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Sleep Apnea And Kidney Disease


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

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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!

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    Kidney Failure Treatment and Kidney Disease Symptoms
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Sleep Apnea And Kidney Disease

  1. 1. Sleep Apnea & Kidney Disease Ed Charnock, M.D Jack Gardner, M.D. Medical Sleep Solutions
  2. 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. 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. 4. OBESITY No data <10% 10%-14% 15%-19%
  5. 5. OBESITY No Data < 10% 10%-14% 15%-19% 20%-24% 25%-29% ≥ 30%
  6. 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>
  7. 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>
  8. 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>
  9. 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>
  10. 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.
  11. 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>
  12. 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>
  13. 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
  14. 17. ATHEROSCLEROSIS Kohler, AJRCCM, 2007 Drager, AJRCCM, 2005 Savransky, AJRCCM, 2007
  15. 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>
  16. 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)
  17. 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>
  18. 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
  19. 22. OSA - SHF
  20. 26. <ul><li>Our screen </li></ul>NPSG
  21. 27. <ul><li>Our screen </li></ul>CPAP
  22. 28. <ul><li>Our screen </li></ul>AUTO-SV
  23. 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>
  24. 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>
  25. 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>
  26. 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>
  27. 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.
  28. 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>
  29. 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>
  30. 36. PROCESS
  31. 37. INTERFACES
  32. 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>
  33. 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>
  34. 40. Ed Charnock, M.D Jack Gardner, M.D. [email_address] Medical Sleep Solutions