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Meta-Analysis
. 2016 Feb 1;39(2):301-8.
doi: 10.5665/sleep.5432.

The Association between Obstructive Sleep Apnea on Diabetic Kidney Disease: A Systematic Review and Meta-Analysis

Wen Bun Leong  1 , Ferozkhan Jadhakhan  2 , Shahrad Taheri  3   4 , G Neil Thomas  5   6 , Peymané Adab  5
Affiliations
Meta-Analysis

The Association between Obstructive Sleep Apnea on Diabetic Kidney Disease: A Systematic Review and Meta-Analysis

Wen Bun Leong et al. Sleep. .

Abstract

Study objective: This systematic review aims to investigate the association between obstructive sleep apnea (OSA) and diabetic kidney disease (DKD).

Methods: MeSH terms and free text searches were performed on MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews from inception to April 2015. Zetoc and OpenGrey databases were queried for grey literature, and lastly, hand searches were carried out. Study selection and quality assessment were conducted by two authors. One author carried out data extraction, which was checked by other authors. The relationships between apneahypopnea index (AHI), oxygen desaturation index (ODI), time spent under 90% oxygen saturation (%TST < 90), and minimum and mean oxygen saturation (O2) on DKD were examined.

Results: Two longitudinal and ten cross-sectional studies were included for our narrative synthesis, and seven studies for meta-analysis. Studies that performed multi-variable analysis demonstrated significant associations between OSA (assessed using either apnea-hypopnea index or ODI) and DKD in type 2 diabetes mellitus (T2DM). This was confirmed by meta-analysis (pooled OR 1.73, 95% CI: 1.13-2.64). There was some evidence to suggest that %TST < 90 may have an association with DKD. There was insufficient evidence to conclude on the relationship between minimum and mean oxygen saturation on DKD. There was no evidence available on the associations between OSA and other respiratory parameters in type 1 diabetes mellitus populations.

Conclusions: There is moderate evidence that OSA is associated with DKD in patients with T2DM. Large prospective studies with long-term follow up are needed to assess the possible bi-directional mechanisms between OSA and DKD.

Keywords: airway; albuminuria; apnea; creatinine; diabetes mellitus; glomerular filtration rate; nephropathy; nocturnal hypoxemia.

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Figures

Figure 1
Figure 1
PRISMA flow chart on study selection. *Meta-analysis carried out in 7 studies which reported on unadjusted odds ratios. $Meta-analysis carried on 4 studies which reported on adjusted odds ratios. OSA, obstructive sleep apnea; DKD, diabetes kidney disease; DM, diabetes mellitus.
Figure 2
Figure 2
Forest plot of the association between obstructive sleep apnea (OSA) and diabetic kidney disease using results from studies which reported adjusted odd ratios and 95% confidence intervals. Furukawa 2013 and Tanaka 2009 diagnosed OSA using 3% ODI ≥ 5 events/h while Tahrani 2013 and Zhang 2014 diagnosed OSA based on AHI ≥ 5 events/h.
See this image and copyright information in PMC

References

    1. Resnick HE, Redline S, Shahar E, et al. Diabetes and sleep disturbances: findings from the Sleep Heart Health Study. Diabetes Care. 2003;26:702–9. - PubMed
    1. Aronsohn RS, Whitmore H, Van Cauter E, Tasali E. Impact of untreated obstructive sleep apnea on glucose control in type 2 diabetes. Am J Respir Crit Care Med. 2010;181:507–13. - PMC - PubMed
    1. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342:1378–84. - PubMed
    1. Guest JF, Panca M, Sladkevicius E, Taheri S, Stradling J. Clinical outcomes and cost-effectiveness of continuous positive airway pressure to manage obstructive sleep apnea in patients with type 2 diabetes in the U.K. Diabetes Care. 2014;37:1263–71. - PubMed
    1. Tan KC, Chow WS, Lam JC, et al. Advanced glycation endproducts in nondiabetic patients with obstructive sleep apnea. Sleep. 2006;29:329–33. - PubMed

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