Obstructive sleep apnea and early kidney damage in young and middle-aged men with arterial hypertension

Aim. To assess the impact of obstructive sleep apnea (OSA) on renal function in young and middle-aged men with stage 1 hypertension.
Materials and methods. A single-center, cross-sectional study included 99 men aged 18–59 years. All patients had such tests, as: office blood pressure (BP) measurement, 24-hour BP monitoring, sleep-disordered breathing testing, and renal function assessment using estimated glomerular filtration rate (eGFR, CKD- EPI formula) and microalbuminuria (MAU).
Results. OSA was detected in 67% of patients (median apnea/hypopnea index (AHI) – 20.05 events/hour). In the group with AHI ≥15 events/h compared with the group with AHI <15 events/h, the eGFR was lower (63.94 [55.95; 85.11] vs. 86.33 [80.11; 94.36] ml/min/1.73 m²; p<0.01), and the MAU value was higher (17.75 [6.90; 35.30] vs. 5.40 [0.30; 13.90] mg/day; p<0.001); the percentage of patients with MAU >30 mg/day was 25.9% vs. 6.7%, respectively (p=0.029). BP levels did not differ significantly between the groups. eGFR correlated negatively with AHI (ρ=−0.33, p=0.001) and positively with mean SpO₂ (ρ=0.41; p<0.001); MAU correlated positively with AHI (ρ=0.29; p=0.004) and negatively with mean SpO₂ (ρ=−0.40; p<0.001). There were predicted a high risk of eGFR decreasing ≤79.43 μmol/L (AUC=0.66±0.06; p<0.00) and a risk of the presence of MAU higher than 17 mg/day (AUC=0.70±0.05; p<0.00) in the group with AHI ≥15 events/h. In a multivariate logistic regression that included age, AHI and BMI, age and AHI were independent markers of decreased renal function (OR 0.92; 95% CI 0.88–0.97; p<0.00; and OR 0.98; 95% CI 0.96–0.99; p=0.03, respectively), while BMI had no significant effect.
Conclusion. In male patients with stage I hypertension, the presence of OSA is associated with worsening renal function (decreased eGFR, increased MAU), which emphasizes the necessity for OSA screening and inclusion its correction in the nephroprotective strategy; prospective studies are needed to clarify the effect of OSA therapy on renal outcomes.

1. Litvin A.Yu., Chazova I.E., Elfimova E.M., Pevzner A.V., Poluektov M.G., Danilov N.M., Mikhailova O.O., Aksenova A.V. Eurasian Association of Cardiology (EAC)/ Russian society of somnologists (RSS) guidelines for the diagnosis and treatment of obstructive sleep apnea in patients with cardiovascular diseases (2024). Eurasian heart journal. 2024;(3):6-27. (In Russ.) https://doi.org/10.38109/2225-1685-2024-3-6-27

2. Benjafield, A. V. et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: A literature-based analysis. Lancet Respir Med. 2019 Aug;7(8):687-698. https://doi.org/10.1016/s2213-2600(19)30198-5

3. Tietjens JR, Claman D, Kezirian EJ еt аl. Obstructive Sleep Apnea in Cardiovascular Disease: A Review of the Literature and Proposed Multidisciplinary Clinical Management Strategy. J Am Heart Assoc. 2019 Jan 8;8(1):e010440. PMID: 30590966; PMCID: PMC6405725. https://doi.org/10.1161/JAHA.118.010440

4. Tsioufis, C. et al. Association of obstructive sleep apnea with urinary albumin excretion in essential hypertension: a cross-sectional study. Am J Kidney Dis. 2008 Aug;52(2):285-93. https://doi.org/10.1053/j.ajkd.2008.05.001

5. Bulcun, E., Ekici, M., Ekici, A., Cimen, D. A. & Kisa, U. Microalbuminuria in obstructive sleep apnea syndrome. Sleep Breath. 2015 Dec;19(4):1191-7. https://doi.org/10.1007/s11325-015-1136-8

6. Jin Hean Koh, Claire Yi Jia Lim, Kvan Jie Ming Yam, Brian Sheng Yep Yeo, Adele Chin Wei Ng, Shaun Ray Han Loh, Pon Poh Hsu, Joshua Gooley, Chieh Suai Tan, Song Tar Toh, Bidirectional association of sleep disorders with chronic kidney disease: a systematic review and meta-analysis. Clinical Kidney Journal. 2024 Oct 18;17(11):sfae279. https://doi.org/10.1093/ckj/sfae279

7. Clinical guidelines for "Chronic Kidney Disease in Adults." Approved in 2024. Developer of the clinical guidelines: National Association of Nephrologists. (In Russ.) https://diseases.medelement.com/disease/хроническая-болезнь-почек-у-воззорлых-кр-рф-2024/18325

8. Tsioufis, C. et al. Association of obstructive sleep apnea with urinary albumin excretion in essential hypertension: a cross-sectional study. Am J Kidney Dis. 2008 Aug;52(2):285-93. https://doi.org/10.1053/j.ajkd.2008.05.001

9. Liu, M., Heizhati, M., Li, N. et al. Association between obstructive sleep apnea and 24-h urine protein quantification in patients with hypertension. Sci Rep. 2024 Sep 6;14(1):20876. https://doi.org/10.1038/s41598-024-71883-5

10. Lee YC, Hung SY, Wang HK, Lin CW, Wang HH, Chen SW, Chang MY, Ho LC, Chen YT, Liou HH, Tsai TC, Tseng SH, Wang WM, Lin SH, Chiou YY. Sleep apnea and the risk of chronic kidney disease: a nationwide population-based cohort study. Sleep. 2015 Feb 1;38(2):213-21. Erratum in: Sleep. 2015 Aug;38(8):1335. PMID: 25409108; PMCID: PMC4288602. https://doi.org/10.5665/sleep.4400

11. Abuyassin B, Badran M, Ayas NT, Laher I (2018) Intermittent hypoxia causes histological kidney damage and increases growth factor expression in a mouse model of obstructive sleep apnea. PLoS ONE 2018 Feb 1;13(2):e0192084. https://doi.org/10.1371/journal.pone.0192084

12. Liu M, Heizhati M, Li N, Gan L, Cai L, Yuan Y, Yao L, Li M, Li X, Aierken X, Wang H, Maitituersun A, Nuermaimaiti Q, Nusufujiang A, Hong J, Jiang W. Association between obstructive sleep apnea and 24-h urine protein quantification in patients with hypertension. Sci Rep. 2024 Sep 6;14(1):20876. PMID: 39242689; PMCID: PMC11379924. https://doi.org/10.1038/s41598-024-71883-5

13. Beaudin AE, Raneri JK, Ahmed SB, Hirsch Allen AJM, Nocon A, Gomes T, Gakwaya S, Series F, Kimoff J, Skomro RP, Ayas NT, Hanly PJ. Risk of chronic kidney disease in patients with obstructive sleep apnea. Sleep. 2022 Feb 14;45(2):zsab267. PMID: 34757390; PMCID: PMC8842337. https://doi.org/10.1093/sleep/zsab267

14. Zamarrón E, Jaureguizar A, García-Sánchez A, Díaz-Cambriles T, Alonso-Fernández A, Lores V, Mediano O, Troncoso-Acevedo F, Cabello-Pelegrín S, Morales-Ruíz E, Ramírez-Prieto MT, Valiente-Díaz MI, GómezGarcía T, Casitas R, Martínez-Cerón E, Galera R, Cubillos-Zapata C, García-Río F. Continuous Positive Airway Pressure Effect on Albuminuria Progression in Patients with Obstructive Sleep Apnea and Diabetic Kidney Disease: A Randomized Clinical Trial. Am J Respir Crit Care Med. 2023 Mar 15;207(6):757-767. PMID: 36342964. https://doi.org/10.1164/rccm.202206-1091OC

15. Hanly PJ, Unruh ML. Continuous Positive Airway Pressure Therapy for Chronic Kidney Disease in Patients with Obstructive Sleep Apnea: The Jury Is Still Out. Am J Respir Crit Care Med. 2023 Mar 15;207(6):657-659. PMID: 36480960; PMCID: PMC10037486. https://doi.org/10.1164/rccm.202211-2171ED

16. Chen R, Huang ZW, Lin XF, Lin JF, Yang MJ. Effect of continuous positive airway pressure on albuminuria in patients with obstructive sleep apnea: a meta-analysis. Sleep Breath. 2022 Mar;26(1):279-285. Epub 2021 May 15. PMID: 33990909. https://doi.org/10.1007/s11325-021-02393-1