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Sleep and Biological Rhythms

, Volume 16, Issue 2, pp 151–167 | Cite as

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

  • Neha Devi Poonit
  • Xiao Hong Cai
Review Article

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.

Keywords

Obstructive sleep apnea syndrome Kidney injury Sympathetic autonomic nervous system Renin–angiotensin–aldosterone system Endothelial dysfunction Atrial natriuretic peptide 

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.

Notes

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.

Compliance with ethical standards

Conflict of interest

The authors Dr. Poonit and Dr. Cai certify that there is no conflict of interest.

Ethical approval

This article does not contain any studies with animals performed by any of the authors. This article does not contain any studies with human participants or animals performed by any of the authors.

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Copyright information

© Japanese Society of Sleep Research 2018

Authors and Affiliations

  1. 1.Department of PediatricsThe Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical UniversityWenzhouPeople’s Republic of China
  2. 2.The Second School Of MedicineWenzhou Medical UniversityWenzhouPeople’s Republic of China

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