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Original Research: SLEEP MEDICINE |

Sleep Apnea in Early and Advanced Chronic Kidney Disease: Kaiser Permanente Southern California Cohort

John J. Sim, MD; Scott A. Rasgon, MD; Dean A. Kujubu, MD; Victoria A. Kumar, MD; In Lu A. Liu, MS; Jiaxiao M. Shi, PhD; Tam T. Pham, MD; Stephen F. Derose, MD, MS
Author and Funding Information

*From the Division of Nephrology and Hypertension (Drs. Sim, Rasgon, Kujubu, Kumar, and Pham), Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA; and the Department of Research and Evaluation (Ms. Liu, and Drs. Shi and Derose), Kaiser Permanente Southern California, Pasadena, CA.

Correspondence to: John J. Sim, MD, Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, 4700 Sunset Blvd, Los Angeles, CA 90027; e-mail: John.j.sim@kp.org


Dr. Derose had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

This research was supported in part by grant No. 5R21DK064598 from the National Institute of Diabetes and Digestive and Kidney Diseases (to Dr. Derose).

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2009;135(3):710-716. doi:10.1378/chest.08-2248
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Background:  Sleep apnea (SA) has been reported to be highly prevalent in the dialysis population. The reported rates of SA in dialysis are severalfold greater than the 2 to 4% estimated in the general population. This study sought to determine whether an association exists between SA and early stages of chronic kidney disease (CKD) where SA may represent an important comorbidity and potential risk factor in kidney disease.

Methods:  Cross-sectional study of adults from an integrated health plan with documented serum creatinine levels in the period January 1, 2002, through December 31, 2004. SA diagnosis determined by International Classification of Diseases, ninth revision, coding for SA and Current Procedural Terminology coding for positive airway pressure devices. Kidney function was determined by the estimated glomerular filtration rate (eGFR). Logistic was regression used to estimate the relative risk for SA.

Results:  The overall prevalence of SA was 2.5% in the study population that included subjects with normal renal function and those with CKD. The odds ratios (ORs) for SA by eGFRs of 75 to 89, 60 to 74, 45 to 59, 30 to 44, and 15 to 29 mL/min per 1.73 m2, respectively, compared to normal kidney function, after adjustment for age, sex, and number of visits, were as follows: 1.22 (95% confidence interval [CI], 1.18 to 1.25); 1.32 (95% CI, 1.27 to 1.37); 1.42 (95% CI, 1.35 to 1.50); 1.37 (95% CI, 1.25 to 1.50); and 1.32 (95% CI, 1.13 to 1.55). The increased ORs for eGFRs > 45 mL/min per 1.73 m2 were sustained even after controlling for diabetes, heart failure, and hypertension.

Conclusion:  This study demonstrated an increased risk of SA in patients with early CKD. Further evidence of a causal relationship should be sought in the hope that the detection and management of SA may improve the course of CKD.

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