Newly Diagnosed Obstructive Sleep Apnea (OSA) Is Common and Is Associated with Increased Cardiovascular Events in Kidney Transplant Recipients
Transplantation, Mayo Clinic, Jacksonville, FL
Pulmonary Medicine, Mayo Clinic, Jacksonville, FL
Biostatistics, Mayo Clinic, Jacksonville, FL
Meeting: 2013 American Transplant Congress
Abstract number: 330
The incidence and effects of newly diagnosed OSA in kidney tx recipients are unclear. Methods: 99 kidney tx recipients without OSA underwent overnight oximetry 1 month from tx. Recipients with abnormal oximetry underwent polysomnography (PSG). The following tests were obtained at 1 month and 1 yr from tx: echocardiogram for ejection fraction (EF) and left ventricular mass index (LVMI); 24-hr blood pressure (BP) monitor for awake and sleep BP and iothalamate GFR. Results: 39 (39%) patients had abnormal oximetry, of these 22 had OSA by PSG, 2 had normal PSG and 15 refused PSG and were excluded. Characteristics of the 22 with and the 62 without OSA are presented in table.
| OSA n=22 | No OSA n=62 | P | |
|---|---|---|---|
| Age (yrs) | 60±11 | 52±15 | 0.006 |
| % Male | 45 | 64 | 0.1 |
| % Caucasian | 54 | 61 | 0.9 |
| % pre-emptive tx | 14 | 31 | 0.1 |
| % pre-tx diabetes | 41 | 6 | 0.001 |
| % Long term steroid | 32 | 26 | 0.6 |
| BMI at 1 month | 32±5 | 27±5 | 0.001 |
| Awake SBP | 135±14 | 130±10 | 0.08 |
| Awake DBP | 75±10 | 76±8 | 0.5 |
| Sleep SBP | 133±14 | 126±11 | 0.03 |
| Sleep DBP | 71±10 | 73±9 | 0.5 |
| LVMI at 1 month (gr/m2) | 107±24 | 99±33 | 0.3 |
| EF at 1 month (%) | 65±8 | 62±7 | 0.2 |
| LVMI at 1 yr (gr/m2) | 108± 28.8 | 94±24* | 0.05 |
| EF at 1 yr (%) | 61±9 | 65±4* | 0.04 |
In recipients without rejection, GFR increased from 67±23 at 1 month to 78±35 ml/min at 1 yr (P=0.04) in non-OSA patients but remained unchanged in OSA patients (70± 23 vs 66±23.ml/min, P=0.6). Mean±SD follow-up was 2.5±0.7 yrs. OSA was associated with increased risk of cardiovascular events (CVS) at last follow-up (Figure). 15 OSA patients started continuous positive airway pressure (CPAP). There was no effect of CPAP on 1-yr EF, LVMI or CVS events (P>0.1 for all)
Conclusions: 1) Undiagnosed OSA is common in kidney tx recipients. 2) OSA is associated with older age, diabetes, higher BMI and elevated nocturnal BP. 3) Patients with OSA are at a higher risk of CVS events 4) 1-yr LVMI, EF and GFR improve in non-OSA but remain unchanged in OSA despite CPAP therapy.
To cite this abstract in AMA style:
Wadei H, Kaplan J, Crook J, Phail AMc, Mai M, Prendergast M, Gonwa T. Newly Diagnosed Obstructive Sleep Apnea (OSA) Is Common and Is Associated with Increased Cardiovascular Events in Kidney Transplant Recipients [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/newly-diagnosed-obstructive-sleep-apnea-osa-is-common-and-is-associated-with-increased-cardiovascular-events-in-kidney-transplant-recipients/. Accessed November 22, 2024.« Back to 2013 American Transplant Congress