Bidirectional association between chronic kidney disease and sleep apnea: a systematic review and meta-analysis

Background: Previous data have suggested a link between chronic kidney disease (CKD) and sleep apnea (SA). However, the prevalence and risk association of both disease entities are not uniformly described. Methods: Ovid MEDLINE, EMBASE, and the Cochrane Library were searched for eligible publications that included patients aged ≥ 18 years diagnosed with CKD or SA. Included studies were divided into two cohorts: (1) a cohort of CKD or end-stage kidney disease (ESKD) patients reporting the prevalence of SA or odds ratio (OR) for SA (CKD cohort) and (2) a cohort of SA patients reporting the prevalence of CKD/ESKD or OR for CKD/ESKD (SA cohort). Results: CKD cohort: Of 16 studies (n = 340,587), the pooled estimated prevalence of SA among CKD/ESKD patients was 47.5% (95% CI 28.8–66.9). The pooled adjusted OR for SA among CKD/ESKD patients was 1.961 (95% CI 1.702–2.260). Male sex, history of diabetes, and lower BMI were associated with increased prevalence of SA. SA cohort: Of 12 studies (n = 3,103,074), the pooled prevalence of CKD/ESKD among patients with SA was 8.2% (95% CI 4.7–13.7), whereas the pooled adjusted OR for CKD/ESKD among patients with SA was 2.088 (95% CI 1.777–2.452). Increasing age, higher BMI, male sex, white race, and history of diabetes were associated with higher prevalence of CKD/ESKD. Conclusion: There was a bidirectional association between CKD/ESKD and SA. Interventions aiming to prevent the progression of either CKD or SA are important.