Kelly A Loffler1, Emma Heeley1,2, Ruth Freed2, Craig S Anderson1,2,3,4,5, Ben Brockway6, Alastair Corbett4,7, Catherina L Chang8, James A Douglas9, Katherine Ferrier10, Neil Graham11, Garun S Hamilton12,13, Michael Hlavac14, Nigel McArdle15, John McLachlan8, Sutapa Mukherjee1,15,16, Matthew T Naughton17, Francis Thien18, Alan Young18, Ronald R Grunstein19,20, Lyle J Palmer21, Richard J Woodman22, Patrick J Hanly23, R Doug McEvoy1,16. 1. 1 Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence and. 2. 2 The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia. 3. 3 Neurology Department and. 4. 4 Central Clinical School and. 5. 5 The George Institute China at Peking University Health Science Center, Beijing, China. 6. 6 Dunedin Hospital, Dunedin, New Zealand. 7. 7 Concord Repatriation General Hospital, Sydney, New South Wales, Australia. 8. 8 Department of Respiratory & Sleep Medicine, Waikato Hospital, Hamilton, New Zealand. 9. 9 The Prince Charles Hospital, Brisbane, Queensland, Australia. 10. 10 Hutt Hospital, Lower Hutt, New Zealand. 11. 11 Tauranga Hospital, Tauranga, New Zealand. 12. 12 Monash Health, Melbourne, Victoria, Australia. 13. 13 School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia. 14. 14 Christchurch Hospital, Christchurch, New Zealand. 15. 15 West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia. 16. 16 Sleep Health Service, Southern Adelaide Local Health Network, Repatriation General Hospital, Daw Park, South Australia, Australia. 17. 17 Alfred Hospital & Monash University-Centre of Clinical Research Excellence Clinical Trial Centre, Melbourne, Victoria, Australia. 18. 18 Eastern Health and Monash University, Melbourne, Victoria, Australia. 19. 20 Respiratory and Sleep Medicine Department, Royal Prince Alfred Hospital, Sydney Health Partners, Sydney, New South Wales, Australia. 20. 19 Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia. 21. 21 School of Public Health, University of Adelaide, Adelaide, Australia; and. 22. 22 Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Bedford Park, South Australia, Australia. 23. 23 Sleep Centre, Foothills Medical Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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 m2), the median (interquartile range) changes in estimated glomerular filtration rate (ml/min/1.73 m2/yr) were -1.64 (-3.45 to -0.740) in the CPAP group and -2.30 (-4.53 to -0.71) 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. Clinical trial registered with www.clinicaltrials.gov (NCT00738179).
RCT Entities:
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 m2), the median (interquartile range) changes in estimated glomerular filtration rate (ml/min/1.73 m2/yr) were -1.64 (-3.45 to -0.740) in the CPAP group and -2.30 (-4.53 to -0.71) 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. Clinical trial registered with www.clinicaltrials.gov (NCT00738179).
Authors: Alex N Rimke; Sofia B Ahmed; Tanvir C Turin; Sachin R Pendharkar; Jill K Raneri; Emma J Lynch; Patrick J Hanly Journal: BMJ Open Date: 2019-03-23 Impact factor: 2.692