The impact of hypoxemia on nephropathy in extremely obese patients with type 2 diabetes mellitus

Wen Bun Leong, Melissa Nolen, G. Neil Thomas, Paymanè Adab, Dev Banerjee, Shahrad Taheri

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Study Objectives: Diabetes mellitus (DM) is associated with obstructive sleep apnea (OSA) and nephropathy. The hypoxemia associated with OSA may exacerbate renal deterioration in DM nephropathy. We examined the role of hypoxemia in the development of DM nephropathy in severely obese patients. Methods: This cross-sectional study examined anonymized data from 90 DM patients with extreme obesity attending a weight management service. All patients underwent a routine overnight sleep study. Respiratory parameters measured included apnea-hypopnea index (AHI), mean and minimum oxygen (O2) saturations, and time spent under 90% O2 saturation (%TST < 90%). Chronic kidney disease (CKD+) was defi ned as estimated glomerular fi ltration rate (eGFR) ≤ 60 mL/min/1.73 m2. Results: Twenty (22%) patients were CKD+. These patients were 7 years older (mean age ± SD 57 ± 11 years, p = 0.003) and had greater adiposity (mean body mass index [BMI] ± SD 50.6 ± 8.7 kg/m2, p = 0.012). No signifi cant differences were found for median AHI and minimum O2 saturation. %TST < 90% was 4 times greater in CKD+ group (p = 0.046). Multivariate regression analysis showed that AHI (β = -0.17, 95% CI: -0.316 to -0.024) and %TST < 90% (β = -0.215, 95% CI: -0.406 to -0.023) were negatively correlated with eGFR after adjustment for age, gender, BMI, comorbidities, insulin treatment, and drugs affecting the renin-angiotensin system. No associations were found between mean and minimum O2 saturations, and eGFR. Conclusion: Apnea and hypopnea events as well as duration of nocturnal hypoxemia were inversely associated with renal function after adjusting for potential confounders. Given the signifi cant burden of renal disease in diabetes, greater vigilance is required in identifying OSA in DM patients with extreme obesity.

Original languageEnglish
Pages (from-to)773-778
Number of pages6
JournalJournal of Clinical Sleep Medicine
Volume10
Issue number7
DOIs
Publication statusPublished - 2014

Fingerprint

Type 2 Diabetes Mellitus
Apnea
Diabetes Mellitus
Obstructive Sleep Apnea
Kidney
Body Mass Index
Obesity
Adiposity
Renin-Angiotensin System
Chronic Renal Insufficiency
Hypoxia
Comorbidity
Sleep
Multivariate Analysis
Cross-Sectional Studies
Regression Analysis
Insulin
Oxygen
Weights and Measures
Pharmaceutical Preparations

Keywords

  • Diabetes mellitus
  • Diabetes nephropathy
  • Extreme obesity
  • Obstructive sleep apnea
  • Sleep disordered breathing

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Neurology
  • Clinical Neurology

Cite this

The impact of hypoxemia on nephropathy in extremely obese patients with type 2 diabetes mellitus. / Leong, Wen Bun; Nolen, Melissa; Thomas, G. Neil; Adab, Paymanè; Banerjee, Dev; Taheri, Shahrad.

In: Journal of Clinical Sleep Medicine, Vol. 10, No. 7, 2014, p. 773-778.

Research output: Contribution to journalArticle

Leong, Wen Bun ; Nolen, Melissa ; Thomas, G. Neil ; Adab, Paymanè ; Banerjee, Dev ; Taheri, Shahrad. / The impact of hypoxemia on nephropathy in extremely obese patients with type 2 diabetes mellitus. In: Journal of Clinical Sleep Medicine. 2014 ; Vol. 10, No. 7. pp. 773-778.
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AU - Banerjee, Dev

AU - Taheri, Shahrad

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N2 - Study Objectives: Diabetes mellitus (DM) is associated with obstructive sleep apnea (OSA) and nephropathy. The hypoxemia associated with OSA may exacerbate renal deterioration in DM nephropathy. We examined the role of hypoxemia in the development of DM nephropathy in severely obese patients. Methods: This cross-sectional study examined anonymized data from 90 DM patients with extreme obesity attending a weight management service. All patients underwent a routine overnight sleep study. Respiratory parameters measured included apnea-hypopnea index (AHI), mean and minimum oxygen (O2) saturations, and time spent under 90% O2 saturation (%TST < 90%). Chronic kidney disease (CKD+) was defi ned as estimated glomerular fi ltration rate (eGFR) ≤ 60 mL/min/1.73 m2. Results: Twenty (22%) patients were CKD+. These patients were 7 years older (mean age ± SD 57 ± 11 years, p = 0.003) and had greater adiposity (mean body mass index [BMI] ± SD 50.6 ± 8.7 kg/m2, p = 0.012). No signifi cant differences were found for median AHI and minimum O2 saturation. %TST < 90% was 4 times greater in CKD+ group (p = 0.046). Multivariate regression analysis showed that AHI (β = -0.17, 95% CI: -0.316 to -0.024) and %TST < 90% (β = -0.215, 95% CI: -0.406 to -0.023) were negatively correlated with eGFR after adjustment for age, gender, BMI, comorbidities, insulin treatment, and drugs affecting the renin-angiotensin system. No associations were found between mean and minimum O2 saturations, and eGFR. Conclusion: Apnea and hypopnea events as well as duration of nocturnal hypoxemia were inversely associated with renal function after adjusting for potential confounders. Given the signifi cant burden of renal disease in diabetes, greater vigilance is required in identifying OSA in DM patients with extreme obesity.

AB - Study Objectives: Diabetes mellitus (DM) is associated with obstructive sleep apnea (OSA) and nephropathy. The hypoxemia associated with OSA may exacerbate renal deterioration in DM nephropathy. We examined the role of hypoxemia in the development of DM nephropathy in severely obese patients. Methods: This cross-sectional study examined anonymized data from 90 DM patients with extreme obesity attending a weight management service. All patients underwent a routine overnight sleep study. Respiratory parameters measured included apnea-hypopnea index (AHI), mean and minimum oxygen (O2) saturations, and time spent under 90% O2 saturation (%TST < 90%). Chronic kidney disease (CKD+) was defi ned as estimated glomerular fi ltration rate (eGFR) ≤ 60 mL/min/1.73 m2. Results: Twenty (22%) patients were CKD+. These patients were 7 years older (mean age ± SD 57 ± 11 years, p = 0.003) and had greater adiposity (mean body mass index [BMI] ± SD 50.6 ± 8.7 kg/m2, p = 0.012). No signifi cant differences were found for median AHI and minimum O2 saturation. %TST < 90% was 4 times greater in CKD+ group (p = 0.046). Multivariate regression analysis showed that AHI (β = -0.17, 95% CI: -0.316 to -0.024) and %TST < 90% (β = -0.215, 95% CI: -0.406 to -0.023) were negatively correlated with eGFR after adjustment for age, gender, BMI, comorbidities, insulin treatment, and drugs affecting the renin-angiotensin system. No associations were found between mean and minimum O2 saturations, and eGFR. Conclusion: Apnea and hypopnea events as well as duration of nocturnal hypoxemia were inversely associated with renal function after adjusting for potential confounders. Given the signifi cant burden of renal disease in diabetes, greater vigilance is required in identifying OSA in DM patients with extreme obesity.

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KW - Extreme obesity

KW - Obstructive sleep apnea

KW - Sleep disordered breathing

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