{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T08:57:18Z","timestamp":1782377838885,"version":"3.54.5"},"reference-count":69,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T00:00:00Z","timestamp":1763942400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aims to comprehensively explore the bidirectional association between obstructive sleep apnea (OSA) and diabetic kidney disease (DKD) through a systematic review and meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Systematically search for relevant literature on the association between OSA and DKD published from database inception to September 2025. Searches were performed in the Cochrane Library, PubMed, Embase, and Web of Science. Study quality was assessed with the Newcastle-Ottawa Scale (NOS). Meta-analysis, sensitivity analysis, and publication bias assessment were conducted using Review Manager 5.4, while R software was employed to calculate prediction intervals. The certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>\n                      A total of 14 articles involving 5,316 subjects were included. Patients with OSA exhibited a 1.92-fold increased risk of DKD compared with the control group (OR = 1.92, 95% CI: 1.59, 2.32, P &amp;lt; 0.0001). Subgroup analysis by OSA severity indicated a higher risk of DKD in patients with severe OSA (OR = 2.29) than in those with mild to moderate disease (OR = 1.52). Additionally, OSA patients showed significantly lower estimated Glomerular Filtration Rate (eGFR) levels (MD = -8.61, 95% CI: -12.92, -4.30) relative to non-OSA controls. In the reverse analysis, while the prevalence of OSA did not differ significantly between DKD and non-DKD groups (OR = 1.56, 95% CI: 0.71 - 3.43, P = 0.27), patients with DKD had significantly higher apnea-hypopnea index (AHI) (MD = 6.48, 95% CI: 1.74 - 11.22, P = 0.007) and lower average blood oxygen saturation (M-SaO2) (MD = -0.59, 95% CI: -0.82 to -0.36, P &amp;lt; 0.00001). No significant differences were observed in the lowest blood oxygen saturation (L-SaO\n                      <jats:sub>2<\/jats:sub>\n                      ) between DKD and non-DKD groups across all subgroup analyses (all P &amp;gt; 0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A significant bidirectional association exists between OSA and DKD, suggesting a mutual exacerbation of risks between the two conditions. These findings highlight the clinical importance of enhanced OSA screening in diabetic populations and regular renal function monitoring in OSA patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2025.1715997","type":"journal-article","created":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T05:14:43Z","timestamp":1763961283000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["The bidirectional association between obstructive sleep apnea and diabetic kidney disease: systematic review and meta-analysis"],"prefix":"10.3389","volume":"16","author":[{"given":"Jieyu","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuandong","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Dai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zheng","family":"Nan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.2109080","article-title":"Epidemiology of obstructive sleep apnea: A population health perspective","volume":"165","author":"Young","year":"2002","journal-title":"Am J Respir Crit Care Med"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200602-270OC","article-title":"Metabolic risk factors for vascular disease in obstructive sleep apnea: A matched controlled study","volume":"175","author":"McArdle","year":"2007","journal-title":"Am J Respir Crit Care Med"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kws342","article-title":"Increased prevalence of sleep-disordered breathing in adults","volume":"177","author":"Peppard","year":"2013","journal-title":"Am J Epidemiol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(15)00043-0","article-title":"Prevalence of sleep-disordered breathing in the general population: the hypnolaus study","volume":"3","author":"Heinzer","year":"2015","journal-title":"Lancet Respir Med"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00587.2005","article-title":"Excess weight and sleep-disordered breathing","volume":"99","author":"Young","year":"2005","journal-title":"J Of Appl Physiol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1053\/smrv.2001.0189","article-title":"Systemic hypertension and obstructive sleep apnoea","volume":"6","author":"Pepperell","year":"2002","journal-title":"Sleep Med Rev"},{"key":"B7","doi-asserted-by":"publisher","first-page":"89","DOI":"10.2337\/dc20-1913","article-title":"Worldwide epidemiology of diabetes-related end-stage renal disease, 2000\u20132015","volume":"44","author":"Cheng","year":"2021","journal-title":"Diabetes Care"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1038\/s41581-020-0278-5","article-title":"Genetics of diabetes mellitus and diabetes complications","volume":"16","author":"Cole","year":"2020","journal-title":"Nat Rev Nephrol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1448","DOI":"10.4239\/wjd.v15.i7.1448","article-title":"Obstructive sleep apnea: overlooked comorbidity in patients with diabetes","volume":"15","author":"Tenda","year":"2024","journal-title":"World J Diabetes"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1172\/JCI118235","article-title":"Sympathetic neural mechanisms in obstructive sleep apnea","volume":"96","author":"Somers","year":"1995","journal-title":"J Clin Invest"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1017\/S146239940900101X","article-title":"The receptor for advanced glycation endproducts (Rage) and cardiovascular disease","volume":"11","author":"Yan","year":"2009","journal-title":"Expert Rev In Mol Med"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2017.05.009","article-title":"Obstructive sleep apnea and diabetes a state of the art review","volume":"152","author":"Reutrakul","year":"2017","journal-title":"CHEST"},{"key":"B13","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.smrv.2014.07.003","article-title":"Oxidative stress in obstructive sleep apnea and intermittent hypoxia - 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