Obstructive Sleep Apnea Independent Risk Factor for DKD Progression: Study

In order to examine the potential effects of sleep disorder on kidney dysfunction, the study was designed longitudinally for patients already diagnosed with diabetic kidney disease. The researchers conducted their research by assessing about 120 patients who fulfilled the criteria of CKD, that is, having eGFR below 60 ml/min/1.73 m² and not being under any form of RRT, along with elevated urine albumin-to-creatinine ratio (UACR). Severity of sleep apnoea was determined based on the Apnea-hypopnea index (AHI) calculated through a well-established portable home sleep study machine known as ApneaLink+.

In the present study, the researchers selected 41 individuals without OSA (AHI < 5/hour) and compared their findings with 36 patients with moderate-to-severe OSA (AHI ≥15/hour). Post-index date was considered as the date when home sleep testing was performed. In that case, the researchers obtained the eGFR and UACR data of 5 years before the index date until the end of the observation period, resulting in a median observation period of 3.2 years.

Key findings:

• eGFR at the time of index was very similar between the non-OSA group and the OSA group (32.2 vs. 32.9 mL/min/1.73 m², respectively).
• Blood pressure, medical history, lipid panel, and glucose level did not differ between the two groups.
• The rate of eGFR decline during the last five years before index and up to the end point was greater among participants with OSA compared to those without OSA (p = 0.016) after adjusting for age, sex, and UACR.
• Patients with moderate or severe OSA had 3.4 times higher risk of developing CKD characterized by an eGFR reduction of more than 50% or beginning of renal replacement therapy (aHR = 3.4; 95% CI = 1.3–9.1) independent of age, sex, eGFR, UACR, BMI, and blood pressure.
• The composite clinical outcome, which included CKD development or death due to any cause, happened more often in participants with OSA (aHR = 3.2; 95% CI = 1.3–7.7).

The current study provides evidence that obstructive sleep apnea is a significant independent factor contributing to the progression of diabetic nephropathy, posing a markedly increased risk for the occurrence of severe renal deterioration and mortality. The observation that sleep apnea significantly elevates the probability of developing a 50% loss of renal function more than thrice is proof that the management of renal diseases is not limited to metabolic factors in the daytime.

Reference:

Nielsen S, Thomsen MB, Nyvad J, et al. Obstructive sleep apnoea is associated with accelerated progression of diabetic kidney disease. Diabet Med. 2026;00:e70340. doi:10.1111/dme.70340