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Contemporary Reviews in Sleep Medicine |

Sleep Apnea and the KidneySleep Apnea and Chronic Kidney Disease: Is Sleep Apnea a Risk Factor for Chronic Kidney Disease?

Patrick J. Hanly, MD; Sofia B. Ahmed, MD, MMSc
Author and Funding Information

From the Division of Respiratory Medicine (Dr Hanly), Sleep Centre, Foothills Medical Centre; and Division of Nephrology (Dr Ahmed), Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.

CORRESPONDENCE TO: Patrick J. Hanly, MD, 1421 Health Sciences Centre, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada; e-mail: phanly@ucalgary.ca


FUNDING/SUPPORT: This study was supported by the Faculty of Medicine, Sleep Research Program, University of Calgary; Canadian Institutes of Health Research; and Alberta Innovates-Health Solutions.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(4):1114-1122. doi:10.1378/chest.14-0596
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The prevalence of chronic kidney disease (CKD) is increasing, which presents challenges for both patients and health-care budgets. Although this phenomenon has been attributed to the growth in diabetes, hypertension, and obesity, sleep apnea and nocturnal hypoxemia may also contribute to the pathogenesis of CKD and its progression to kidney failure. Two pathophysiologic mechanisms responsible for CKD are glomerular hyperfiltration and chronic intrarenal hypoxia, resulting in tubulointerstitial injury, the final common pathway to end-stage kidney disease (ESKD). Multiple descriptive studies have demonstrated an association between CKD and sleep apnea. Although sleep apnea is common in patients with CKD and associated with significant nocturnal hypoxemia, it is often relatively free of sleep-related symptoms, making it difficult to detect without objective nocturnal monitoring. Nevertheless, sleep apnea and nocturnal hypoxemia have been associated with loss of kidney function and kidney injury, suggesting that they contribute to the pathogenesis of continued deterioration in kidney function. There are several pathways through which sleep apnea may achieve this, including a direct effect of intrarenal hypoxia and activation of the systemic and renal renin-angiotensin system. Further research is required to better understand these relationships and determine whether specific interventions in patients with sleep apnea have an impact on clinical outcomes, such as reducing the prevalence of CKD and delaying its progression to ESKD.

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