Impact of kidney transplantation on sleep apnoea in patients with end-stage renal disease

Abstract

Background. Sleep apnoea is common in patients with end-stage renal disease. Although individual case reports have described an improvement in sleep apnoea following kidney transplantation, there have been no longitudinal studies of a case series to determine what proportion of patients with sleep apnoea improve. Methods. Dialysis-dependent patients awaiting kidney transplantation and pre-dialysis patients with an identified living donor kidney had overnight polysomnography, which was repeated several months after successful kidney transplantation. Patients were divided into apnoeic and non-apnoeic groups based on an apneoa-hypopnoea index (AHI) >10/h during pre-transplant polysomnography and, following transplantation, apnoeic patients were further divided into responders and non-responders based on >50% reduction in AHI and/or AHI <10/h. Results. Eighteen patients (11 men, 7 women), aged 27-65, were studied. Pre-transplant sleep apnoea was present in 11 of 18 (61%) patients. Although transplantation was associated with a significant reduction in blood urea nitrogen and serum creatinine, there were no significant changes in AHI (pre vs post: 20.2 AE 15.1 vs 23.5 AE 21.3). Among the 11 apnoeic patients, only three met the criteria for a significant improvement ('responder'). There were no patient characteristics, sleep apnoea indices or renal function changes that distinguished responders from non-responders. Conclusions. Sleep apnoea improves in a minority of patients with end-stage renal disease following successful kidney transplantation. Specific determinants of improvement were not identified.

Sleep Apnea Is Associated with Cardiovascular Risk Factors among Kidney Transplant Patients

“…Previously, we found that the prevalence of high risk for OSAS is approximately 30% in both WL and Tx patients (11). A case series indicated that AHI did not change after transplantation in 73% of the patients (12). Conversely, Mallamaci et al (13) recently reported that 22% of renal Tx recipients had a respiratory disturbance index Ͼ5, which was similar to results seen in the general population.…”

“…Our previous results (11) and a case series (12), however, suggested that the risk for OSA may not improve substantially after transplantation. We hypothesized, therefore, that the prevalence of OSA would be similar in Tx versus WL patients.…”

Depressive Symptoms Are Associated With Objectively Measured Sleep Parameters in Kidney Transplant Recipients

“…Laboratory-assessed PSG studies among the kTx recipient population included much fewer patients (n 1 = 18; n 2 = 9; n 3 = 34, respectively) and mainly focused on sleep apnea and the change of the sleep structure associated with apnea treatment or transplantation. [56][57][58] Although some sleep macrostructure parameters were reported in these studies, little attention was paid to stage 2 sleep or REM sleep.…”

“…In earlier PSG studies among kTx recipients the proportion of REM sleep was variable, from normal (21.6 ± 5.9%; 18.9 ± 8.3%) 56,58 to low (14 ± 9.2%). 57 REM latency was only reported in one study (133 ± 76 minutes).…”

“…17,19,20 In this respect it is also interesting to note that SWS was higher in patients on dialysis compared to predialysis or transplanted patients. 53,56 These results may indicate that the modality of the renal replacement therapy or the kidney disease itself may affect SWS and the regulation of non-rapid eye movement (NREM) sleep in some yet undefined way. It is also possible that the lack of significant association was due to the relatively small sample size and the consequently low statistical power.…”