Obstructive sleep apnea, coronary calcification and arterial stiffness in patients with diabetic kidney disease

• Published in: Atherosclerosis 2024-07, Vol.394, p.117170, Article 117170
• Main Authors: Nielsen, Sebastian, Nyvad, Jakob, Christensen, Kent Lodberg, Poulsen, Per Løgstrup, Laugesen, Esben, Grove, Erik Lerkevang, Buus, Niels Henrik
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Arterial stiffness; Computed Tomography Angiography; Coronary agatston score; Coronary Angiography; Coronary Artery Disease - complications; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - physiopathology; Coronary calcification; Cross-Sectional Studies; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - physiopathology; Diabetic kidney disease; Diabetic Nephropathies - diagnosis; Diabetic Nephropathies - physiopathology; Female; Glomerular Filtration Rate; Humans; Kidney - physiopathology; Male; Middle Aged; Obstructive sleep apnea; Pulse Wave Analysis; Risk Factors; Severity of Illness Index; Sleep Apnea, Obstructive - complications; Sleep Apnea, Obstructive - physiopathology; Vascular Calcification - diagnostic imaging; Vascular Calcification - physiopathology; Vascular Stiffness
• ISSN: 0021-9150; 1879-1484; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2023.06.076

Obstructive sleep apnea (OSA) may accelerate arterial calcification, but the relation remains unexplored in diabetic kidney disease (DKD). We examined the associations between OSA, coronary calcification and large artery stiffness in patients with DKD and reduced renal function. Patients with type 2 diabetes, estimated glomerular filtration rate (eGFR)  30 mg/g were tested for OSA quantified by the apnea-hypopnea index (AHI, events/hour). Patients without OSA (AHI< 5) were compared to patients with moderate (AHI 15–29) or severe (AHI ≥30) OSA and underwent computed tomography angiography with coronary Agatston scoring (CAS) to quantify coronary calcification. Arterial stiffness was determined as carotid-femoral pulse wave velocity (PWV). Among 114 patients with acceptable AHI recordings had 43 no OSA, 33 mild OSA and 38 moderate-severe OSA. Mean age of the 74 patients completing the study was 71.5 ± 9.4 years (73% males), eGFR 32.2 ± 12.3 ml/min/1.73 m2 and UACR 533 (192–1707) mg/g. CAS (ln-transformed) was significantly higher in patients with OSA compared to patients without (6.6 ± 1.7 vs. 5.6 ± 2.4, p = 0.04), and the same was observed for PWV (11.9 ± 2.7 vs. 10.5 ± 2.2 m/s, p = 0.02). In multivariable linear regression analyses adjusted for sex, age, body mass index, UACR, and mean arterial pressure, moderate-severe OSA remained significantly associated with PWV but not with CAS. Dominance analysis revealed OSA as the third and second most important factor relative to CAS and PWV respectively. In DKD patients, moderate-severe OSA is a significant predictor of arterial stiffness but is not independently associated with coronary calcification. [Display omitted] •Obstructive sleep apnea (OSA) is associated with cardiovascular disease.•OSA is very frequent in diabetic kidney disease (DKD) patients.•OSA has more impact on large artery stiffness than coronary calcification in DKD.