Clinical Presentation of Obstructive Sleep Apnea in Patients with Chronic Kidney Disease

Nicholl, David D M; Ahmed, Sofia B.; Loewen, Andrea; Hemmelgarn, Brenda R.; Sola, Darlene Y.; Beecroft, Jaime M.; Turin, Tanvir Chowdhury; Hanly, Patrick J.

doi:10.5664/jcsm.2028

Cited by 45 publications

(35 citation statements)

References 32 publications

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“…Similar findings were reported in another study (28) where, however, the OSA patients had been taken from a sleep laboratory population, so that they could represent a group preselected for OSA symptoms and risk factors. Instead, in Adams' study all OSA subjects came from the general population (26), which demonstrates that OSA with coexistent CKD is really associated with fewer symptoms than isolated OSA, particularly as concerns snoring and witnessed apneas.…”

Section: Editorialsupporting

confidence: 85%

Obstructive sleep apnea and chronic kidney disease: open questions on a potential public health problem

Marrone

Bonsignore

2018

J. Thorac. Dis.

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Section: Editorialsupporting

confidence: 85%

Obstructive sleep apnea and chronic kidney disease: open questions on a potential public health problem

Marrone

Bonsignore

2018

J. Thorac. Dis.

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“…Over the years, several mechanistic explanations have been put forward. Sleep apnea is highly prevalent in patients on dialysis, and hypoxemia has been observed in patients while sleeping on dialysis (33,34). Reduced respiratory drive has been incriminated, because CO 2 may diffuse from the blood into the dialysate, resulting in decreased partial pressure of CO 2 .…”

Section: Discussionmentioning

confidence: 99%

Intradialytic Hypoxemia and Clinical Outcomes in Patients on Hemodialysis

Meyring-Wösten

Zhang

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background and objectives Intradialytic hypoxemia has been recognized for decades, but its associations with outcomes have not yet been assessed in a large patient cohort.Design, setting, participants, & measurements Our retrospective cohort study was conducted between January of 2012 and January of 2015. We recorded blood oxygen saturation every minute during hemodialysis in patients with arteriovenous access. A 6-month baseline period with at least 10 treatments with oxygen saturation measurements preceded a 12-month follow-up. Patients were stratified by the presence or absence of prolonged intradialytic hypoxemia defined as oxygen saturation ,90% for at least one third of the treatment time. Demographic, laboratory, and treatment data and hospitalization and mortality rates were compared between the groups. Multivariate Cox regression analysis was used to assess baseline predictors of all-cause mortality during follow-up.Results In total, 100 (10%) of 983 patients had prolonged intradialytic hypoxemia. These patients were older (+3.6 years; 95% confidence interval, 0.8 to 6.3), had longer dialysis vintage (+1.2 years; 95% confidence interval, 0.3 to 2.1), and had higher prevalence of congestive heart failure (+10.8%; 95% confidence interval, 1.6 to 20.7) and chronic obstructive pulmonary disease (+13%; 95% confidence interval, 5 to 21.2). They also resembled an inflammatory phenotype, with lower serum albumin levels (20.1 g/dl; 95% confidence interval, 20.2 to 0) and higher neutrophil-to-lymphocyte ratios (+1; 95% confidence interval, 0.5 to 1.6). They had lower hemoglobin levels (20.2 g/dl; 95% confidence interval, 20.4 to 0) and required more erythropoietin (+1374 U per hemodialysis treatment; 95% confidence interval, 343 to 2405). During follow-up, all-cause hospitalization (1113 hospitalizations; univariate hazard ratio, 1.46; 95% confidence interval, 1.22 to 1.73) and mortality (89 deaths; adjusted hazard ratio, 1.98; 95% confidence interval, 1.14 to 3.43) were higher in patients with prolonged intradialytic hypoxemia.Conclusions Prolonged intradialytic hypoxemia was associated with laboratory indicators of inflammation, higher erythropoietin requirements, and higher all-cause hospitalization and mortality.

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“…The presentation of OSA in CKD usually lacks the typical features of OSA including loud snoring, apneic episodes, and daytime somnolence, which leads to the underdiagnosis of OSA in this patient population [13] . Features associated with CKD such as chronic fatigue, uremia or side effects of medications may overshadow the complaint of subjective sleepiness, and the increased sympathetic activity in the setting of volume overload may hinder the development of excessive sleepiness [14] . Approximately 50% of the patients with ESRD have OSA, making it common among this patient group [15] .…”

Section: Osa Hypertension and Ckdmentioning

confidence: 99%

The Triad of Sleep Apnea, Hypertension, and Chronic Kidney Disease: A Spectrum of Common Pathology

2016

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Obstructive sleep apnea (OSA), hypertension, and chronic kidney disease (CKD) are different entities and are generally managed individually most of the time. However, CKD, OSA, and hypertension share many common risk factors and it is not uncommon to see this complex triad together. In fact, they share similar pathophysiology and have been interlinked with each other. The common pathophysiology includes chronic volume overload, hyperaldosteronism, increased sympathetic activity, endothelial dysfunction, and increased inflammatory markers. The combination of this triad has significant negative impact on the cardiovascular health, and increases the mortality and morbidity in this complicated group of patients. On one hand, progression of CKD can lead to the worsening of OSA and hypertension; similarly, worsening sleep apnea can make the hypertension difficult to treat and enhance the progression of CKD. This review article highlights the bidirectional interlink among these apparently different disease processes which share common pathophysiological mechanisms and emphasizes the importance of treating them collectively to improve outcomes.

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Clinical Presentation of Obstructive Sleep Apnea in Patients with Chronic Kidney Disease

Abstract: The presence of OSA in patients with CKD is unlikely to be clinically apparent. Consequently, objective cardiopulmonary monitoring during sleep is required to reliably identify this comorbidity.

Cited by 45 publications

References 32 publications

Obstructive sleep apnea and chronic kidney disease: open questions on a potential public health problem

Obstructive sleep apnea and chronic kidney disease: open questions on a potential public health problem

Intradialytic Hypoxemia and Clinical Outcomes in Patients on Hemodialysis

The Triad of Sleep Apnea, Hypertension, and Chronic Kidney Disease: A Spectrum of Common Pathology

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