Details

Autor(en) / Beteiligte

• Zamarrón, Ester
• Jaureguizar, Ana
• García-Sánchez, Aldara
• Díaz-Cambriles, Trinidad
• Alonso-Fernández, Alberto
• Lores, Vanesa
• Mediano, Olga
• Troncoso-Acevedo, Fernanda
• Cabello-Pelegrín, Sheila
• Morales-Ruíz, Enrique
• Ramírez-Prieto, María T
• Valiente-Díaz, María Isabel
• Gómez-García, Teresa
• Casitas, Raquel
• Martínez-Cerón, Elisabet
• Galera, Raúl
• Cubillos-Zapata, Carolina
• García-Río, Francisco

Titel

Continuous Positive Airway Pressure Effect on Albuminuria Progression in Patients with Obstructive Sleep Apnea and Diabetic Kidney Disease: A Randomized Clinical Trial

Ist Teil von

• American journal of respiratory and critical care medicine, 2023-03, Vol.207 (6), p.757-767

Ort / Verlag

United States: American Thoracic Society

Erscheinungsjahr

2023

Quelle

MEDLINE

Beschreibungen/Notizen

• Obstructive sleep apnea (OSA) is associated with impaired glycemic control and a higher risk of vascular complications, such as diabetic kidney disease (DKD). However, the effect of apnea-hypopnea suppression on DKD progression is unclear. To assess the effect of continuous positive airway pressure (CPAP) on the urinary albumin-to-creatinine ratio (UACR) in patients with DKD and OSA. In a 52-week, multicentric, open-label, parallel, and randomized clinical trial, 185 patients with OSA and DKD were randomized to CPAP and usual care (  = 93) or usual care alone (  = 92). UACR, estimated glomerular filtration rate, serum concentrations of creatinine and glycated hemoglobin, insulin resistance, lipid concentrations, sleepiness, and quality of life. A 52-week change in UACR from baseline did not differ significantly between the CPAP group and the usual-care group. However, in per-protocol analyses that included 125 participants who met prespecified criteria for adherence, CPAP treatment was associated with a great reduction in UACR (mean difference, -10.56% [95% confidence interval, -19.06 to -2.06];  = 0.015). CPAP effect on UACR was higher in nonsleepy patients with more severe OSA, worse renal function, and a more recent diagnosis of DKD. CPAP treatment also improved glycemic control and insulin resistance, as well as sleepiness and health-related quality of life. In patients with OSA and DKD, the prescription of CPAP did not result in a statistically significant reduction in albuminuria. However, good adherence to CPAP treatment in addition to usual care may result in long-term albuminuria reduction compared with usual care alone. Clinical trial registered with www.clinicaltrials.gov (NCT02816762).