Bidirectional Interactions Between Obstructive Sleep Apnea and Chronic Kidney Disease- A Review

Chronic kidney disease (CKD) is a major cause of morbidity and mortality in India, with a prevalence estimated at 13-15%. Obstructive sleep apnea (OSA) is an emerging threat, significantly contributing to CKD development. Over 50% of end-stage renal disease (ESRD) patients exhibit OSA symptoms. Co-existing OSA exacerbates CKD through mechanisms such as tissue hypoxia and increased inflammatory mediators, while CKD worsens OSA due to volume overload and respiratory muscle weakening. The pathophysiology involves nocturnal hypoxia causing glomerular hypertension and subsequent renal injury. Treatment options for OSA include behavioral modifications, CPAP therapy, and surgery. CPAP therapy shows potential in improving renal parameters but requires further long-term studies. Dialysis, especially nocturnal hemodialysis, significantly reduces OSA severity and improves oxygen saturation levels. Surgical interventions, while reducing ESRD risk, carry a short-term increased risk of non-cardiovascular mortality. Recognizing and treating OSA in CKD and ESRD patients is crucial to breaking the cycle of mutual exacerbation and improving patient outcomes. This review highlights the pathophysiology and management strategies of the OSA-CKD complex.