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Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
Sleep Apnea And Kidney Disease
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Sleep Apnea And Kidney Disease

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This presentation describes the relationship between Sleep Apnea and Kidney Disease.

This presentation describes the relationship between Sleep Apnea and Kidney Disease.

Published in: Health & Medicine
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  • Thank for sharing this presentation. I founded Omnisleep Solutions for sleep apnea treatment in India and am creating awareness among the medical community about the risks and comorbidities from sleep apnea. Once again, thanks for sharing this.
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  • Thank you for posting this interesting blog. :) I really appreciate the content of this blog .. We must need to take good care of our Kidney. specially into kidney disease diet .. I am looking forward to see more content like this .. Keep on posting.. It helps a lot!

    If you have time you can also visit this site that I managed to surf in:
    Kidney Failure Treatment and Kidney Disease Symptoms
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  • 1. Sleep Apnea & Kidney Disease Ed Charnock, M.D Jack Gardner, M.D. Medical Sleep Solutions www.medicalsleep.com
  • 2. OSA DISCUSSIONS <ul><li>Prevalence of Sleep Apnea </li></ul><ul><li>Medical complications of Sleep Apnea </li></ul><ul><li>Renal complications of Sleep Apnea </li></ul><ul><li>Screening for Sleep Apnea </li></ul><ul><li>Treatment- Does it make a difference? </li></ul>
  • 3. OSA & OBESITY <ul><li>General Population </li></ul><ul><ul><li>2 – 4 % Wisconsin Cohort Study 1988 </li></ul></ul><ul><ul><li>6% Female – 10% Male Young, et al 1993 </li></ul></ul><ul><ul><li>5% Female – 17% Male Bixler, et al 2001 </li></ul></ul><ul><li>Obesity is the major cause of OSA </li></ul><ul><li>50% of obese people have OSA </li></ul>
  • 4. OBESITY No data <10% 10%-14% 15%-19%
  • 5. OBESITY No Data < 10% 10%-14% 15%-19% 20%-24% 25%-29% ≥ 30%
  • 6.  
  • 7.  
  • 8. OSA & OBESITY <ul><li>72 Million Obese Adults </li></ul><ul><li>36 Million have OSA </li></ul><ul><li>12% of Adults with OSA </li></ul><ul><li>This estimate does not include non-obese adults with OSA </li></ul><ul><li>Javaheri, Univ. Cinncinati, NWPSA Conference </li></ul>
  • 9. SLEEP APNEA <ul><li>Hypertension </li></ul><ul><li>Heart attack </li></ul><ul><li>Stroke </li></ul><ul><li>CHF </li></ul><ul><li>Cardiac arrhythmia </li></ul><ul><li>Inflammatory factors </li></ul><ul><li>Glucose intolerance – Insulin resistance </li></ul><ul><li>Increased incidence of MVA’s </li></ul><ul><li>Progression of chronic kidney disease? </li></ul>
  • 10. HTN - OSA <ul><li>OSA is a primary cause of hypertension </li></ul><ul><li>JNC 7 REPORT; JAMA, 2003 </li></ul><ul><li>OSA is an independent risk factor for hypertension Pankow Chest 1997 Nov 5, 112(5): 1253-8 </li></ul><ul><li>Curr Opin Neprol & Hypertens. 2004 May 13(3) 359-364 </li></ul><ul><li>OSA may be responsible for 30% of cases </li></ul><ul><li>of essential hypertension </li></ul><ul><li>Silverberg Curr Opin Nephrol Hypertens. 1998 Jul;7(4):353-7 </li></ul>
  • 11.  
  • 12. <ul><li>41 patients – BP 140/90 on 3 or more anti-hypertensives </li></ul><ul><li>96% of the men and 65% of the women had OSA with AHI > 10. </li></ul><ul><li>Logan et al J Hypertension 2001 Dec;19(12):2271-7 </li></ul>
  • 13. OSA - HTN Epidemiological studies showing association of OSA with HTN are not the proof of causality. Only well done randomized placebo- controlled trials showing that elimination of OSA improves HTN prove that OSA is a cause of HTN.
  • 14. OSA - HTN <ul><li>Pepperell et al, Lancet 2001 </li></ul><ul><li>Becker et al, Circulation 2003 </li></ul><ul><li>Coughlin et al, ERJ, 2007 </li></ul>
  • 15. OSA - HTN <ul><li>In hypertensive patients with moderate to severe OSA, there is a BP drop of about 5-10mm Hg with CPAP therapy </li></ul><ul><li>The key is effective therapy and adherence to CPAP </li></ul><ul><li>The short term reduction in BP occurs within a few weeks </li></ul>
  • 16. OSA - HTN 9 Prospective Studies; N= 420,000; Mean F/U 10 Y Decrease in DB, mm Hg 5 7.5 10 Decrease in CHD, % 21 29 37 Decrease in stroke, % 34 46 56 Mac Mahon et al. Lancet. 1999
  • 17. ATHEROSCLEROSIS Kohler, AJRCCM, 2007 Drager, AJRCCM, 2005 Savransky, AJRCCM, 2007
  • 18. Atherosclerosis <ul><li>Reduction of early signs of atherosclerosis </li></ul><ul><li>Reduction on arterial stiffness </li></ul><ul><li>Reduction of intima-media thickness </li></ul><ul><li>Drager, AJRCCM, 2007 </li></ul>
  • 19. ARRHYTHMIA Tachy-brady arrhythmias: Most common Atrial: Sinus Arrest, Atrial Fibrillation AV nodal: Complete Heart Block Ventricular: PVC’s. VT Effective CPAP therapy decreases nocturnal arrhythmias (CSA & OSA)
  • 20. ARRHYTHMIA <ul><li>45 patients with OSA- mean AHI 50 </li></ul><ul><ul><li>8 had nocturnal pathologic rhythm </li></ul></ul><ul><ul><li>Severity of rhythm disturbance correlated with OSA severity </li></ul></ul><ul><ul><li>Rhythm normalized in 7of 8 patients </li></ul></ul><ul><ul><li>The 8 th patient had severe aortic valve disease. </li></ul></ul><ul><ul><li>Harbison Chest 2000 Sep;118(3):591-5 </li></ul></ul>
  • 21. 100 out of 114 consecutive patients AHI ≥ 5/h (mild) 68% AHI ≥ 15/h (moderate) 49% Javaheri : Ann Intern Med 1995 Circulation 1998 Int J Cardiol 2006
  • 22. OSA - SHF
  • 23.  
  • 24.  
  • 25.  
  • 26. <ul><li>Our screen </li></ul>NPSG
  • 27. <ul><li>Our screen </li></ul>CPAP
  • 28. <ul><li>Our screen </li></ul>AUTO-SV
  • 29. SLEEP APNEA <ul><li>50–73% on dialysis have sleep apnea </li></ul><ul><li>Chest 2009; 135:710-716 </li></ul><ul><li>Strong association with severe OSA </li></ul><ul><li>More sleep time with oxygen <90% </li></ul><ul><li>Sleepiness often attributed to uremia </li></ul><ul><li>Higher incidence of HTN & DM </li></ul><ul><li>Increased cTnT and CRP indicating cardiac </li></ul><ul><li>stress and inflammation </li></ul>
  • 30. SLEEP APNEA <ul><li>Sleep Apnea is complex with central and obstructive components </li></ul><ul><li>Traditional risk factors, plus – </li></ul><ul><ul><li>Decreased pharyngeal cross section </li></ul></ul><ul><ul><li>Increased chemosensitivity causing destabilization of respiratory control </li></ul></ul><ul><ul><li>Accumulation of toxins and cytokines, particularly TNF-alpha and IL-6 </li></ul></ul><ul><li>80% have sleep disorders including insomnia, PLMS, RLS, circadian rhythm disturbance </li></ul>
  • 31. CKD <ul><li>20-40% increased risk of sleep apnea in early CKD </li></ul><ul><li>Chest 2009:135: 710-716 </li></ul><ul><li>CKD – an independent risk factor for OSA </li></ul><ul><li>30% increase in CKD in past decade </li></ul><ul><li>Mostly attributed to rising rates of DM and HTN </li></ul><ul><li>Association -- sleep apnea and earlier CKD??? </li></ul><ul><li>Known pathologic mechanisms make it conceivable that sleep apnea may contribute to the development and progression of CKD </li></ul>
  • 32. CKD <ul><li>Reactive oxidative stress is associated with </li></ul><ul><li>recurrent hypoxia with ischemia </li></ul><ul><li>OSA is associated with “non-dippers” </li></ul><ul><li>Progression of CKD is greater in “non-dippers” </li></ul><ul><li>CPAP reverses “non-dippers” </li></ul><ul><li>CPAP therapy reduces inflammatory factors associated with endothelial dysfuntion </li></ul><ul><li>CPAP therapy may reduce proteinurea </li></ul>
  • 33. HTN RATE 28% in pts without OSA or CKD 50% in pts with OSA 70% in pts with OSA and CKD Numerous RCT’s in DM & non-DM pts with early renal insufficiency reveal that lowering blood pressure is associated with slowing the progression of CKD.
  • 34. <ul><li>Early intervention is KEY to preservation </li></ul><ul><li>of renal function. </li></ul><ul><li>Does CPAP therapy stabilize and prevent or slow the progression of kidney disease? </li></ul>
  • 35. CLINICAL <ul><li>Less likely to be obese </li></ul><ul><li>Frequently don’t snore </li></ul><ul><li>Daytime sleepiness often attributed </li></ul><ul><li>to uremia </li></ul><ul><li>Underdiagnosed </li></ul>
  • 36. PROCESS
  • 37. INTERFACES
  • 38. BENEFITS <ul><li>Better blood pressure control </li></ul><ul><li>Lower MI and CVA risk </li></ul><ul><li>Fewer arrhythmias </li></ul><ul><li>Lower mortality </li></ul><ul><li>Slow the progression of renal failure </li></ul><ul><li>Improved diabetes control </li></ul><ul><li>Better quality of life </li></ul>
  • 39. ACCREDITED AASM <ul><li>Improve health and QOL of your patients </li></ul><ul><li>Management of associated sleep disorders </li></ul><ul><li>Board Certified Sleep Specialists </li></ul><ul><li>Accredited Sleep Disorders Center by the AASM </li></ul><ul><li>20 years experience in sleep medicine </li></ul><ul><li>Education / Compliance Program </li></ul><ul><li>Complete management – dental, DME, follow-up </li></ul><ul><li>Research Opportunities </li></ul>
  • 40. Ed Charnock, M.D echarnock@medicalsleep.com Jack Gardner, M.D. [email_address] Medical Sleep Solutions www.medicalsleep.com

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