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Effect of continuous positive airway pressure on proteinuria in obstructive sleep apnea.

Masuda T, Honma S, Sasaki N, Hanawa-Yazawa S, Iwazu Y, Kusano E, Asano Y - Clin Kidney J (2012)

Bottom Line: However, the effect on proteinuria of OSA treatment with continuous positive airway pressure (CPAP) is unknown.We experienced a case of severe OSA, where proteinuria was clearly improved after CPAP initiation without any changes of medication or body weight.The remarkable reduction of repetitive apnea and hypopnea by CPAP might ameliorate proteinuria by lessening renal hypoxia and sympathetic nerve activation.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, Japanese Red Cross Koga Hospital, Koga, Ibaraki, Japan ; Divisionsof Nephrology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan.

ABSTRACT
Obstructive sleep apnea (OSA) is common in patients with renal disease, and an association between OSA and proteinuria has been proposed. However, the effect on proteinuria of OSA treatment with continuous positive airway pressure (CPAP) is unknown. We experienced a case of severe OSA, where proteinuria was clearly improved after CPAP initiation without any changes of medication or body weight. The remarkable reduction of repetitive apnea and hypopnea by CPAP might ameliorate proteinuria by lessening renal hypoxia and sympathetic nerve activation. This case suggests that CPAP is a promising option for OSA with proteinuria.

No MeSH data available.


Related in: MedlinePlus

Changes of proteinuria, BMI, HR and BP before and after CPAP initiation. Proteinuria clearly decreased after CPAP initiation without any changes of medication. PSG was performed before and after CPAP initiation. HR and BP were measured at home in the morning.
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fig1: Changes of proteinuria, BMI, HR and BP before and after CPAP initiation. Proteinuria clearly decreased after CPAP initiation without any changes of medication. PSG was performed before and after CPAP initiation. HR and BP were measured at home in the morning.

Mentions: After obtaining informed consent, CPAP treatment using a nasal mask (AutoSet C; Teijin Pharma Ltd and ResMed, Sydney, Australia) was initiated. The setting of the device was auto-titration mode (pressure 4.0–20.0 cm H2O), and we instructed the patient to use it overnight. This device could store compliance and efficacy data, which were downloaded using software at follow-up visits every month. At 3 months after CPAP initiation, CPAP usage days and daily hours were 96.4% and 5.3 h, respectively (Table 1). Then, PSG was performed to evaluate the effect of CPAP on OSA. The data exhibited clear improvement of OSA: total AHI, 6.1 events per h; average SaO2, 96.0%; minimum SaO2, 93.0% and SaO2 <90%, 0% (Table 1). Importantly, total elimination of saturated oxygen levels <90% indicated the disappearance of severe hypoxia during sleep. Along with the reduction of apnea and hypopnea events, proteinuria also clearly decreased (Table 1 and Figure 1), although no other medication was changed. In addition, home BP in the morning, which was measured within 1 h after waking as described previously [9, 10], decreased mildly (Figure 1 and Table 1). Then, we stopped amlodipine at 5 months after CPAP initiation (Figure 1). Heart rate (HR) and pulse rate rise index-6, the number of pulse rate increases ≥6 per h determined by pulse oximetry, decreased clearly after CPAP treatment (Table 1). On the other hand, an apparent change of BMI was not found during the period (Figure 1). At 6 months after CPAP initiation, the low level of proteinuria (≤0.3 g/g Cr) had continued (Figure 1). In addition, average proteinuria for 6 months after CPAP was markedly lower (0.3 g/g Cr) than before CPAP treatment (1.2 g/g Cr).


Effect of continuous positive airway pressure on proteinuria in obstructive sleep apnea.

Masuda T, Honma S, Sasaki N, Hanawa-Yazawa S, Iwazu Y, Kusano E, Asano Y - Clin Kidney J (2012)

Changes of proteinuria, BMI, HR and BP before and after CPAP initiation. Proteinuria clearly decreased after CPAP initiation without any changes of medication. PSG was performed before and after CPAP initiation. HR and BP were measured at home in the morning.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4400518&req=5

fig1: Changes of proteinuria, BMI, HR and BP before and after CPAP initiation. Proteinuria clearly decreased after CPAP initiation without any changes of medication. PSG was performed before and after CPAP initiation. HR and BP were measured at home in the morning.
Mentions: After obtaining informed consent, CPAP treatment using a nasal mask (AutoSet C; Teijin Pharma Ltd and ResMed, Sydney, Australia) was initiated. The setting of the device was auto-titration mode (pressure 4.0–20.0 cm H2O), and we instructed the patient to use it overnight. This device could store compliance and efficacy data, which were downloaded using software at follow-up visits every month. At 3 months after CPAP initiation, CPAP usage days and daily hours were 96.4% and 5.3 h, respectively (Table 1). Then, PSG was performed to evaluate the effect of CPAP on OSA. The data exhibited clear improvement of OSA: total AHI, 6.1 events per h; average SaO2, 96.0%; minimum SaO2, 93.0% and SaO2 <90%, 0% (Table 1). Importantly, total elimination of saturated oxygen levels <90% indicated the disappearance of severe hypoxia during sleep. Along with the reduction of apnea and hypopnea events, proteinuria also clearly decreased (Table 1 and Figure 1), although no other medication was changed. In addition, home BP in the morning, which was measured within 1 h after waking as described previously [9, 10], decreased mildly (Figure 1 and Table 1). Then, we stopped amlodipine at 5 months after CPAP initiation (Figure 1). Heart rate (HR) and pulse rate rise index-6, the number of pulse rate increases ≥6 per h determined by pulse oximetry, decreased clearly after CPAP treatment (Table 1). On the other hand, an apparent change of BMI was not found during the period (Figure 1). At 6 months after CPAP initiation, the low level of proteinuria (≤0.3 g/g Cr) had continued (Figure 1). In addition, average proteinuria for 6 months after CPAP was markedly lower (0.3 g/g Cr) than before CPAP treatment (1.2 g/g Cr).

Bottom Line: However, the effect on proteinuria of OSA treatment with continuous positive airway pressure (CPAP) is unknown.We experienced a case of severe OSA, where proteinuria was clearly improved after CPAP initiation without any changes of medication or body weight.The remarkable reduction of repetitive apnea and hypopnea by CPAP might ameliorate proteinuria by lessening renal hypoxia and sympathetic nerve activation.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, Japanese Red Cross Koga Hospital, Koga, Ibaraki, Japan ; Divisionsof Nephrology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan.

ABSTRACT
Obstructive sleep apnea (OSA) is common in patients with renal disease, and an association between OSA and proteinuria has been proposed. However, the effect on proteinuria of OSA treatment with continuous positive airway pressure (CPAP) is unknown. We experienced a case of severe OSA, where proteinuria was clearly improved after CPAP initiation without any changes of medication or body weight. The remarkable reduction of repetitive apnea and hypopnea by CPAP might ameliorate proteinuria by lessening renal hypoxia and sympathetic nerve activation. This case suggests that CPAP is a promising option for OSA with proteinuria.

No MeSH data available.


Related in: MedlinePlus