Association between nocturnal continuous positive airway pressure and renal function decline in a cohort of elderly patients with obstructive sleep apnoea syndrome-An observational study.

Abstract

Background: Obstructive sleep apnoea (OSA) plays a key role in the pathogenesis of rapid kidney function decline (RKFD). Intermittent hypoxia, oxidative stress, inflammation and endothelial dysfunction cause structural and functional renal damage, leading to chronic kidney disease (CKD). Continuous positive airway pressure (CPAP) treatment potentially prevents these deleterious effects on kidney function.

Purpose: The purpose of this study was to evaluate the potential impact of CPAP therapy on RKFD, defined as annual GFR loss ≥5 mL/min/1.73m², in elderly patients with moderate-to-severe OSA and multiple comorbidities.

Methods: This prospective single-centre observational study enrolled 469 elderly outpatients complaining of excessive daytime sleepiness (ESS) with a new diagnosis of moderate-to-severe OSA. During the enrolment visit, medical history, physical examination and blood samples were collected. A 1-week auto-CPAP trial was performed, and according to compliance, patients were divided into the CPAP group or best medical therapy (BMT) group. Follow-up was conducted as scheduled office visits. A log-rank test compared hazard function estimates between groups, followed by multivariable Cox regression analysis of variables significantly associated with RKFD occurrence.

Results: We enrolled 469 elderly patients: 327 men, 142 women; mean age 74.41 ± 5.33 years. Following a seven-day CPAP titration period, 210 patients demonstrated good adherence (>4 h/night) and continued CPAP therapy, while the remaining 259 received only supportive care. After 20.7 ± 5.5 months of follow-up, 129 (27.5%) renal events were observed: 8.33 events/100 patients/year in the CPAP group versus 18.20 events/100 patients/year in the untreated group (p < .001). The difference in RKFD incidence was statistically significant between groups throughout follow-up (log-rank χ²-test p < .001). Multivariable Cox regression analysis indicated CPAP was associated with reduced RKFD risk (HR .376, CI 95% .254-.557, p < .001). SGLT2i therapy reduced risk (HR .293, 95% CI .177-.483, p < .001); atrial fibrillation, type 2 diabetes mellitus and previous TIA/stroke were associated with increased RKFD risk.

Conclusion: These findings confirm CPAP therapy's positive impact in slowing renal damage progression in elderly patients with several comorbidities.