Abstract: TH-PO454

Obstructive Sleep Apnea and Cardiovascular Outcomes in CKD Patients

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

  • Loivos, Claudio Pinheiro, State University of Rio de Janeiro, Rio de Janeiro, Brazil
  • Fernandes, Julia F, State University of Rio de Janeiro, Rio de Janeiro, Brazil
  • Meira, Vagner Silva, State University of Rio de Janeiro, Rio de Janeiro, Brazil
  • Lemos, Carla C.S., State University of Rio de Janeiro, Rio de Janeiro, Brazil
  • Kaiser, Sergio E, State University of Rio de Janeiro, Rio de Janeiro, Brazil
  • Klein, Márcia RST, State University of Rio de Janeiro, Rio de Janeiro, Brazil
  • Barreto-Silva, Maria Ines, State University of Rio de Janeiro, Rio de Janeiro, Brazil
  • Bregman, Rachel, State University of Rio de Janeiro, Rio de Janeiro, Brazil
Background

Chronic kidney disease (CKD) is a non-traditional risk factor for cardiovascular disease (CVD). The frequency of obstructive sleep apnea (OSA) in this population is not well established. CVD and hypertension are related to OSA. The aim was to investigate the presence of OSA in CKD patients, its relation with blood pressure (BP) and cardiovascular outcomes.

Methods

Longitudinal study including 74 CKD patients stages 3b-4 (eGFR: CKD-EPI) under regular treatment, for 21 months. Sleep study was performed with the equipment Watch-PAT200®. OSA diagnosis: apnea-hipopnea index (AHI) ≥ 5 events/h, mild: AHI ≥ 5 ≤ 15, moderate: AHI > 15 ≤ 30, severe: AHI > 30 events/h. Blood pressure (BP) evaluated in office and by 24-hour ambulatory BP monitoring (ABPM). Statistics: SPSS 20

Results

Mean age 63.2 ± 9.3 years, 55% men. Mean eGFR: 28.7 ± 8.3 ml/min/1.73m2, 64% CKD stage 4. All patients were under regular treatment for at least 6 months. OSA was present in 70.3% (OSA group, n=52), of which mild form: 50%, moderate: 33%, severe: 17%. Office BP in OSA group, showed higher systolic (SBP) values (153 ± 23 vs 140 ± 17 mmHg, p=0.016) and pulse pressure (PP) (71 ± 21 vs 60 ± 15 mmHg, p=0.034). ABPM showed higher values for SBP and PP in all periods (p < 0.05). When comparing patients from stages 3b and 4, no differences were observed in office BP and ABPM. AHI showed a correlation with: 24-hour mean PP (R=0.274, p=0.033), daytime PP (R=0.281, p=0.028), SBP and diastolic BP in all periods (p<0.05) regardless eGFR values. Among nondippers 77.8% presented OSA. All cardiovascular events (n=7, acute myocardial infarction and/or cerebrovascular accident) occurred in patients with OSA

Conclusion

CKD patients 3b-4 presented high OSA frequency. OSA was associated with higher SBP and PP, both in office measurements and in ABPM, despite a higher usage of antihypertensive drugs in this group. We suggest that the presence of OSA as well as systolic hypertension might be modifiable risk factors for CVD in CKD (3b-4) patients.