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The relation and mechanism of kidney injury in obstructive sleep apnea: a literature review

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Abstract

Up to date, it is found that the presence of obstructive sleep apnea (OSA) contributes to the development of structural, ultra-structural, functional, and proteomics changes in the kidney. These changes are based on pathological processes, such as increased production of free radicals, disruption of mediated NO vasodilation reactions, activation of the sympathetic autonomic nervous system, the renin–angiotensin–aldosterone system, dysfunction of endothelium, the development of renal venous hypertension, and stimulation of atrial natriuretic peptide production. All this in turn contributes to an increase in intra-glomerular pressure, the occurrence of glomerular hyperfiltration, nocturnal polyuria, renal functional changes, proteinuria and renal tubular dysfunction. Kidney injury in OSA patients can also be caused by pathological conditions associated with OSA, such as cor pulmonale, erythrocytosis, diabetes mellitus, metabolic syndrome, hypertension, coronary heart diseases, and atherosclerosis, which in isolated conditions can lead to development of kidney damage, and co-occurring with OSA can even aggravate the course of the latter. There is a bidirectional relationship between kidney diseases and OSA through a number of potential pathological mechanisms, which suggests the possibility of both diseases to be a possible risk factor for each other. Moreover, kidney diseases may lead to OSA through a multifarious of mechanisms, including chemoreflex responsiveness, pharyngeal narrowing due to fluid overload, and accumulation of uremic toxins.

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Abbreviations

OSAS:

Obstructive sleep apnea syndrome

CRF:

Chronic renal failure

CPAP:

Continuous positive airway pressure

ROS:

Reactive oxygen species

SANS:

Sympathetic autonomic nervous system

NO:

Nitric oxide

ED:

Endothelial dysfunction

VEGF:

Vascular endothelial growth factor

HIF-1α:

Hypoxia inducible factor-1α

NFκB:

Nuclear factor κ B

AP1:

Activator protein1

Nrf2:

Nuclear factor (erythroid-derived 2)-like2

RAS:

Renin–angiotensin system

Ang II:

Angiotensin II

ANP:

Atrial natriuretic peptide

ESRD:

End-stage renal disease

PE:

Pulmonary embolism

AHI:

Apnea–hypoapnea index

BIPAP:

Bi-level positive airway pressure

DVT:

Deep vein thrombosis

VTE:

Venous thromboembolism.

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Acknowledgements

This work was supported by Zhejiang Provincial Natural Science Foundation Grant (LY17H010004), Scientific Research Foundation of Health Bureau of Zhejiang Province (2018ZD010), Wenzhou City Science and Technology Bureau Grant (Y20170133), National Science-technology Support Program (2015BAI12B09), and Project of Key Innovative Disciplines of Children Sleep Medicine of Zhejiang.

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  1. Department of Pediatrics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, 109 Xueyuan Western Road, Wenzhou, 325027, Zhejiang, People’s Republic of China

    Neha Devi Poonit & Xiao Hong Cai

  2. The Second School Of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China

    Neha Devi Poonit & Xiao Hong Cai

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Poonit, N.D., Cai, X.H. The relation and mechanism of kidney injury in obstructive sleep apnea: a literature review. Sleep Biol. Rhythms 16, 151–167 (2018). https://doi.org/10.1007/s41105-018-0146-x

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