Abstract
Background: Diabetes-related nephropathy (DN) is characterized by decreasing glomerular filtration rate (eGFR) and increasing urine albumin-to-creatinine ratio (UACR). Sleep-disordered breathing (SDB) may promote the development of DN. The aim of the present study was to assess whether SDB is correlated with renal impairment in patients with diabetes mellitus type 2 (DM2).
Methods: eGFR and UACR were determined in 679 patients with DM2. Patients were stratified according to the severity of SDB, defined as an apnea-hypopnea index (AHI) <15, ≥15 to 29 and ≥ 30 events per hour as no or mild, moderate and severe SDB, respectively.
Results: 228 (33.6%) patients had SDB of which 65 (9.6%) had severe SDB. SDB was significantly more frequent in men, in patients with higher body-mass-index, hypertension and in the elderly (each p<0.005), but not in patients with higher HbA1c (p>0.05). Higher classes of SDB were associated with a significantly lower eGFR [mean±SD] (no or mild, moderate, severe SDB: 79.7±19.5, 76.0±19.6 and 70.0±18.2 ml/min, p<0.001) and significantly higher ln(UACR) [median (IQR)] (9.0 (4.2-22.4), 11.9 (4.6-40.0) and 20.2 (5.4-63.2) mg/g, p<0.005). In a linear regression model with gender, age, body-mass-index, hypertension, HbA1c and AHI as covariates, only AHI (beta -0.08, p=0.02) and age (beta -0.54, p<0.001) showed significant and independent correlation with eGFR. AHI (beta 0.11, p<0.01), age (beta 0.08, p<0.05), HbA1c (beta 0.14, p<0.001) and hypertension (beta 0.24, p<0.001) were significantly and independently correlated with ln(UACR).
Conclusion: In patients with DM 2 SDB is an independent predictor for lower renal function and increased albuminuria.
- Copyright ©ERS 2015