AHA23: Unexpected Link Between Sleep Apnea and Cardiovascular Events in Kidney Disease Patients

MedicalResearch.com Interview with:

Lead Author: Rupak Desai, MBBS
Atlanta Veterans Affairs Medical Center
Independent Researcher, Atlanta, GA,

Presenter: Vamsikalyan Borra, MD
Resident Physician, Internal Medicine
University of Texas Rio Grande Valley, Weslaco, TX

MedicalResearch.com: What is the background for this study?

Response: The relationship between sleep apnea (OSA) and chronic kidney disease (CKD) is quite complex. OSA can cause hypoxia, activation of the sympathetic nervous system, and hypertension, all of which can have negative effects on kidney function. On the other hand, in patients with end-stage renal disease (ESRD), intensifying renal replacement therapy has shown some improvement in sleep apnea severity, suggesting a bi-directional relationship between the two conditions. While there are still uncertainties, recent studies have focused on understanding the interplay between OSA and CKD.

The role of CPAP therapy, a common treatment for OSA, in relation to CKD is not yet clear. Observational studies present findings regarding the impact of CPAPs on kidney function. However, researchers are actively investigating its cardiovascular benefits and its influence on the progression of CKD.

The objective of this study is to analyze the trends in composite cardiovascular events in hospital encounters among geriatric patients with CKD, comparing those with and without obstructive sleep apnea. Additionally, we are also investigating sex and racial disparities in trends of major adverse cardiovascular and cerebrovascular events (MACCE) among geriatric patients with obstructive sleep apnea (OSA). Furthermore, we are assessing the impact of continuous positive airway pressure (CPAP) treatment and dependence on MACCE outcomes in OSA patients

MedicalResearch.com: What are the main findings?

Response:  Even though MACCE (major adverse cardiac and cerebrovascular events) are up-trending in both OSA and non-OSA cohorts among older CKD patients from 2016–2019, the overall prevalence is low among the OSA cohort, indicating a paradoxical association.

The OSA cohort also had a lower rate of all-cause mortality (3.2% vs. 4.7%),  acute myocardial infarction (AMl) (6.3% vs. 7.2%), and cardiac arrest (1.0% vs. 1.3%), with p<0.001. Patients on BiPAP/CPAP therapy have further decreased odds of MACCE, which is statistically significant (p<0.001).

In the OSA group, men had an increased prevalence of major adverse cardiovascular and cerebrovascular events (MACCE) (12.0% v/s 9.7%) and acute myocardial infarction (AMl) (7.0%–5.2%) with p<0.001.

The adjusted odds of MACCE in CKD patients were lower in the OSA cohort (aOR 0.80), which further decreased for patients on CPAP/BiPAP treatment (aOR 0.69). Males and Asian/Pacific Islanders had a higher prevalence of composite MACCE events. 

MedicalResearch.com: What should readers take away from your report?

Response: CPAP/BiPAP may have improved MACEE in CKD patients with OSA. The low prevalence of MACCE in OSA compared to those without OSA in CKD patients can also be attributed to the difference in cardiovascular disease risk factors like obesity, diabetes mellitus, and hyperlipidemia in CKD patients. The unexpected link between sleep apnea (OSA) and a lower likelihood of cardiovascular events goes against what we typically believe, as OSA is generally seen as a risk factor for heart health. Possible explanations for this paradox include the body’s adaptability to oxygen deprivation, the positive effects of preconditioning on the cardiovascular system, and the influence of other comorbid medical conditions. Future prospective studies are required to explore this association further.

MedicalResearch.com: What recommendations do you have for future research as a results of this study?

Response: We should prioritize longitudinal studies to assess the evolving impact of OSA and associated treatments, like  BiPAP/CPAP therapy on CKD patients’ long-term cardiovascular outcomes Investigating sex and racial disparities, exploring the impact of different renal replacement therapies, and conducting mechanistic studies are crucial for a comprehensive understanding of the intricate pathways connecting OSA, CKD, and MACCE.
Developing risk stratification models, assessing sleep quality comprehensively, prioritizing patient-centered outcomes, studying healthcare utilization patterns, and fostering multidisciplinary research will further enhance our knowledge and guide personalized interventions for improved patient management in CKD.

No disclosures.

Citation: AHA23 Sessions-A15816

Contemporary Nationwide Trends in Major Adverse Cardiovascular and Cerebrovascular Events Among Elderly Chronic Kidney Disease Patients With versus Without Obstructive Sleep Apnea and Associated Sex and Racial Disparities, 2016-2019

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Last Updated on November 15, 2023 by Marie Benz