Association of Sleep-disordered Breathing and Blood Pressure with Albuminuria: The Nagahama Study.

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Abstract

Rationale: Although sleep-disordered breathing (SDB) may increase urinary albumin excretion (UAE) by raising nocturnal blood pressure (BP) in addition to diurnal BP, the correlation has not been investigated in a general population. Objectives: To evaluate the relationships among UAE, SDB, and BP during sleep in a large population cohort. Methods: Among 9,850 community residents, UAE was assessed by the urinary albumin-to-creatinine ratio (UACR) in spot urine. Sleep duration and SDB were evaluated by a wearable actigraph and pulse oximeter, respectively. We calculated the actigraphy-modified 3% oxygen desaturation index (Acti-3%ODI) by correcting the time measured by pulse oximetry according to sleep duration obtained by actigraphy. Furthermore, participants were instructed to measure morning and sleep BP at home by a timer-equipped oscillometric device. Results: Measurements of sleep parameters, UAE, and office BP were obtained in 6,568 participants. The multivariate analysis that included confounders showed a significant association of Acti-3%ODI with UACR (β = 0.06, P < 0.001). Furthermore, a positive interaction between office systolic BP (SBP) and Acti-3%ODI for UACR was found (β = 0.06, P < 0.001). Among the 6,568 persons enrolled in the analysis, 5,313 completed measurements of BP at home. In this cohort, the association of Acti-3%ODI with UACR remained significant (β = 0.06, P < 0.001) even after morning and sleep SBP were included in the analysis. Furthermore, a mediation analysis revealed that 28.3% (95% confidence interval, 14.9-41.7%; P < 0.001) of the association of Acti-3%ODI with UACR was explained by the mediation of morning and sleep SBP metrics. Conclusions: SDB and office SBP were independently and synergistically associated with UAE, which is considered a risk factor for chronic kidney disease and cardiovascular events. SDB may raise UAE not only by increasing BP but also by involving other pathologic pathways.

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Journal

Journal ID (iso-abbrev): Ann Am Thorac Soc

Title: Annals of the American Thoracic Society

Publisher: American Thoracic Society

ISSN (Electronic): 2325-6621

ISSN (Print): 2325-6621

Publication date (Electronic): March 2022

Volume: 19

Issue: 3

Affiliations

[1 ] Department of Respiratory Care and Sleep Control Medicine.

[2 ] Department of Respiratory Medicine.

[3 ] Department of Respiratory Medicine, Saiseikai-Noe Hospital, Osaka, Japan.

[4 ] Center for Genomic Medicine.

[5 ] Department of Child Health and Child Health Research Institute, University of Missouri, Columbia, Missouri.

[6 ] Department of Primary Care and Emergency Medicine.

[7 ] Department of Advanced Medicine for Respiratory Failure.

[8 ] Nursing Science, Human Health Sciences.

[9 ] Department of Food and Nutrition, Kyoto Women's University, Kyoto, Japan; and.

[10 ] Department of Biomedical Statistics and Bioinformatics.

[11 ] Department of Health Informatics, School of Public Health, and.

[12 ] Department of Nephrology, Kyoto University Graduate School of Medicine, Kyoto, Japan.

[13 ] Department of Sleep Medicine and Respiratory Care, Division of Sleep Medicine, Department of Internal Medicine, Nihon University, Tokyo, Japan.

Article

DOI: 10.1513/AnnalsATS.202105-528OC

PubMed ID: 34347565

SO-VID: 6bc81b09-a6a8-4fb8-870e-1d7c9c56b713

History

Keywords: urinary albumin excretion,blood pressure,sleep disordered breathing

Data availability:

Keywords: urinary albumin excretion, blood pressure, sleep disordered breathing

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