Renaler Widerstandsindex bei obstruktiver Schlafapnoe

Zusammenfassung

Hintergrund und Fragestellung: Frühere Studien zeigten eine eingeschränkte Nierenfunktion bei obstruktiver Schlafapnoe (OSA). Der duplexsonographisch ermittelte renale Widerstandsindex (RI) ist zugleich Marker der Nierenparenchymschädigung und Prädiktor für die Progression einer Niereninsuffizienz. Wir haben untersucht, inwieweit sich eine OSA auf den RI auswirkt.

Patienten und Methodik: Der renale RI (RI = 1 - [enddiastolische/maximale systolische Flussgeschwindigkeit]) wurde bei 97 Patienten mit und 61 überwiegend hypertensiven Patienten ohne OSA verglichen. Der RI wurde zudem auf das Alter normiert durch Berechnung der prozentualen Abweichung vom altersabhängigen Normwert (RI_%).

Ergebnisse: Bei OSA-Patienten zeigte sich ein Trend hinsichtlich erhöhter Werte für den RI (69,1±8,8 vs. 66,5±8,3 %, p = 0,068) bzw. RI_% (10,2±12,9 vs. 6,4±11,4 %, p = 0,060). Bei Patienten mit leichter bis moderater OSA (Apnoe-Hypopnoe-Index [AHI] 5 - 30/h) war dieser Unterschied signifikant (RI: 70,5±9,1 vs. 66,5±8,2, p = 0,012; RI_%: 12,1±13,4 vs. 6,5±11,4 %, p = 0,012). Für Patienten mit schwerer OSA zeigte sich dieser Unterschied nicht. Bei den Patienten mit leichter bis moderater OSA fand sich ein signifikanter Zusammenhang zwischen AHI und RI bzw. RI_%. Dieser Einfluss war in einer multivariaten Analyse unabhängig vom Vorliegen einer Hypertonie oder eines Diabetes mellitus.

Folgerung: Da Patienten mit obstruktiver Schlafapnoe durch eine deutlich erhöhte Sympathikusaktivität charakterisiert sind, kann man vermuten, dass der erhöhte renale Widerstandsindex Ausdruck einer durch sympathische Neurotransmitter vermittelten Nierenschädigung ist.

Summary

Background and objective: Previous studies have demonstrated renal dysfunction in patients with obstructive sleep apnea (OSA). The renal resistance index (RI) measured by renal duplexsonography (RI = 1 - [enddiastolic velocity/peak systolic velocity]) is at the same time a marker of parenchymal renal damage and predictor of the progression of renal dysfunction. It was the aim of this study to test the influence of OSA on RI.

Patients and Methods: RI was compared between patients with (n = 97) and those without OSA (n = 61). The impact of OSA on the RI was analysed by adjusting for age. Thus, the difference between the measured RI and the age-based RI was expressed as a percentage of the normal age-adjusted value (RI_%).

Results: OSA patients showed a trend towards an increase in RI (69.1±8.8 vs. 66.5±8.3 %, p = 0.068) and RI_% (10.2±12.9 vs. 6.4±11.4 %, p = 0.060), respectively. In patients with mild or moderate OSA (apnea-hypopnea-index [AHI] 5 - 30/h) this difference was significant (RI: 70.5±9.1 vs. 66.5±8.2, p = 0.012; RI_%: 12.1±13,4 vs. 6.5±11.4 %, p = 0.012). RI of patients with severe OSA did not significantly differ from those without OSA. In patients with mild and moderate OSA there was a significant linear association between AHI and RI or RI_%. This association was independent of hypertension or diabetes.

Conclusion: An impairment of renal perfusion and renal parenchymal damage due to increased sympathetic activity may promote renal dysfunction in patients with obstructive sleep apnea.

obstruktive Schlafapnoe - renaler Widerstandsindex - Niereninsuffizienz

obstructive sleep apnea - renal resistance index - renal dysfunction

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