
CP
Chang
Tsai-Chung
TC
Li
Liang-Wen
LW
Hang
Shinn-Jye
SJ
Liang
Jen-Jyn
JJ
Lin
Che-Yi
CY
Chou
Jeffrey J P
JJP
Tsai
Po-Yen
PY
Ko
Chiz-Tzung
CT
Chang
D001794:Blood Pressure / Q000502:physiology*; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D015994:Incidence; D008297:Male; D017286:Polysomnography; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D013624:Taiwan / Q000453:epidemiology