title: Association of sleep-disordered breathing with diabetes-associated kidney disease.
abstract: Diabetes-associated kidney disease is characterized by impairment of renal function and albuminuria. The aim of the present study was to assess whether sleep-disordered breathing is associated with decreased estimated glomerular filtration rate or increased urine-albumin-to-creatinine-ratio independently from known modulators of diabetes-associated kidney disease.
  
  
  
  Estimated glomerular filtration rate and urine-albumin-to-creatinine-ratio were determined in the baseline survey of the DIACORE-SDB substudy, a prospectively planned study of Diabetes mellitus 2 patients. As a measure of the severity of sleep-disordered breathing, the apnea-hypopnea-index was assessed using a 2-channel ambulatory SDB-monitoring device.
  
  
  
  A total of 679 patients (mean age 66 years, men 61%, mean body-mass-index 31.2 kg/m2) were analyzed. In multivariable linear regression models adjusting for known modulators of diabetes-associated kidney disease, such as sex, age, body-mass-index, systolic blood pressure, duration of diabetes and HbA1c, apnea-hypopnea-index [beta-estimate -0.2 ml/min/1.73 m2, 95% CI (-0.3; -0.1), p = .004], duration of diabetes and age were associated with estimated glomerular filtration rate. Apnea-hypopnea-index [beta-estimate 0.01 mg/g, 95% CI (0.00; 0.02), p = .009], duration of diabetes, HbA1c and systolic blood pressure were associated with ln(urine-albumin-to-creatinine-ratio).
  
  
  
  In patients with diabetes mellitus type 2, more severe sleep-disordered breathing is significantly associated with lower estimated glomerular filtration rate and increased albuminuria, independent of known modulators of diabetes-associated kidney disease.
authors.affiliation: a Department of Internal Medicine II , University Hospital Regensburg , Regensburg , Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Stadler
authors.affiliation: a Department of Internal Medicine II , University Hospital Regensburg , Regensburg , Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Zimmermann
authors.affiliation: a Department of Internal Medicine II , University Hospital Regensburg , Regensburg , Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Franke
authors.affiliation: b Department of Nephrology , University Hospital Regensburg , Regensburg , Germany.
authors.forename: Myriam
authors.initials: M
authors.lastname: Rheinberger
authors.affiliation: c Department of Genetic Epidemiology , University Regensburg , Regensburg , Germany.
authors.forename: Iris M
authors.initials: IM
authors.lastname: Heid
authors.affiliation: b Department of Nephrology , University Hospital Regensburg , Regensburg , Germany.
authors.forename: Carsten A
authors.initials: CA
authors.lastname: Böger
authors.affiliation: a Department of Internal Medicine II , University Hospital Regensburg , Regensburg , Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Arzt
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000209:etiology / Q000652:urine; D015992:Body Mass Index; D003404:Creatinine / Q000652:urine; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000652:urine; D003928:Diabetic Nephropathies / Q000150:complications* / Q000503:physiopathology / Q000652:urine; D005260:Female; D005919:Glomerular Filtration Rate; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017286:Polysomnography; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012890:Sleep / Q000502:physiology; D012891:Sleep Apnea Syndromes / Q000209:etiology*
chemical_list: D003404:Creatinine; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Diabetes mellitus; kidney disease; sleep-disordered breathing