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Self-reported Sleep Disorder and Ambulatory Blood Pressure Phenotypes in Patients with or without Chronic Kidney Disease: Findings from Ibadan CRECKID Study
Abstract
Background:
Sleep disordered breathing has been closely linked to pathogenesis, poor control of hypertension, and progression of chronic kidney disease (CKD). Though hypertension and CKD are highly prevalent in Nigeria, the effects of sleep disorders on CKD and hypertension phenotypes have not been widely studied. This study investigated the relationship between self-reported sleep disorders, and ambulatory blood pressure phenotypes in patients with hypertension and those with or without CKD.
Methods:
Participants aged 18 years and above who consented were recruited into the study. Anthropometric measurements including height, weight, and waist and hip circumferences were obtained, Office/clinic hypertension was defined as SBP =140mmHg and/or DBP =90mmHg or being on pharmacological treatment for hypertension. 24-hour ambulatory blood pressure monitoring were done. Obstructive sleep apnea was assessed using Stop Bang questionnaire. Estimated GFR was calculated using CKD-EPI Creatinine 2Equation and CKD was defined as eGFR<60ml/min/1.73m .
Results:
A total of three hundred and forty-nine (349) patients were enrolled for the study: 175 males and 174 females. Moderate to severe risk for obstructive sleep apnea (OSA) was observed in 51.4% of patients with CKD, 58.5% of hypertensive and 17.3% of apparently healthy participants. Male participants were more likely than female patients to have moderate and high OSA risk (41.7% vs 32.8%) and (10.3% vs 4.6%) respectively. Compared with other groups, CKD patients had the highest office and ambulatory blood pressure parameters; p<0.0001.
Conclusion:
This study has demonstrated that obstructive sleep apnoea is prevalent among patients with chronic kidney disease and hypertension. Furthermore, the phenotypes of hypertension are accentuated in CKD and therefore, OSA may well be an important risk factor for CKD.
Introdução: Comprometimento cognitivo (CC) é comum no paciente renal crônico, porém pouco avaliado. A anemia e a deficiência de ferro podem contribuir para o CC. Objetivo: avaliar CC e sua associação com alterações no metabolismo do ferro na DRC pré-dialítica. Método: Estudo transversal com 54 pacientes entre 21 e 65 anos avaliados sociodemografica, clínica e laboratorialmente. Realizada triagem cognitiva completa, teste de rastreio de cognição global: Montreal Cognitive Assessment (MoCA), bateria de testes de memória, atenção, velocidade de processamento, fluência verbal e funções executivas, escalas de sono (Escala de Sonolência Diurna de Epworth, Questionário Clínico de Apnéia Obstrutiva do Sono de Berlin(AOS), Questionário de cinco perguntas de sintomas de Pernas Inquietas, depressão (Inventário de depressão de Beck, Mini-Plus para Episódio Depressivo Maior (DSM-IV) e de funcionalidade (Questionário de Atividades Funcionais de Pfeffer). Resultados: AOS esteve presente em 76,9%, pernas inquietas e sonolência diurna (35,2%) e sintomas depressivos (34,7%). O MoCA esteve alterado em 59,3%. Correlação de Pearson entre testes neuropsicológicos e Hemoglobina(Hb), índice de Saturação de Transferrina(IST), ferritina e PCRus, mostrou associação entre MoCA e Hb (r=0,310 e p=0,02). Regressão Linear utilizando três modelos ajustados por variáveis sociodemográficas e IST ou ferritina ou Hb: modelo 1 e 2-escolaridade e depressão se associaram ao MoCA, modelo 3-Hb e depressão se associaram ao MoCA. Conclusão: O nível sérico de Hb e a presença de depressão foram associadas com CC. Níveis mais baixos de ferritina se correlacionaram com o MoCA, enquanto não encontramos associação com os demais marcadores do metabolismo do ferro.
Résumé
Le syndrome d’apnée-hypopnée obstructif du sommeil (SAHOS) est fréquent, sous diagnostiqué et grave. Il augmente la morbidité et la mortalité cardiovasculaires, réduit l’espérance de vie et altère la qualité de vie.
L’objectif de ce travail était de faire une revue de la littérature scientifique sur le SAHOS, en Afrique Sub-Saharienne, de 2009 à Septembre 2019. Une recherche sur PubMed, Science Direct, African Index Medicus, African Journals on line et Google scholar a permis de trouver un total de 43 références pertinentes pour le thème.
Les publications sur le SAHOS sont rares en Afrique Sub-Saharienne avec absence de données pour 36 pays. Le niveau de connaissance des praticiens sur la maladie était faible. La polygraphie et/ou la polysomnographie n’étaient pas disponibles dans la majorité des pays de l’Afrique Sub-Saharienne. Les prévalences obtenues restaient supérieures à celles retrouvées en Europe et aux USA. Le SAHOS prédominait chez les hommes, avec un pic autour de 55 ans. Le facteur de risque le plus constant était l’obésité. L’association SAHOS pathologie chronique demeurait fréquente. Le coût excessif de la pression positive continue, de la chirurgie et l’absence de système d’assurance maladie dans ces pays limitaient l’accès au traitement.
Cette étude montre la nécessité, Afrique Sub-Saharienne,d’améliorer les connaissances des praticiens dans le domaine de la médecine du sommeil, de rendre disponible la polysomnographie dans les structures de santé publiques, créer des unités de sommeil dans les centres hospitaliers universitaires pour renforcer la formation pratique et enfin rendre accessible le traitement.
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