Study On The Risk Factors Of Renal Dysfunction In Patients With Obstructive Sleep Apnea Hypopnea Syndrome

Background and Objective Obstructive sleep apnea hypopnea syndrome?OSAHS?is a common disease of respiratory system.Its characterized by recurrent episodes of upper airway collapse,resulting in oxygen desaturation and sleep fragmentation.It causes multisystem damages.It has been also associated with chronic kidney disease?CKD?.A number of descriptive studies have confirmed that there is an association between OSAHS and CKD,which can lead to renal impairment in patients,and foreign scholars have found in a study that 30.5% of OSAHS patients have CKD,and associated with sleep apnea and nocturnal hypoxemia.In this study,BUN,SCr,Cys C and e GFR were used as indicators to explore whether OSAHS patients with impaired renal function and risk factors of OSAHS-related renal impairment and provide the basis for the prevention and treatment of chronic kidney disease?CKD?in OSAHS patients.Subjects and Method A total of 178 patients with polysomnography?PSG?were enrolled in the Department of Sleep and Sleep Medicine,the First Affiliated Hospital of Zhengzhou University from July 2016 to January 2017.The patients were divided according to the apnea-hypopnea index?AHI?scores into non-OSAHS group and OSAHS group.And There are 145 cases with OSAHS group,33 cases with non-OSAHS group in patiences diagnosed with PSG,excluding patients with diabetes,hypertension,hyperlipidemia and acute renal insufficiency,glomerular disease,urinary tract infection and other diseases.Questionnaire survey ? physical examination and polysomnography?PSG?were performed for all the patients.Some indicators were monitored and recorded,such as gender,age,height,neck circumference,waist circumference,weight,BMI,AHI,lowest oxygen saturation,longest apnea time,cumulative percentages of time spent at oxygen saturation below 90%,Serum cystatin C levels,serum creatinine,urea,e GFR,fasting blood glucose,T-CHO,TG,HDL,LDL,blood pressure and so on.SPSS 22.0 software was used for data analyzing.According to the different variables,with OSAHS group and non-OSAHS group,the two groups were analyzed by using t test?chi-square test?rank test respectively.In OSAHS group,the relationship between variables and serum urea,serum cystatin C,e GFR were analyzed by Preason correlation analysis.Multiple linear regression analysis was also performed for serum urea serum cystatin C and e GFR?P<0.05?.Result1 145 patients with OSAHS patients with renal impairment accounted for21.8%,of which 6.9% of patients with moderate to severe renal impairment.2 e GFR was statistically significant differences between the two groups,???±s in OSAHS group was?103.490±27.260?ml/min·1.73m²,non-OSAHS group was?115.355±27.630?ml/min·1.73m²?t=-2.251,P=0.026?;Cys C was statistically significant differences between the two groups,???±s in OSAHS group was?0.979±0.377?mg/L,non-OSAHS group was?0.830±0.115?mg/L?t=2.239,P=0.026?;BUN was statistically significant differences between the two groups,x± s in OSAHS group was?5.519±1.859?mmol/L,non-OSAHS group was?4.750±0.896?mmol/L?t=2.312,P=0.022?;Age was statistically significant differences between the two groups,???±s in OSAHS group was?50.060±11.112?years,non-OSAHS group was?43.090±12.546?years?t=3.171,P=0.002?;Weight was statistically significant differences between the two groups,???±s in OSAHS group was?83.266±13.460?Kg,non-OSAHS group was?72.091±9.221?Kg?t=4.529,P=0.000?;BMI was statistically significant differences between the two groups,???±s in OSAHS group was?28.894±4.010?Kg/m²,non-OSAHS group was?25.401± 3.103?Kg/m²?t = 4.690,P = 0.000?;Neck circumference was statistically significant differences between the two groups,???±s in OSAHS group was?41.430±2.728?cm,non-OSAHS group was?38.970±2.756?cm?t=4.663,P=0.000?;Waist circumference was statistically significant differences between the two groups,???±s in OSAHS group was?102.940±9.129?cm,non-OSAHS group was?95.210±8.517?cm?t=4.44,P=0.000?;La SO₂ was statistically significant differences between the two groups,x± s in OSAHS group was?73.840 ± 11.178?%,non-OSAHS group was?89.880±4.136?%?t=-8.102,P=0.000?;CT90% was statistically significant differences between the two groups,???±s in OSAHS group was?16.950±19.693?%,non-OSAHS group was?0.250±0.675?%?t=4.861,P=0.000?;Longest apnea time was statistically significant differences between the two groups,???±s in non-OSAHS group was?62.041±27.491?s,OSAHS group was?26.279± 16.904?s?t =7.162,P =0.0006?;And there were no differences in gender,age,height,SCr,glucose,T-CHO,TG,LDLand HDL between each group?all P>0.05?.3 One-way ANOVA was used to analyze the differences between BUN,SCr,Cys C and e GFR in patients with mild,moderate and severe OSAHS.e GFR was statistically significant differences between the three groups,???±s in mild OSAHS group was?111.605±20.893?ml/min·1.73m²,moderate OSAHS group was?82.947± 28.443?ml/min · 1.73m²,severe OSAHS group was?82.947 ± 28.443?ml/min·1.73m²?P<0.05?;Cys C was statistically significant differences between the three groups,???±s in mild OSAHS group was?0.824±0.118?mg/L,moderate OSAHS group was?1.008±0.255?mg/L,severe OSAHS group was?1.043±0.441?mg/L?P<0.05?;and there was no significant difference in BUN and SCr betwent each group?P>0.05?.4 In OSAHS group,Preason's test were proformed to analyze the correlations between e GFR,BUN,Cys C and factors affecting the of kidney function.e GFR were negatively correlated with age,BMI,CT90%?r=-0.343,P=0.000;r=-0.207,P= 0.012;r=-0.300,P=0.000?.BUN were correlated with neck circumference,CT90%?all P < 0.05?.Cys C were correlated with weight,BMI,neck circumference,waist circumference,AHI,La SO₂,CT90%,longest apnea time?all P < 0.05?.Multipie regression analysis with e GFR,BUN,Cys C as the dependent variable was peformed respectively,the results shown: e GFR is associated with age,BMI,CT90 %,a significant correlation were revealed betwent CT90% and BUN,Cys C.Conclusion1 The patients with the OSAHS had renal impairment and the extent of renal impairment increased with the severity of the disease.2 CT90% is an independent risk factor for renal impairment in OSAHS patients.3 e GFR,Cys C can be used as an indicator of early renal impairment in patients with OSAHS.