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Association between obstructive sleep apnea and 24-h urine chemistry risk factors for urinary stone disease

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Abstract

The effect of obstructive sleep apnea (OSA) on 24-h urine parameters and resultant kidney stone risk is unknown. We sought to compare urinary lithogenic risk factors among patients with kidney stone disease with and without OSA. We performed a retrospective cohort study of adult patients with nephrolithiasis undergoing both polysomnography and 24-h urine analysis. Measures of acid load including gastrointestinal alkali absorption, urinary titratable acid, and net acid excretion were calculated from 24-h urine. We performed univariable comparisons of 24-h urine parameters between those with and without OSA and fit a multivariable linear regression model adjusting for age, sex, and BMI. Overall, there were 127 patients who underwent both polysomnography and a 24-h urine analysis from 2006 to 2018. There were 109 (86%) patients with OSA and 18 (14%) without. Patients with OSA were more commonly male, had greater BMI and had higher rates of hypertension. Patients with OSA had significantly higher levels of 24-h urinary oxalate, uric acid, sodium, potassium, phosphorous, chloride, and sulfate; higher supersaturation of uric acid; higher titratable acid, and net acid excretion; and lower urinary pH and supersaturation of calcium phosphate (p < 0.05). The difference in urinary pH and titratable acid, but not net acid excretion, remained significant when adjusting for BMI, age, and gender (both p = 0.02). OSA is associated with changes in urinary analytes that promote kidney stone formation, similar to those observed with obesity. After accounting for BMI, OSA is independently associated with lower urine pH and increased urinary titratable acid.

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Data Availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

AADM:

American academy of sleep medicine

BMI:

Body mass index

ICD-9:

International classification of diseases

IQR:

Interquartile range

OSA:

Obstructive sleep apnea

PSG:

Polysomnography testing

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Funding

The project described was supported by CTSA award No. UL1 TR002243 from the National Center for Advancing Translational Sciences.

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Authors and Affiliations

  1. Vanderbilt University Medical Center, 1301 Medical Center Dr Suite 3823, Nashville, TN, 37232, USA

    Jacob E. Tallman, Benjamin V. Stone, Wilson Sui, Nicole L. Miller & Ryan S. Hsi

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  1. Jacob E. Tallman
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  2. Benjamin V. Stone
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  3. Wilson Sui
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  4. Nicole L. Miller
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  5. Ryan S. Hsi
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Contributions

JT: Methodology, Formal Analysis, Data Curation, Writing—Original Draft, Writing—Review and Editing; BS: Conceptualization, Methodology, Software, Data Curation, Formal Analysis, Writing—Review and Editing; WS: Conceptualization, Methodology, Software, Data Curation, Formal Analysis, Writing—Review and Editing; NM: Conceptualization, Resources, Writing—Review and Editing, Supervision; RH: Conceptualization, Methodology, Resources, Formal Analysis, Writing—Original Draft, Writing—Review and Editing, Supervision, Project Administration.

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Correspondence to Jacob E. Tallman.

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Tallman, J.E., Stone, B.V., Sui, W. et al. Association between obstructive sleep apnea and 24-h urine chemistry risk factors for urinary stone disease. Urolithiasis 51, 46 (2023). https://doi.org/10.1007/s00240-023-01421-x

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