Exploring the impact of sleep apnea on renal transplant outcomes

BACKGROUND: Sleep apnea (SA), a common diagnosis, has been shown to exhibit increased prevalence in patients with end-stage renal disease (ESRD). There is no clear consensus on the impact of SA on renal transplant outcomes. METHODS: We performed a retrospective analysis of the United States Renal Data System (USRDS) to evaluate the impact of SA on renal transplant outcomes, including transplant failure or rejection, post-transplantation new onset chronic kidney disease (CKD) levels 3, 4, or 5, and mortality. Demographic variables of interest included age at transplant, race, sex, ethnicity, and Charlson Comorbidity Index (CCI). Cox proportional hazards (CPH) modeling was used to examine the association of SA with transplant outcomes. RESULTS: When examining the final multivariable CPH models, patients with SA were less likely to experience a transplant failure or rejection (HR: 0.93, CI: 0.89-0.96). SA did not have a significant effect on mortality (HR: 1.04; CI: 0.99-1.09) in the final analysis. SA was significantly associated with new onset CKD 3 (HR: 1.22; CI: 1.19-1.27), CKD 4 (HR: 1.20; CI: 1.13-1.27), and CKD 5 (HR: 1.08; CI: 1.01-1.14). DISCUSSION: SA significantly increases the risk of post-transplantation progression to CKD 3, 4, and 5. SA mildly decreases the risk of transplant failure or rejection with no significant effect on mortality. The protective effect of SA on transplant failure and rejection is of unclear clinical significance. CONCLUSIONS: This study elucidates a potential link between SA and renal transplant outcomes. Further studies are required to better characterize the association and develop treatment guidelines.