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Chest. 2018 Aug;154(2):326-334. doi: 10.1016/j.chest.2018.04.020. Epub 2018 Apr 24.

Fixed But Not Autoadjusting Positive Airway Pressure Attenuates the Time-dependent Decline in Glomerular Filtration Rate in Patients With OSA.

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CNR, Institute of Biomedicine and Molecular Immunology, Palermo, Italy. Electronic address:
CNR, Institute of Biomedicine and Molecular Immunology, Palermo, Italy.
INSERM Unit 1042, Université Grenoble Alpes, and CHU de Grenoble, Laboratoire EFCR, Pôle Thorax et Vaisseaux, Grenoble, France.
Sleep Medicine, Sahlgrenska University Hospital and Sahlgrenska Academy, Gothenburg, Sweden.
Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Edegem-Antwerp, Belgium.
Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, and Sleep Research Center, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland.
ENT Department, Førde Central Hospital, Førde, Norway.
Department of Chest Diseases, Ege University School of Medicine, Izmir, Turkey.
Sleep Disorders Center, Department of Cardiovascular Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milano-Bicocca University, Milan, Italy.
School of Medicine and Medical Science, University College Dublin, and Department of Respiratory and Sleep Medicine, St. Vincent's Hospital Group, Dublin, Ireland.
CNR, Institute of Biomedicine and Molecular Immunology, Palermo, Italy; DiBiMIS, University of Palermo, Palermo, Italy.



The impact of treating OSA on renal function decline is controversial. Previous studies usually included small samples and did not consider specific effects of different CPAP modalities. The aim of this study was to evaluate the respective influence of fixed and autoadjusting CPAP modes on estimated glomerular filtration rate (eGFR) in a large sample of patients derived from the prospective European Sleep Apnea Database cohort.


In patients of the European Sleep Apnea Database, eGFR prior to and after follow-up was calculated by using the Chronic Kidney Disease-Epidemiology Collaboration equation. Three study groups were investigated: untreated patients (n = 144), patients receiving fixed CPAP (fCPAP) (n = 1,178), and patients on autoadjusting CPAP (APAP) (n = 485).


In the whole sample, eGFR decreased over time. The rate of eGFR decline was significantly higher in the subgroup with eGFR above median (91.42 mL/min/1.73 m2) at baseline (P < .0001 for effect of baseline eGFR). This decline was attenuated or absent (P < .0001 for effect of treatment) in the subgroup of patients with OSA treated by using fCPAP. A follow-up duration exceeding the median (541 days) was associated with eGFR decline in the untreated and APAP groups but not in the fCPAP group (P < .0001 by two-way ANOVA for interaction between treatment and follow-up length). In multiple regression analysis, eGFR decline was accentuated by advanced age, female sex, cardiac failure, higher baseline eGFR, and longer follow-up duration, whereas there was a protective effect of fCPAP.


fCPAP but not APAP may prevent eGFR decline in OSA.


OSA; automatic CPAP; fixed CPAP; glomerular filtration rate; therapy

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