Relação da apneia obstrutiva do sono com adiposidade corporal, sarcopenia e resistência à insulina em pacientes com doença renal crônica em tratamento não dialítico

• Ano de defesa: 2017
• Autor(a) principal: Fernandes, Julia Freitas Rodrigues
• Orientador(a): Klein, Márcia Regina Simas Torres
• Banca de defesa: Bregman, Rachel , Neves, Mário Fritsch Toros , Rosa, Glorimar , Rosado, Eliane Lopes
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade do Estado do Rio de Janeiro
• Programa de Pós-Graduação: Programa de Pós-Graduação em Fisiopatologia Clínica e Experimental
• Departamento: Centro Biomédico::Faculdade de Ciências Médicas
• País: BR
• Palavras-chave em Português: Apneia obstrutiva do sono; Doença Renal Crônica; Obesidade; Sarcopenia; Resistência à insulina; Apneia; Apneias do sono tipo obstrutiva; Rins Doenças
• Palavras-chave em Inglês: Obstructive sleep apnea; Chronic kidney disease; Obesity; Sarcopenia; Insulin resistence
• Área do conhecimento CNPq: CNPQ::CIENCIAS DA SAUDE::NUTRICAO
• Link de acesso: http://www.bdtd.uerj.br/handle/1/12682

Studies suggest that the prevalence of obstructive sleep apnea (OSA) is high in patients with chronic kidney disease (CKD). In the general population, OSA has been associated with obesity, sarcopenia, insulin resistance, high blood pressure and endothelial dysfunction. However, these associations have not yet been established in patients with CKD. To evaluate the association of OSA with total and central body adiposity, sarcopenia, metabolic profile, blood pressure, cutaneous microvascular reactivity and proteinuria in nondialyzed CKD patients. Cross-sectional study involving patients with CKD (stages 3b-4). The glomerular filtration rate was estimated (eGFR) by the CKD-EPI equation. Patients were assessed for: 1) OSA: by Watch-PAT200® equipment (apnea / hypopnea index (AHI) &#8805; 5 events / h); 2) total body adiposity: body mass index and body fat (electrical bioimpedance; BIA and dual energy X-ray absorptiometry; DXA); 3) central body adiposity: neck circumference, waist circumference, waist-to-hip ratio, waist-to-height ratio, neck-to-height ratio and trunk and visceral fat (DXA); 4) sarcopenia: as proposed by the European Working Group on Sarcopenia in Older People: muscle mass (DXA), muscle strength: handgrip strength, physical performance: gait speed; 5) metabolic profile: serum concentrations of glucose, insulin, adiponectin, total cholesterol and fractions and triglycerides; 6) blood pressure: oscillometric method; 7) cutaneous microvascular reactivity: Laser Speckle Contrast Imaging; 8) proteinuria. A total of 73 patients were evaluated: 58% men, age = 62.88 ± 1.06 years, eGFR = 27.1 (22.1-35.8) mL/min/1.73 m². OSA was present in 67% of participants (n = 49). Patients with OSA compared to those without OSA had higher values for all parameters of total and central body adiposity (p<0.001). After adjusting for confounding factors (including body fat), OSA was not associated with lean mass, muscle mass, muscle function, insulin resistance, adiponectin, lipid profile, blood pressure and proteinuria. AHI presented a negative and significant correlation with the amplitude of cutaneous vascular conductance, even after adjusting for confounders (r = -0.26, p = 0.04). Conclusion: The present study suggests that, in nondialyzed CKD patients, the frequency of OSA is high, being associated with a greater total and central body adiposity and presenting potential deleterious effects on cutaneous microvascular reactivity. OSA is not associated with sarcopenia, insulin resistance, lipid profile, blood pressure and proteinuria after adjustment for confounders including body adiposity.