• Stefan Stadler, Tanja Zimmermann, Franziska Franke, Myriam Rheinberger, Iris M Heid, Carsten A Böger, Michael Arzt, and DIACORE study group.
• a Department of Internal Medicine II , University Hospital Regensburg , Regensburg , Germany.
• Ann. Med. 2017 Sep 1; 49 (6): 487495487-495.

IntroductionDiabetes-associated kidney disease is characterized by impairment of renal function and albuminuria. The aim of the present study was to assess whether sleep-disordered breathing is associated with decreased estimated glomerular filtration rate or increased urine-albumin-to-creatinine-ratio independently from known modulators of diabetes-associated kidney disease.Material And MethodsEstimated glomerular filtration rate and urine-albumin-to-creatinine-ratio were determined in the baseline survey of the DIACORE-SDB substudy, a prospectively planned study of Diabetes mellitus 2 patients. As a measure of the severity of sleep-disordered breathing, the apnea-hypopnea-index was assessed using a 2-channel ambulatory SDB-monitoring device.ResultsA total of 679 patients (mean age 66 years, men 61%, mean body-mass-index 31.2 kg/m2) were analyzed. In multivariable linear regression models adjusting for known modulators of diabetes-associated kidney disease, such as sex, age, body-mass-index, systolic blood pressure, duration of diabetes and HbA1c, apnea-hypopnea-index [beta-estimate -0.2 ml/min/1.73 m2, 95% CI (-0.3; -0.1), p = .004], duration of diabetes and age were associated with estimated glomerular filtration rate. Apnea-hypopnea-index [beta-estimate 0.01 mg/g, 95% CI (0.00; 0.02), p = .009], duration of diabetes, HbA1c and systolic blood pressure were associated with ln(urine-albumin-to-creatinine-ratio).ConclusionIn patients with diabetes mellitus type 2, more severe sleep-disordered breathing is significantly associated with lower estimated glomerular filtration rate and increased albuminuria, independent of known modulators of diabetes-associated kidney disease.

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