As soon as it gets cold, many people get up more often. They often want to get up to go to the toilet as soon as they lie down, or they are suffocated by urine when they fall asleep, which seriously affects the quality of sleep. If this is what you really are, you’d better check whether you have obstructive sleep apnea syndrome (OSA).
Obstructive sleep apnea syndrome is a chronic disease characterized by frequent respiratory interruption caused by collapse of upper airway during sleep, mainly manifested as snoring, apnea, suffocation, headache, dizziness, fatigue, inattention and other symptoms. If not treated in time, it may lead to serious complications and even sudden death.
At the 2016 study class on new progress in diagnosis and treatment of cardiovascular diseases combined with sleep apnea in Guangdong Province, Professor Liang min, Department of Nephrology, Nanfang Hospital, Southern Medical University, said that about 80% of OSA patients had frequent urination and polyuria at night, and if not intervened in time, the symptoms would continue to worsen.
poor kidney, poor sleep, poor kidney
In patients with chronic kidney disease, sleep apnea is high.
Large clinical studies have shown that with the decline of renal function, the incidence of sleep apnea will gradually increase, and the prevalence of hypoxemia at night in patients with chronic kidney disease and end-stage kidney disease will significantly increase.
The kidney removes harmful substances from the blood outside the body, and this clearance function is the filtration function of the glomerulus. The glomerular filtration rate reflects the health of the kidney.
Glomerular filtration rate was negatively correlated with nocturnal sleep hypoxia index. Nocturnal hypoxemia was mainly caused by OSA.
A Japanese study of 4056 patients with sleep related respiratory abnormalities showed that patients with sleep apnea had lower glomerular filtration rate than healthy people. This indicates that nocturnal hypoxemia is an independent related factor of accelerated renal function decline.
three manifestations of kidney injury caused by sleep apnea
Liang min pointed out that among OSA patients, the risk of chronic kidney disease increased by 94%, and the risk of end-stage kidney disease increased by 120%. For patients with diabetes, combining with OSA will promote their renal function decline, while for non diabetes and non hypertension people, if they have OSA, they will also increase the risk of chronic kidney disease.
Therefore, the influence of OSA on glomerular filtration rate does not depend on diabetes or hypertension, and it is an independent risk factor.
At the same time, patients with OSA may have adaptive focal stage glomerulosclerosis and tubulointerstitial lesions.
OSA leads to renal dysfunction, which is mainly manifested in the following three aspects:
1. Decreased glomerular filtration function
Normal people can develop chronic kidney disease; The glomerular filtration rate of patients with chronic nephritis decreased faster than that of normal people.
2. Proteinuria
Mild proteinuria increased in normal people and diabetes patients.
3. Renal tubular injury
Increased nocturia and frequent nocturia. Normal people reduce urine through neurohumoral regulation at night. When this regulatory mechanism is destroyed, the urine at night increases, exceeding 1 / 3 of the urine in the whole day, which is called nocturnal urine increase.
Nocturia is actually an obstacle in the regulation of urine, which is one of the manifestations of renal tubular injury.
how does sleep apnea hurt the kidney
At present, it is believed that the kidney may be composed of two parts with different functions but connected anatomically, including the glomerulus mainly in the renal cortex and the renal tubules mainly in the medulla.
In the pathogenesis of chronic kidney disease, although glomerular hypertension is one of the important reasons, renal tubular and tubulointerstitial damage is more likely to lead to renal dysfunction.
The blood supply of the kidney is abundant, but the blood supply and oxygen supply in the kidney are seriously unbalanced. The medulla of the kidney receives only 10% of the blood supply and oxygen supply of the kidney, which is a sensitive tissue for hypoxia injury. Some studies have proved that renal hypoxia is closely related to the occurrence of chronic kidney disease.
Animal experiments have proved that hypoxia can cause proteinuria, renal tubular epithelial cell damage and inflammatory cell infiltration in normal rats.
Some clinical studies have also proved this conclusion. When sleep breathing disorders occur in the elderly, proteinuria does increase. However, more research is needed to further confirm it.
In addition, some studies have pointed out that OSA can activate the whole-body RAS system (renin angiotensin system, an important humoral regulatory system in the human body, plays an important role in the normal development of the cardiovascular system, cardiovascular function homeostasis, electrolyte and blood pressure regulation), leading to a decrease in the responsiveness of renal vessels to angiotensin II in patients with OSA and a decrease in the sensitivity of renal vessels. And the responsiveness of renal vessels to angiotensin II is related to the degree of hypoxia at night.
Liang min points out that only when you sleep well can you have a good kidney. Continuous positive pressure ventilation (CPAP) can be used to intervene OSA and protect the kidney. Studies have shown that CPAP can improve renal hemodynamics in patients with OSA, and can also activate RAS, which is an effective way to improve OSA.
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