Did you know that sleeping and snoring can be the culprit of kidney disease?!

Snoring and poor sleep quality may be more than just annoying - they could be putting your kidneys at risk. Discover the connection between sleep and kidney health here.

Mar 23, 2023 - 13:38
Mar 23, 2023 - 14:37
Did you know that sleeping and snoring can be the culprit of kidney disease?!
Snoring Could Be Linked to Kidney Disease?

Do you experience snoring, interruptions in your breathing, or wake up frequently during sleep? Is your snoring sporadic and irregular? Do you wake up feeling dizzy or with a headache? Are you experiencing symptoms such as nocturia, dry mouth, daytime sleepiness, or fatigue? If so, it's possible that you may have sleep apnea, and it's important to seek medical attention promptly. Not only can sleep apnea negatively impact your quality of life and sleep, but it can also lead to complications affecting multiple systems and organs, including the heart, brain, kidneys, blood vessels, and endocrine system. March 21st is recognized as "World Sleep Day." Let's take the opportunity to learn about snoring and sleep apnea, including their interaction with kidney disease, and prioritize getting high-quality sleep.


What is Obstructive Sleep Apnea (osa)?

Snoring is a common occurrence that can affect people of all ages. While some may consider it a sign of sound sleep or exhaustion, snoring can vary in intensity. Mild cases are generally harmless, but severe snoring can result in repeated sleep apnea, interrupted breathing, and decreased oxygen supply to the body, which can lead to multi-system damage and is medically known as obstructive sleep apnea (OSA). OSA is closely linked to a range of cardiovascular and cerebrovascular conditions, including congestive heart failure, hypertension, arrhythmia, coronary heart disease, and stroke. Additionally, OSA can contribute to the onset and progression of chronic kidney disease.


Obstructive sleep apnea (OSA) has the potential to lead to damage in the kidneys.

The mechanisms underlying renal injury resulting from obstructive sleep apnea (OSA) include chronic intermittent hypoxia, hypercapnia, activation of the renin-angiotensin system, and inflammatory responses. Clinical manifestations of OSA-related kidney damage may include microalbuminuria, renal insufficiency, and nocturia. Renal biopsy may reveal an increase in glomerular volume and the presence of fat droplets in the renal tubules and glomerular basement membranes. In some cases, there may be segmental diabetic nephropathy-like changes, or focal segmental glomerulosclerosis observed under the microscope.

There is a high incidence of metabolic diseases associated with obstructive sleep apnea (OSA), which can lead to kidney damage in conditions such as diabetic kidney disease, hypertension-related kidney damage, obesity-related kidney disease, hyperuricemia-related kidney damage, and hyperlipidemia-related kidney damage. The underlying pathogenesis is linked to factors such as inadequate control of the primary disease, chronic inflammatory states, insulin resistance, and endothelial dysfunction.


Sleep apnea can be caused by chronic kidney disease.

Obstructive sleep apnea (OSA) is highly prevalent in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). Compared to the general population, the prevalence of sleep apnea in CKD patients is 10 times higher, and between 50% to 60% of ESRD patients have sleep apnea. According to a study involving 254 CKD patients divided into three groups based on baseline renal function, it was found that the prevalence of OSA increased as renal function declined, with the hemodialysis group exhibiting a 57% prevalence rate of OSA and a 48% prevalence rate of nocturnal hypoxemia.


There are several factors that may explain the high prevalence of obstructive sleep apnea (OSA) in CKD and ESRD patients: 

  1.  CKD patients often have significant fluid retention, which can shift to the upper half of the body when lying down, causing increased neck fluid volume, thickened neck circumference, and upper respiratory tract mucosal edema, all of which can contribute to the collapse of the upper airway and the onset of OSA; 
  2.  In end-stage renal disease, the accumulation of toxins and chronic inflammation can impair the sensory function of the upper respiratory tract mucosa, reduce the sensitivity of peripheral chemoreceptors, and lead to ventilation disorders; 
  3.  Fluid retention can also cause pulmonary interstitial edema, hyperventilation, and central apnea.


How to diagnose Obstructive sleep apnea?

Polysomnography (PSG) monitoring is widely recognized as the primary method for diagnosing obstructive sleep apnea (OSA) due to its accuracy and ability to monitor sleep throughout the night in a hospital setting. Portable monitoring (PM) can serve as an alternative means of examination and can be conducted at home or at the patient's bedside in the hospital. Doctors diagnose OSA by following established international and domestic guidelines, which involve taking a detailed medical history and identifying any comorbidities, administering scales to assess sleep quality and daytime sleepiness, and confirming the diagnosis with the results of PM or PSG monitoring.

The treatment of obstructive sleep apnea (OSA) when accompanied by renal injury/nephropathy requires a comprehensive approach that addresses both conditions simultaneously.

Continuous positive airway pressure (CPAP), oral appliances, behavioral therapy, and surgery are among the primary treatment methods for obstructive sleep apnea (OSA). CPAP is considered the preferred treatment for moderate to severe OSA in the general population. CPAP therapy not only alleviates symptoms such as daytime fatigue, lethargy, and inattention, but also improves the patient's quality of life, reduces systemic damage, controls blood pressure, and reduces inflammatory reactions and insulin resistance. Observational studies suggest that in peritoneal dialysis patients with OSA, CPAP therapy may reduce mortality.

Oral appliances are a suitable alternative or supplementary treatment to CPAP for patients with simple snoring and mild to moderate OSA. Surgical treatment for OSA requires strict control of indications, including tonsil and uvulopharyngoplasty and mandibular anterior transfer.

Intensive blood purification therapy can reduce volume load at night and the severity of OSA-related respiratory distress in patients with end-stage renal disease (ESRD). This can be achieved through methods such as switching from conventional hemodialysis to nocturnal hemodialysis, changing continuous ambulatory peritoneal dialysis to nighttime peritoneal dialysis, or using ultrafiltration dehydration. Studies have shown that these interventions can increase oxygen saturation, reduce the frequency of sleep apnea and hypopnea attacks.

Comprehensive prevention and treatment measures are essential for managing OSA combined with kidney injury/nephropathy. These measures include correcting OSA, controlling blood pressure, blood sugar, hyperlipidemia, and hyperuricemia, controlling weight, reducing urinary protein, quitting smoking and drinking, and using caution with hypnosis and sedative drugs.


It is crucial to seek medical attention promptly if severe snoring is suspected to be OSA. Once diagnosed, effective treatment measures must be taken. Patients with OSA should also monitor for nocturia and increased urine foam, conduct urine tests, and monitor renal function for signs of kidney damage caused by OSA. For patients with chronic kidney disease, screening for sleep apnea is also crucial to timely diagnosis and treatment.

OSA and CKD have a two-way relationship, with OSA accelerating the decline in renal function and CKD contributing to the pathogenesis of OSA. Intervention for OSA or treatment of CKD may help break this cycle, delaying disease progression and even reducing mortality.

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Sakib I am Sajedul Islam Sakib from Bangladesh. Currently, I am a student at AIUB studying computer science but I also like reading and learning new things, especially about Blogging and Education.