Abstract P186: Obstructive Sleep Apnea and Risk of Chronic Kidney Disease in the ARIC Sleep Heart Health Study

Abstract

Background: Obstructive sleep apnea (OSA) is a prevalent sleep disorder and may be associated with the development of chronic kidney disease (CKD) through hypoxia, inflammation, and oxidative stress. However, the prospective relationship between OSA and incident CKD remains unknown. In this study, we leveraged in-home polysomnography (PSG) data from a large community-based cohort of adults to examine the association between OSA and risk of incident CKD in late-midlife. Methods: Participants in the Atherosclerosis Risk in Communities (ARIC) study (N=1,525; mean age=62.5 ± 5.4 years, 52.4% female) completed in-home PSG assessments as part of the Sleep Heart Health Study. OSA severity was defined according to apnea-hypopnea index (AHI) (events/hour): normal <5.0, mild 5.0-14.9, moderate 15.0-29.9, and severe ≥30.0. Incident CKD was defined according to estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m 2 and at least 25% decline in eGFR from baseline, CKD-related hospitalization or death, or end-stage renal disease. Cox proportional hazards regression was used to estimate OSA severity with risk of incident CKD. Models were adjusted for demographics, health behaviors, BMI, and other markers of cardiometabolic conditions. Results: Among 1,525 participants, a total of 461 CKD events occurred over an average of 19 years of follow-up. After adjustment for demographics and health behaviors, severe OSA (AHI ≥30.0) was associated with increased risk of CKD (Hazard Ratio (HR): 1.51; 95% Confidence Interval (CI): 1.08, 2.10). This association was attenuated after additional adjustment for BMI (HR; 1.07, CI: 0.75, 1.52). Conclusions: Overall, OSA was linked to greater CKD risk. The association was attenuated after adjusting for obesity, a risk factor for both conditions. Due the high prevalence of OSA and CKD in the US adult population, more investigation is needed. Figure 1. Estimated probability of years free of Chronic Kidney Disease (CKD) by obstructive sleep apnea (OSA) severity in the ARIC Sleep Heart Health Study: