Sleep Apnea, Coronary Atherosclerosis and Heart Failure in Diabetes Patients With Nephropathy

Sleep Apnea, Coronary Atherosclerosis and Heart Failure in Diabetes Patients With Nephropathy

Sponsors

Lead Sponsor: University of Aarhus

Source University of Aarhus
Brief Summary

Background:

Diabetes, and especially diabetic kidney disease is associated with the development of cardiovascular disease such as calcification in the coronary arteries and heart failure. Sleep apnea is frequent among patients with diabetes and diabetic kidney disease and sleep apnea itself is a solitary risk factor in the development of cardiovascular disease. Nonetheless, sleep apnea is underdiagnosed in diabetes patients because of a discrepancy between sleep apnea severity and actual oxygen deficiency symptoms which makes the diagnosis difficult. For that reason, many diabetics have undiagnosed sleep apnea together with cardiovascular disease. Early discovery of sleep apnea among high risk diabetic patients may therefore be considered crucial before cardiovascular complications develop. For this reason, sleep apnea screening of high-risk diabetics can possibly improve early diagnostics of cardiovascular disease.

Aim:

This study will seek to establish the association between obstructive sleep apnea (OSA) and coronary calcification and heart failure in patients with diabetic kidney disease. The basic hypothesis of the study is that patients with diabetic kidney disease and concurrent OSA have a higher prevalence and severity of coronary calcification and heart failure compared to patients without OSA.

Methods:

Diabetic adult patients with scheduled check-ups at Steno Diabetes Center Aarhus, or Department of Renal Medicine on Aarhus University Hospital will be included in the study.

Firstly, all included patients are screened for sleep apnea with the devices SomnoTouch® and ApneaLink®. Based on the sleep apnea determination; 40 patients with moderate-severe sleep apnea are compared with 40 patients without sleep apnea. In both groups, the patients are examined for calcification in the coronary vessels using a CT-scan while the function of the heart is examined by ultrasound (echocardiography). The stiffness of aorta is measured and performed using radial artery tonometry (SphygmoCor®).

Furthermore, range of blood- and urine samples will be performed

The perspectives are that patients with diabetes should be regularly evaluated for sleep apnea and that patients with moderate/severe sleep apnea should undergo further examination for cardiovascular disease even though the patients don't display any symptoms of either cardiovascular disease or sleep apnea.

Overall Status Recruiting
Start Date October 1, 2020
Completion Date September 2021
Primary Completion Date August 31, 2021
Study Type Observational
Primary Outcome
Measure Time Frame
The association between sleep apnea and coronary atherosclerosis (Agatston Score) measured with cardiac CT-scan in patients with diabetic nephropathy. Cardiac CT-scan will be performed no later than 1 month after inclusion. All Agatston scores will be estimated straight after the cardiac CT-scan.
The association between sleep apnea and systolic function in patients with diabetic nephropathy. Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
The association between sleep apnea and diastolic heart failure in patients with diabetic nephropathy. Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
The association between sleep apnea and systolic function in patients with diabetic nephropathy. Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Secondary Outcome
Measure Time Frame
The association between sleep apnea and coronary plaque volume in patients with diabetic nephropathy. Cardiac CT-scan will be performed no later than 1 month after inclusion.
Association of sleep apnea and aortic stiffness (defined as Pulse Wave Velocity (PWV)) in patients with diabetic nephropathy. PWV is performed the same day as the patient is included.
Association between Matrix Gla Protein (MGP) and coronary calcification in patients with sleep apnea and diabetic nephropathy. Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021
Association between Calcification propensity score (T50test) and coronary calcification in patients with sleep apnea and diabetic nephropathy. Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021
Association between sRANKL (soluble receptor activator of nuclear factor kappa-B ligand) and coronary calcification in patients with sleep apnea and diabetic nephropathy. Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021
Association between 25-OH-Vitamin D(D3+D2) and coronary calcification in patients with sleep apnea and diabetic nephropathy. Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021
Association between Fetuin-A(alfa-2-Heremans Schmid glycoprotein; AHSG) and coronary calcification in patients with sleep apnea and diabetic nephropathy. Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021.
Association between Sclerostin and coronary calcification in patients with sleep apnea and diabetic nephropathy. Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021
Association between osteoprotegerin and coronary calcification in patients with sleep apnea and diabetic nephropathy. Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021
Association between BsAP (bone-specific alkaline phosphatase) and coronary calcification in patients with sleep apnea and diabetic nephropathy. Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021
Association between TRAP5B (tartrate-resistant acid phosphatase 5b) and coronary calcification in patients with sleep apnea and diabetic nephropathy. Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021
Association between P1NP (procollagen type 1 N propeptide) and coronary calcification in patients with sleep apnea and diabetic nephropathy. Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021
Association between LVEDd (Left ventricular end diastolic diameter) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy. Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between LVEDs (Left ventricular end systolic diameter) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy. Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between IVSd (Interventricular Septal Thickness at Diastole) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy. Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between IVSs (Interventricular Septal Thickness at Systole) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy. Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between PWTd (Posterior wall thickness at end-diastole) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy. Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between PWTs (Posterior wall thickness at end-systole) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy. Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between Aorta (sinus valsalva) diameter as determined during echocardiography and sleep apnea in patients with diabetic nephropathy. Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between Aorta (Ascendens) diameter as determined during echocardiography and sleep apnea in patients with diabetic nephropathy. Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between Aorta (Abdominalis) diameter as determined during echocardiography and sleep apnea in patients with diabetic nephropathy. Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between maximum Vena Cava Inferior diameter as determined during echocardiography and sleep apnea in patients with diabetic nephropathy. Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between minimum Vena Cava Inferior diameter as determined during echocardiography and sleep apnea in patients with diabetic nephropathy. Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between Early mitral inflow velocity (E) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy. Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between Late mitral inflow velocity (A) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy. Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between E/A-ratio as determined during echocardiography and sleep apnea in patients with diabetic nephropathy. Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between Deceleration time of early diastolic transmittal flow (dtE) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy. Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between Right ventricular diameter (RVD) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy. Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between left atrial volume (LAV) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy. Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between 2D atrial global strain as determined during echocardiography and sleep apnea in patients with diabetic nephropathy. Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Enrollment 80
Condition
Eligibility

Sampling Method: Non-Probability Sample

Criteria:

Inclusion Criteria:

- ≥ 18 years.

- Diabetes Mellitus Type 2 with an eGFR between 10-60 ml/min/1,73 m^2 (Equalling CKD-group 3, 4 and 5 non-dialysis).

Exclusion Criteria:

- Known sleep apnea in continuous positive airway pressure(CPAP) treatment.

- Known mild sleep apnea (AHI 5-14) after the sleep apnea measurement.

- Participants with central apnea (> 50 % of central apnea episodes in the AHI ≥ 15 group.) or Cheyne Stokes after the sleep apnea measurement.

- < 4 hours of recording (ApneaLink)

- Known coronary arterial disease with previous revascularization (PCI or CABG)

Gender: All

Minimum Age: 18 Years

Maximum Age: N/A

Healthy Volunteers: Accepts Healthy Volunteers

Overall Official
Overall Contact

Last Name: Niels H. Buus, MD PhD DMSc

Phone: 454-046-0338

Email: [email protected]

Location
Facility: Status: Contact: Aarhus University Hospital Sebastian Nielsen, MD student 51889528 0045 [email protected]
Location Countries

Denmark

Verification Date

September 2020

Responsible Party

Type: Sponsor

Has Expanded Access No
Condition Browse
Arm Group

Label: Sleep Apnea (AHI ≥ 15 per hour)

Description: Patients with moderate/severe sleep apnea (Apnea/hypopnea-index ≥ 15 per hour).

Label: Non-Sleep Apnea (AHI < 5 per hour)

Description: Patients without sleep apnea (Apnea/hypopnea-index < 5 per hour).

Acronym SLEEP
Patient Data No
Study Design Info

Observational Model: Cohort

Time Perspective: Cross-Sectional

Source: ClinicalTrials.gov