Relationship between sleep-disordered breathing and renal dysfunction in acute coronary syndrome

• Published in: Journal of cardiology 2018-02, Vol.71 (2), p.168-173
• Main Authors: Kiyokuni, Masayoshi, Kawashima, Chika, Konishi, Masaaki, Sakamaki, Kentaro, Iwata, Kiwamu, Nakayama, Naoki, Komura, Naohiro, Kosuge, Masami, Sugano, Teruyasu, Ishigami, Tomoaki, Endo, Tsutomu, Ishikawa, Toshiyuki, Yamanaka, Takeharu, Kimura, Kazuo, Tamura, Kouichi
• Format: Article
• Language: English
• Subjects: Acute coronary syndrome; Apnea-hypopnea index; Kidney; Renal function; Sleep-disordered breathing
• ISSN: 0914-5087; 1876-4738
• DOI: 10.1016/j.jjcc.2017.07.017

•A sleep study by apnomonitor was performed in 154 acute coronary syndrome patients.•Sleep-disordered breathing was related to renal dysfunction.•Hypersympathetic activity may be one of the mechanisms of renal deterioration. Sleep-disordered breathing (SDB) is associated with cardiovascular complications. However, the effect of SDB on renal function in patients with acute coronary syndrome (ACS) treated by percutaneous coronary intervention (PCI) remains unclear. We enrolled 154 consecutive ACS patients without heart failure. A sleep study was performed immediately after PCI. The mean apnea-hypopnea index (AHI) was 16.4±13.1, and 33 patients (21%) had severe SDB, defined as AHI≥25. Estimated glomerular filtration rate (eGFR) values on admission (60±12mL/min/1.73m2 vs. 67±17mL/min/1.73m2, p=0.046) and at discharge (54±15mL/min/1.73m2 vs. 63±15mL/min/1.73m2, p=0.002) were lower in patients with severe SDB than in those patients without severe SDB. Multiple linear regression analysis showed that AHIs were significantly correlated with absolute changes in eGFR values from admission to discharge (β=0.201, p=0.004). Median 24-h urinary noradrenaline excretion measured on the same day of the sleep study was higher [297 (interquartile range {IQR}: 232–472) vs. 174 (IQR: 107–318)μg/day, p=0.021] in patients with severe SDB. On multivariate logistic regression analysis, the presence of severe SDB was a significant predictor (adjusted odds ratio 3.76, 95% confidence interval 1.06–13.9, p=0.047) for eGFR of less than 45mL/min/1.73m2 at discharge. This association was independent of age, eGFR on admission, and a presentation of ST-segment elevation myocardial infarction. In patients with ACS who undergo PCI, severe SDB is associated with impaired renal function on admission and its deterioration during hospitalization. Further studies will be needed to conclude that SDB would be a therapeutic target in ACS.