The Links Between Sleep Apnea and Chronic Kidney Disease

Recent research suggests an association between the development and progression of chronic kidney disease (CKD) - which affects 10–13% of the general population and leads to high rates of morbidity - and sleep apnea (SA). SA impacts 2–4% of middle aged adults through one of its three forms: obstructive (OSA), central (CSA) and mixed sleep apnea, respectively. SA is associated with sleep fragmentation and hypoxemia during the apneic phenomena. Sleep fragmentation activates the renin-angiotensin-aldosterone system and the sympathetic nervous system, and alters the cardiovascular hemodynamic. It also results in the production of free radicals. SA is a risk factor for CKD progression because it is associated with glomerular hyper-filtration and may be an independent predictor of proteinuria. More specifically, the treatment of sleep apnea, manifested through one of its three forms - obstructive, central, and mixed, respectively - can reduce the severity of CKD and delay its progression by reducing CKD risk factors. This paper discusses the mechanisms that link CKD and sleep apnea, and suggests SA treatments with beneficial effects to CKD-related cases. Optimizing sleep duration and quality and treating sleep disorders, especially SA, we can reduce the severity of CKD and the delay of progression.