Haemodialysis patients with sleep apnoea syndrome experience increased central adiposity and altered muscular composition and functionality

Sakkas, Giorgos K.; Gourgoulianis, Konstantinos; Karatzaferi, Christina; Liakopoulos, Vassilios; Maridaki, Μaria; Pastaka, Chaido; Lavdas, Eleftherios; Soher, Brian J.; Dovas, Spiros; Fezoulidis, Ioannis; Hadjigeorgiou, Georgios M.; Stefanidis, Ioannis

doi:10.1093/ndt/gfm559

Cited by 32 publications

(27 citation statements)

References 46 publications

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“…It is well known that several disturbances related to the loss of renal function as well as obesity may affect the pattern of sleep [42,43]. A study using polysomnographic analysis in 43 patients on hemodialysis showed an elevated prevalence of sleep apnea (51.2 %) that was more severe in patients with greater amount of body fat and lower physical capacity [44].…”

Section: Discussionmentioning

confidence: 99%

Impact of home-based aerobic exercise on the physical capacity of overweight patients with chronic kidney disease

et al. 2014

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Section: Discussionmentioning

confidence: 99%

Impact of home-based aerobic exercise on the physical capacity of overweight patients with chronic kidney disease

et al. 2014

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“…Disturbed sleep is reported to be associated with reductions in circulating anabolic hormones [14], [15] thus it could affect muscle metabolism. Indeed, some data indicates that the lack of sleep is associated with reduced muscle size in HD patients [16] and it is plausible that in HD patients with RLS the anabolic effect of sleep might be further reduced. Given that RLS disturbs sleep quality, we hypothesized that this could have a detrimental effect in the HD patient's muscle quantity and/or quality.…”

Section: Introductionmentioning

confidence: 99%

Evidence of Increased Muscle Atrophy and Impaired Quality of Life Parameters in Patients with Uremic Restless Legs Syndrome

et al. 2011

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BackgroundRestless Legs Syndrome is a very common disorder in hemodialysis patients. Restless Legs Syndrome negatively affects quality of life; however it is not clear whether this is due to mental or physical parameters and whether an association exists between the syndrome and parameters affecting survival.Methodοlogy/Principal FindingsUsing the Restless Legs Syndrome criteria and the presence of Periodic Limb Movements in Sleep (PLMS/h >15), 70 clinically stable hemodialysis patients were assessed and divided into the RLS (n = 30) and non-RLS (n = 40) groups. Physical performance was evaluated by a battery of tests: body composition by dual energy X ray absorptiometry, muscle size and composition by computer tomography, while depression symptoms, perception of sleep quality and quality of life were assessed through validated questionnaires. In this cross sectional analysis, the RLS group showed evidence of thigh muscle atrophy compared to the non-RLS group. Sleep quality and depression score were found to be significantly impaired in the RLS group. The mental component of the quality of life questionnaire appeared significantly diminished in the RLS group, reducing thus the overall quality of life score. In contrast, there were no significant differences between groups in any of the physical performance tests, body and muscle composition.ConclusionsThe low level of quality of life reported by the HD patients with Restless Legs Syndrome seems to be due mainly to mental health and sleep related aspects. Increased evidence of muscle atrophy is also observed in the RLS group and possibly can be attributed to the lack of restorative sleep.

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“…In the present study, the respiratory disturbance index did not correlate with ISI Matsuda ; neither did it differ significantly between the two groups. This result is somehow unexpected since hemodialysis patients with sleep apnea syndrome have reduced functional capacity and altered muscle composition (55), both predisposing to impaired glucose tolerance. It is possible that the longer the patients suffer from sleep disorders, the more insulin resistant they become; however, no such data are yet available for this population of hemodialysis patients.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, hemodialysis patients also suffer from sleep disorders (46,55) and show increased levels of visceral adiposity and central obesity (43,56). It seems, therefore, that factors involved in the development of IR and glucose intolerance in nonrenal failure populations, are present and might even be compounded under uremic conditions.…”

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confidence: 99%

Liver fat, visceral adiposity, and sleep disturbances contribute to the development of insulin resistance and glucose intolerance in nondiabetic dialysis patients

Sakkas¹,

Karatzaferi²,

Ζιντζαράς³

et al. 2008

American Journal of Physiology-Regulatory, Integrative and Comp

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The aim of this study was to identify contributors to IR and to develop a model for predicting glucose intolerance in nondiabetic hemodialysis patients. After a 2-h, 75-g oral glucose tolerance test (OGTT), 34 hemodialysis patients were divided into groups with normal (NGT) and impaired glucose tolerance (IGT). Indices of insulin sensitivity were derived from OGTT data. Measurements included liver and muscle fat infiltration and central adiposity by computed tomography scans, body composition by dual energy X-ray absorptiometer, sleep quality by full polysomnography, and functional capacity and quality of life (QoL) by a battery of exercise tests and questionnaires. Cut-off points, as well as sensitivity and specificity calculations were based on IR (insulin sensitivity index by Matsuda) using a receiver operator characteristics (ROC) curve analysis. Fifteen patients were assigned to the IGT, and 19 subjects to the NGT group. Intrahepatic fat content and visceral adiposity were significantly higher in the IGT group. IR indices strongly correlated with sleep disturbances, visceral adiposity, functional capacity, and QoL. Visceral adiposity, O 2 desaturation during sleep, intrahepatic fat content, and QoL score fitted into the model for predicting glucose intolerance. A ROC curve analysis identified an intrahepatic fat content of Ͼ3.97% (sensitivity, 100; specificity, 35.7) as the best cutoff point for predicting IR. Visceral and intrahepatic fat content, as well as QoL and sleep seemed to be involved at some point in the development of glucose intolerance in hemodialysis patients. Means of reducing fat depots in the liver and splachnic area might prove promising in combating IR and cardiovascular risk in hemodialysis patients.insulin sensitivity index by Matsuda; homeostasis assessment model of insulin resistance; functional capacity; oral glucose insulin sensitivity; quality of life; quantitative insulin-sensitivity check index

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Haemodialysis patients with sleep apnoea syndrome experience increased central adiposity and altered muscular composition and functionality

Cited by 32 publications

References 46 publications

Impact of home-based aerobic exercise on the physical capacity of overweight patients with chronic kidney disease

Impact of home-based aerobic exercise on the physical capacity of overweight patients with chronic kidney disease

Evidence of Increased Muscle Atrophy and Impaired Quality of Life Parameters in Patients with Uremic Restless Legs Syndrome

Liver fat, visceral adiposity, and sleep disturbances contribute to the development of insulin resistance and glucose intolerance in nondiabetic dialysis patients

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