Risk of Nephrolithiasis in Patients With Sleep Apnea: A Population-Based Cohort Study

Study Objectives: To delineate the relationship between sleep apnea and subsequent risk of nephrolithiasis. Methods: We conducted a retrospective cohort analysis of a general population sample from Taiwan National Health Insurance Research Database (NHIRD) from January 1, 2000 to December 31, 2012. Patients with sleep apnea without prior diagnosis of nephrolithiasis (n = 7,831) were identified and subsequent development of nephrolithiasis was compared to an age- and sex-matched control group (n = 31,293) without sleep apnea. The Cox proportional hazard regression models were used to evaluate the association between sleep apnea and subsequent nephrolithiasis development. Results: After adjusting for age, sex, and comorbidities, the risk of nephrolithiasis remained significantly increased in the sleep apnea group (hazard ratio [HR] =1.35; 95% confidence interval [CI] =1.23-1.48; P< .001). Compared to controls, elevated HRs of nephrolithiasis were observed for male patients (HR = 1.22; 95% CI 1.09-1.36: P < .001) and those aged 20-39 years (HR = 1.28: 95% CI 1.09-1.49: P < .01) and 40-59 years (HR = 1.17, 95% CI 1.03-1.34, P < .05) in the sleep apnea cohort. Risk of nephrolithiasis in patients with sleep apnea increased significantly with concomitant metabolic-related comorbidities, gouty arthritis, and urinary tract infection. Conclusions: Sleep apnea is associated with an increased subsequent risk of the development of nephrolithiasis. Young male patients with sleep apnea and concomitant comorbidities are at the greatest risk for nephrolithiasis formation.