Effect of obstructive sleep apnea treatment on renal function in patients with cardiovascular disease

Kelly A. Loffler, Emma Heeley, Ruth Freed, Craig S. Anderson, Ben Brockway, Alastair Corbett, Catherina L. Chang, James A. Douglas, Katherine Ferrier, Neil Graham, Garun S. Hamilton, Michael Hlavac, Nigel McArdle, John McLachlan, Sutapa Mukherjee, Matthew T. Naughton, Francis Thien, Alan Young, Ronald R. Grunstein, Lyle J. Palmer & 4 others Richard J. Woodman, Patrick J. Hanly, R. Doug McEvoy, on behalf of the SAVE (Sleep Apnea Cardiovascular Endpoints) Investigators

Research output: Contribution to journalArticleResearchpeer-review

11 Citations (Scopus)

Abstract

Rationale: Obstructive sleep apnea (OSA) is associated with impaired renal function, but uncertainty exists over whether OSA treatment can influence renal outcomes. Objectives: To determine the effects of continuous positive airway pressure (CPAP) on renal function in subjects with coexisting OSA and cardiovascular disease. Methods: This was a substudy of the international SAVE (Sleep Apnea Cardiovascular Endpoints) trial, in which 2,717 patients with moderate to severe OSA and established coronary or cerebrovascular disease were randomized to receive either CPAP plus usual care or usual care alone. Renal function and adverse renal events were compared between the CPAP (n = 102) and usual care (n = 98) groups. Glomerular filtration rate was estimated at randomization and at the end of follow-up, and the urinary albumin-to-creatinine ratio was measured at study exit. Measurements and Main Results: In 200 substudy participants (mean age, 64 yr; median, 4% oxygen desaturation index; 20 events/h; mean estimated glomerular filtration rate at baseline, 82 ml/min/ 1.73 m 2 ), the median (interquartile range) changes in estimated glomerular filtration rate (ml/min/1.73 m 2 /yr) were 21.64 (23.45 to 20.740) in the CPAP group and 22.30 (24.53 to 20.71) in the usual care group (P = 0.21) after a median of 4.4 years. There were no between-group differences in end-of-study urinary albumin-to-creatinine ratio or in the occurrence of serious renal or urinary adverse events during the trial. The level of CPAP adherence did not influence the findings. Conclusions: CPAP treatment of OSA in patients with cardiovascular disease does not alter renal function or the occurrence of renal adverse events.

Original languageEnglish
Pages (from-to)1456-1462
Number of pages7
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume196
Issue number11
DOIs
Publication statusPublished - 1 Dec 2017

Keywords

  • Albuminuria
  • Continuous positive airway pressure
  • Glomerular filtration rate
  • Obstructive sleep apnea
  • Randomized controlled trial

Cite this

Loffler, K. A., Heeley, E., Freed, R., Anderson, C. S., Brockway, B., Corbett, A., ... on behalf of the SAVE (Sleep Apnea Cardiovascular Endpoints) Investigators (2017). Effect of obstructive sleep apnea treatment on renal function in patients with cardiovascular disease. American Journal of Respiratory and Critical Care Medicine, 196(11), 1456-1462. https://doi.org/10.1164/rccm.201703-0603OC
Loffler, Kelly A. ; Heeley, Emma ; Freed, Ruth ; Anderson, Craig S. ; Brockway, Ben ; Corbett, Alastair ; Chang, Catherina L. ; Douglas, James A. ; Ferrier, Katherine ; Graham, Neil ; Hamilton, Garun S. ; Hlavac, Michael ; McArdle, Nigel ; McLachlan, John ; Mukherjee, Sutapa ; Naughton, Matthew T. ; Thien, Francis ; Young, Alan ; Grunstein, Ronald R. ; Palmer, Lyle J. ; Woodman, Richard J. ; Hanly, Patrick J. ; McEvoy, R. Doug ; on behalf of the SAVE (Sleep Apnea Cardiovascular Endpoints) Investigators. / Effect of obstructive sleep apnea treatment on renal function in patients with cardiovascular disease. In: American Journal of Respiratory and Critical Care Medicine. 2017 ; Vol. 196, No. 11. pp. 1456-1462.
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title = "Effect of obstructive sleep apnea treatment on renal function in patients with cardiovascular disease",
abstract = "Rationale: Obstructive sleep apnea (OSA) is associated with impaired renal function, but uncertainty exists over whether OSA treatment can influence renal outcomes. Objectives: To determine the effects of continuous positive airway pressure (CPAP) on renal function in subjects with coexisting OSA and cardiovascular disease. Methods: This was a substudy of the international SAVE (Sleep Apnea Cardiovascular Endpoints) trial, in which 2,717 patients with moderate to severe OSA and established coronary or cerebrovascular disease were randomized to receive either CPAP plus usual care or usual care alone. Renal function and adverse renal events were compared between the CPAP (n = 102) and usual care (n = 98) groups. Glomerular filtration rate was estimated at randomization and at the end of follow-up, and the urinary albumin-to-creatinine ratio was measured at study exit. Measurements and Main Results: In 200 substudy participants (mean age, 64 yr; median, 4{\%} oxygen desaturation index; 20 events/h; mean estimated glomerular filtration rate at baseline, 82 ml/min/ 1.73 m 2 ), the median (interquartile range) changes in estimated glomerular filtration rate (ml/min/1.73 m 2 /yr) were 21.64 (23.45 to 20.740) in the CPAP group and 22.30 (24.53 to 20.71) in the usual care group (P = 0.21) after a median of 4.4 years. There were no between-group differences in end-of-study urinary albumin-to-creatinine ratio or in the occurrence of serious renal or urinary adverse events during the trial. The level of CPAP adherence did not influence the findings. Conclusions: CPAP treatment of OSA in patients with cardiovascular disease does not alter renal function or the occurrence of renal adverse events.",
keywords = "Albuminuria, Continuous positive airway pressure, Glomerular filtration rate, Obstructive sleep apnea, Randomized controlled trial",
author = "Loffler, {Kelly A.} and Emma Heeley and Ruth Freed and Anderson, {Craig S.} and Ben Brockway and Alastair Corbett and Chang, {Catherina L.} and Douglas, {James A.} and Katherine Ferrier and Neil Graham and Hamilton, {Garun S.} and Michael Hlavac and Nigel McArdle and John McLachlan and Sutapa Mukherjee and Naughton, {Matthew T.} and Francis Thien and Alan Young and Grunstein, {Ronald R.} and Palmer, {Lyle J.} and Woodman, {Richard J.} and Hanly, {Patrick J.} and McEvoy, {R. Doug} and {on behalf of the SAVE (Sleep Apnea Cardiovascular Endpoints) Investigators}",
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Loffler, KA, Heeley, E, Freed, R, Anderson, CS, Brockway, B, Corbett, A, Chang, CL, Douglas, JA, Ferrier, K, Graham, N, Hamilton, GS, Hlavac, M, McArdle, N, McLachlan, J, Mukherjee, S, Naughton, MT, Thien, F, Young, A, Grunstein, RR, Palmer, LJ, Woodman, RJ, Hanly, PJ, McEvoy, RD & on behalf of the SAVE (Sleep Apnea Cardiovascular Endpoints) Investigators 2017, 'Effect of obstructive sleep apnea treatment on renal function in patients with cardiovascular disease', American Journal of Respiratory and Critical Care Medicine, vol. 196, no. 11, pp. 1456-1462. https://doi.org/10.1164/rccm.201703-0603OC

Effect of obstructive sleep apnea treatment on renal function in patients with cardiovascular disease. / Loffler, Kelly A.; Heeley, Emma; Freed, Ruth; Anderson, Craig S.; Brockway, Ben; Corbett, Alastair; Chang, Catherina L.; Douglas, James A.; Ferrier, Katherine; Graham, Neil; Hamilton, Garun S.; Hlavac, Michael; McArdle, Nigel; McLachlan, John; Mukherjee, Sutapa; Naughton, Matthew T.; Thien, Francis; Young, Alan; Grunstein, Ronald R.; Palmer, Lyle J.; Woodman, Richard J.; Hanly, Patrick J.; McEvoy, R. Doug; on behalf of the SAVE (Sleep Apnea Cardiovascular Endpoints) Investigators.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 196, No. 11, 01.12.2017, p. 1456-1462.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Effect of obstructive sleep apnea treatment on renal function in patients with cardiovascular disease

AU - Loffler, Kelly A.

AU - Heeley, Emma

AU - Freed, Ruth

AU - Anderson, Craig S.

AU - Brockway, Ben

AU - Corbett, Alastair

AU - Chang, Catherina L.

AU - Douglas, James A.

AU - Ferrier, Katherine

AU - Graham, Neil

AU - Hamilton, Garun S.

AU - Hlavac, Michael

AU - McArdle, Nigel

AU - McLachlan, John

AU - Mukherjee, Sutapa

AU - Naughton, Matthew T.

AU - Thien, Francis

AU - Young, Alan

AU - Grunstein, Ronald R.

AU - Palmer, Lyle J.

AU - Woodman, Richard J.

AU - Hanly, Patrick J.

AU - McEvoy, R. Doug

AU - on behalf of the SAVE (Sleep Apnea Cardiovascular Endpoints) Investigators

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Rationale: Obstructive sleep apnea (OSA) is associated with impaired renal function, but uncertainty exists over whether OSA treatment can influence renal outcomes. Objectives: To determine the effects of continuous positive airway pressure (CPAP) on renal function in subjects with coexisting OSA and cardiovascular disease. Methods: This was a substudy of the international SAVE (Sleep Apnea Cardiovascular Endpoints) trial, in which 2,717 patients with moderate to severe OSA and established coronary or cerebrovascular disease were randomized to receive either CPAP plus usual care or usual care alone. Renal function and adverse renal events were compared between the CPAP (n = 102) and usual care (n = 98) groups. Glomerular filtration rate was estimated at randomization and at the end of follow-up, and the urinary albumin-to-creatinine ratio was measured at study exit. Measurements and Main Results: In 200 substudy participants (mean age, 64 yr; median, 4% oxygen desaturation index; 20 events/h; mean estimated glomerular filtration rate at baseline, 82 ml/min/ 1.73 m 2 ), the median (interquartile range) changes in estimated glomerular filtration rate (ml/min/1.73 m 2 /yr) were 21.64 (23.45 to 20.740) in the CPAP group and 22.30 (24.53 to 20.71) in the usual care group (P = 0.21) after a median of 4.4 years. There were no between-group differences in end-of-study urinary albumin-to-creatinine ratio or in the occurrence of serious renal or urinary adverse events during the trial. The level of CPAP adherence did not influence the findings. Conclusions: CPAP treatment of OSA in patients with cardiovascular disease does not alter renal function or the occurrence of renal adverse events.

AB - Rationale: Obstructive sleep apnea (OSA) is associated with impaired renal function, but uncertainty exists over whether OSA treatment can influence renal outcomes. Objectives: To determine the effects of continuous positive airway pressure (CPAP) on renal function in subjects with coexisting OSA and cardiovascular disease. Methods: This was a substudy of the international SAVE (Sleep Apnea Cardiovascular Endpoints) trial, in which 2,717 patients with moderate to severe OSA and established coronary or cerebrovascular disease were randomized to receive either CPAP plus usual care or usual care alone. Renal function and adverse renal events were compared between the CPAP (n = 102) and usual care (n = 98) groups. Glomerular filtration rate was estimated at randomization and at the end of follow-up, and the urinary albumin-to-creatinine ratio was measured at study exit. Measurements and Main Results: In 200 substudy participants (mean age, 64 yr; median, 4% oxygen desaturation index; 20 events/h; mean estimated glomerular filtration rate at baseline, 82 ml/min/ 1.73 m 2 ), the median (interquartile range) changes in estimated glomerular filtration rate (ml/min/1.73 m 2 /yr) were 21.64 (23.45 to 20.740) in the CPAP group and 22.30 (24.53 to 20.71) in the usual care group (P = 0.21) after a median of 4.4 years. There were no between-group differences in end-of-study urinary albumin-to-creatinine ratio or in the occurrence of serious renal or urinary adverse events during the trial. The level of CPAP adherence did not influence the findings. Conclusions: CPAP treatment of OSA in patients with cardiovascular disease does not alter renal function or the occurrence of renal adverse events.

KW - Albuminuria

KW - Continuous positive airway pressure

KW - Glomerular filtration rate

KW - Obstructive sleep apnea

KW - Randomized controlled trial

UR - http://www.scopus.com/inward/record.url?scp=85038102416&partnerID=8YFLogxK

U2 - 10.1164/rccm.201703-0603OC

DO - 10.1164/rccm.201703-0603OC

M3 - Article

VL - 196

SP - 1456

EP - 1462

JO - American Journal of Respiratory and Critical Care Medicine

JF - American Journal of Respiratory and Critical Care Medicine

SN - 1073-449X

IS - 11

ER -