Improvement of sleep-related breathing disorder in patients with end-stage renal disease after kidney transplantation

Abstract

Sleep-related breathing disorder (SRBD) is a common symptom of end-stage renal disease (ESRD). The aim of this study was to determine whether kidney transplantation improves SRBD. Twenty-four patients with ESRD, who were admitted for kidney transplantation, underwent a sleep study using a portable ventilation effort recorder on the night before transplantation. Of these patients, 20 could repeat the overnight monitoring two wk after the transplantation. The median apnea-hypopnea index (AHI) of the 20 patients was 13.5 (range, 2-40), and significantly reduced to 4.5 (range, 0-20) after transplantation (p = 0.003). This reduction was most prominent in 12 patients with SRBD, for whom the median AHI fell from 22 (range, 10-40) to 6.5 (range, 1-20; p = 0.010). SRBD improvement, defined as an AHI equal to or >50% and/or reduced to <10/h, was observed in eight of the 12 apneic patients. These results suggest that kidney transplantation may immediately improve SRBD in patients with ESRD. However, conclusions from this study should be taken with caution because of the limitations of our method, specifically the use of a portable recorder and a small number of patients.

Effect of kidney transplantation on sleep-disordered breathing in patients with End Stage Renal Disease: a polysomnographic study

“…The present study detected that the median value of AHI was 1.2 (range 0e28.9), which decreased to 0.4 (range 0–7) (p = 0.034), which indicates that in addition to improvement in metabolic parameters there is a significant improvement in SDB after renal transplant. The results are in contrast to the studies by Beecroft et al [16] and Rodrigues et al [17], which showed no or minimal improvement in AHI after renal transplant, although the results are similar to those by Jurado-Gamez et al [18] and Lee et al [19], which showed significant improvement in AHI post-transplant.…”

“…We could find only four studies that have examined the effect of transplant on SDB in patients with ESRD; three of these studies have been carried out using PSG; one each from Canada (n = 18) [16], Spain (n = 9) [18], and Brazil (n = 34) [17], while one has additionally been carried out using portable ventilation recorder in South Korea (n = 20) [19]. Our sample size (n = 18) is similar to the ones in these studies.…”

“…Another study found the prevalence of Sleep ApneaeHypopnea Syndrome (SAHS) in patients on HD to be 44% [15]. There have been conflicting results regarding the effect of renal transplantation, with two studies [16,17] showing no or minimal improvement in AHI or SDB and two studies showing marked improvement [18,19]. …”

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

“…Thus, preventing hypervolemia in the patients with ESRD can significantly improve OSA and resistant hypertension. In a trial where a sleep study was performed before and after transplant, there was a significant decrease in AHI in OSA patients after transplant [70] . In another study, renal transplantation was found to ameliorate sleep disturbances and lead to improvement of sleep architecture [71] .…”

Niereninsuffizienz und schlafbezogene Atemstörungen

“…Einige Studien ergeben Hinweise darauf, dass sich die SBAS nach einer Nierentransplantation verbessern, andere Studien konnten keinen Einfluss belegen [8,16]. Allerdings sind die bislang untersuchten Patientenkollektive relativ klein und die Studienprotokolle selten vergleichbar, sodass eine grundsätzliche Aussage nicht möglich scheint.…”