Reduced renal function and sleep-disordered breathing in community-dwelling elderly men

Canales, Muna T.; Taylor, Brent C.; Ishani, Areef; Mehra, Reena; Steffes, Michael; Stone, Katie L.; Redline, Susan; Ensrud, Kristine E.; For the Osteoporotic Fractures in Men (MrOS) Study Group,

doi:10.1016/j.sleep.2007.08.021

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Volume 9, Issue 6 , Pages 637-645, August 2008

Reduced renal function and sleep-disordered breathing in community-dwelling elderly men

Muna T. Canales
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Minnesota, MMC 736 Mayo Building, 420 Delaware Street S.E., Minneapolis, MN, USA
- Corresponding author. Tel.: +1 612 624 9444; fax: +1 612 626 3840.
Brent C. Taylor
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
- Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MN, USA
Areef Ishani
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Minnesota, MMC 736 Mayo Building, 420 Delaware Street S.E., Minneapolis, MN, USA
- Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MN, USA
Reena Mehra
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Case Western Reserve University, Cleveland, OH, USA
Michael Steffes
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
Katie L. Stone
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
Susan Redline
- Departments of Pediatrics, Medicine, and Epidemiology & Biostatistics, Case Western Reserve University, Cleveland, OH, USA
Kristine E. Ensrud
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Minnesota, MMC 736 Mayo Building, 420 Delaware Street S.E., Minneapolis, MN, USA
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
- Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MN, USA
For the Osteoporotic Fractures in Men (MrOS) Study Group

Received 6 June 2007; received in revised form 2 August 2007; accepted 19 August 2007.

Abstract

Background

Sleep-disordered breathing (SDB) may increase the risk of cardiovascular disease (CVD) and death in chronic kidney disease (CKD). However, the association between mild reductions in renal function and SDB is uncertain.

Methods

We studied 508 community-dwelling men aged ⩾67 years (mean 76.0±5.3) who were enrolled at the Minnesota site for the Minneapolis center of the Outcomes of Sleep Disorders in Older Men (MrOS) sleep study and had serum cystatin-C and creatinine measured coincident with overnight polysomnography. CKD was defined as estimated glomerular filtration rate (eGFR) <60ml/min/1.73m² using Cockcroft–Gault (CG), modification of diet in renal disease (MDRD) and Mayo Clinic formulae. SDB was defined by a respiratory disturbance index (RDI) ⩾15events/h.

Results

Mean cystatin-C was 1.21±0.30mg/L, and mean creatinine was 1.09±0.23mg/dL. Median RDI was 7.0events/h (range 0–73). Higher quartiles of cystatin-C were associated with higher mean RDI (p for trend=0.007). This association persisted after adjustment for age and race (p for trend=0.03), but not after adjustment for body mass index (BMI, p for trend=0.34). After adjusting for age, race, BMI, diabetes, hypertension, and CVD, CKD defined by the Mayo Clinic formula, but not CG or MDRD, was associated with a higher odds of SDB [odds ratio (OR) 1.95, 95% confidence interval (CI) 1.04–3.65, p=0.04].

Conclusions

Older men with reduced renal function as defined by higher cystatin-C concentration have higher average RDI. This effect is explained by higher BMI in men with higher cystatin-C. CKD defined by the Mayo Clinic formula is independently associated with twofold higher odds for SDB. Therefore, reduced renal function may be associated with SDB in older men.

Keywords: Chronic kidney disease, Kidney dysfunction, Cystatin-C, Sleep disorders, Sleep-disordered breathing, Sleep apnea syndromes