Declining Kidney Function Increases the Prevalence of Sleep Apnea and Nocturnal Hypoxia

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:10.1378/chest.11-1809

Cited by 172 publications

(117 citation statements)

References 42 publications

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“…Cross-sectional cohort studies have demonstrated a significant direct association between the severity of sleep apnea and the severity of renal dysfunction. [270][271][272][273][274][275][276] In addition, cohort studies of the longitudinal relationship between sleep apnea and kidney function show that apnea is independently associated with an increased risk of accelerated loss of kidney function. 277,278 Conversely, as kidney function declines, the prevalence of sleep apnea and nocturnal hypoxia increases.…”

Section: Repeated Episodes Of Acute Kidney Injurymentioning

confidence: 99%

“…277,278 Conversely, as kidney function declines, the prevalence of sleep apnea and nocturnal hypoxia increases. 272 Furthermore, aggressive dialysis has been found to improve obstructive sleep apnea. These findings have led to the contention that sleep apnea and CKD have a bidirectional relationship with both diseases being a risk factor for the other.…”

Section: Repeated Episodes Of Acute Kidney Injurymentioning

confidence: 99%

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Hypoxia: The Force that Drives Chronic Kidney Disease

Colgan

Shelley

2016

Clinical Medicine & Research

125

111

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In the United States the prevalence of end-stage renal disease (ESRD) reached epidemic proportions in 2012 with over 600,000 patients being treated. The rates of ESRD among the elderly are disproportionally high. Consequently, as life expectancy increases and the baby-boom generation reaches retirement age, the already heavy burden imposed by ESRD on the US health care system is set to increase dramatically. ESRD represents the terminal stage of chronic kidney disease (CKD). A large body of evidence indicating that CKD is driven by renal tissue hypoxia has led to the development of therapeutic strategies that increase kidney oxygenation and the contention that chronic hypoxia is the final common pathway to end-stage renal failure. Numerous studies have demonstrated that one of the most potent means by which hypoxic conditions within the kidney produce CKD is by inducing a sustained inflammatory attack by infiltrating leukocytes. Indispensable to this attack is the acquisition by leukocytes of an adhesive phenotype. It was thought that this process resulted exclusively from leukocytes responding to cytokines released from ischemic renal endothelium. However, recently it has been demonstrated that leukocytes also become activated independent of the hypoxic response of endothelial cells. It was found that this endothelium-independent mechanism involves leukocytes directly sensing hypoxia and responding by transcriptional induction of the genes that encode the β2-integrin family of adhesion molecules. This induction likely maintains the long-term inflammation by which hypoxia drives the pathogenesis of CKD. Consequently, targeting these transcriptional mechanisms would appear to represent a promising new therapeutic strategy.

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Section: Repeated Episodes Of Acute Kidney Injurymentioning

confidence: 99%

Section: Repeated Episodes Of Acute Kidney Injurymentioning

confidence: 99%

Hypoxia: The Force that Drives Chronic Kidney Disease

Colgan

Shelley

2016

Clinical Medicine & Research

125

111

View full text Add to dashboard Cite

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“…Some of the data have previously been published in a study that investigated the prevalence of sleep apnea and nocturnal hypoxia in CKD. 13 The current study was designed to evaluate the prevalence and clinical significance of RLS in CKD with an expanded cohort of patients. The study was approved by the University of Calgary Conjoint Health Research Ethics Board.…”

Section: Patient Recruitment and Data Collectionmentioning

confidence: 99%

The Prevalence of Restless Legs Syndrome across the Full Spectrum of Kidney Disease

Lee

Nicholl

Ahmed

et al. 2013

Journal of Clinical Sleep Medicine

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Study Objectives: Although restless legs syndrome (RLS) is common and well recognized as an important and potentially treatable cause of sleep disruption in end-stage renal disease (ESRD), few studies have evaluated the prevalence of RLS and its impact on sleep in the non-dialysis-dependent chronic kidney disease (CKD) population. The objectives of the study were to determine the prevalence of RLS across the full spectrum of kidney disease and to assess the impact of RLS on sleep quality and daytime function. Methods: Five hundred patients were recruited from nephrology clinics and were stratifi ed according to estimated glomerular fi ltration rate (eGFR): eGFR ≥ 60 mL/min/1.73m 2 (n = 127), CKD (eGFR < 60, not on dialysis, n = 242), and ESRD (on hemodialysis, n = 131). All subjects completed a sleep and medical history questionnaire, an RLS questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the Epworth Sleepiness Scale (ESS). Results:The prevalence of RLS did not differ among the three groups (18.9% [eGFR ≥ 60], 26% (CKD), and 26% (ESRD) p = 0.27). However, many symptoms of sleep disruption were more common in patients with RLS, and RLS was independently correlated with the PSQI score both in the full cohort (OR = 2.63, CI = 1.60-4.00, p < 0.001) and the CKD group (OR = 2.39, CI = 1.20-4.79, p = 0.014). Conclusions: RLS is common in non-dialysis-dependent CKD patients and is an important source of sleep disruption.

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“…Sleep disordered breathing is common in CKD cohorts, and its prevalence increases as renal function deteriorates, with a study of 254 subjects representing the full spectrum of renal function finding that 41% of CKD patients and 57% of ESRD patients had significant sleep apnea, as defined by an RDI ≥15, compared to 27% of those with an eGFR ≥60 mL/min/kg 2 (104). In OSA, a combination of anatomical features, changes in ventilatory control, and modifiable environmental factors such as obesity lead to an increased propensity for upper airways collapse during sleep (105).…”

Section: Ckd As a Contributor To Osa Severitymentioning

confidence: 99%

Emerging co-morbidities of obstructive sleep apnea: cognition, kidney disease, and cancer

Gildeh¹,

Drakatos²,

Higgins³

et al. 2016

J. Thorac. Dis.

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Obstructive sleep apnea (OSA) causes daytime fatigue and sleepiness, and has an established relationship with cardiovascular and metabolic disease. Recent years have seen the emergence of an evidence base linking OSA with an increased risk of degenerative neurological disease and associated cognitive impairment, an accelerated rate of decline in kidney function with an increased risk of clinically significant chronic kidney disease (CKD), and with a significantly higher rate of cancer incidence and death. This review evaluates the evidence base linking OSA with these seemingly unrelated co-morbidities, and explores potential mechanistic links underpinning their development in patients with OSA, including intermittent hypoxia (IH), sleep fragmentation, sympathetic excitation, and immune dysregulation.

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Declining Kidney Function Increases the Prevalence of Sleep Apnea and Nocturnal Hypoxia

Cited by 172 publications

References 42 publications

Hypoxia: The Force that Drives Chronic Kidney Disease

Hypoxia: The Force that Drives Chronic Kidney Disease

The Prevalence of Restless Legs Syndrome across the Full Spectrum of Kidney Disease

Emerging co-morbidities of obstructive sleep apnea: cognition, kidney disease, and cancer

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