Kidney Transplantation Improves Sleep-Related Breathing in Hemodialysis Patients

Jurado-Gámez, Bernabé; Martín‐Malo, Alejandro; Rodríguez‐Benot, Alberto; Muñoz-Cabrera, Luis; Povedano, Andrés Cosano; Aljama, Pedro

doi:10.1159/000157373

Cited by 21 publications

(24 citation statements)

References 47 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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Background: Sleep-disordered breathing (SDB) is common in patients with end-stage renal disease (ESRD). SDB is associated with comorbidities such as hypertension, diabetes mellitus, and obesity, interplaying with metabolic derangements in the form of uremia, acidosis, and hypervolemia. Renal transplant has been observed to correct most of these metabolic derangements and to control progression of comorbidities. While SDB is highly prevalent among patients in the pretransplant stage, it remains to be seen whether the beneficial aspects of transplant are extended to improvement in SDB in patients with ESRD. Methods: Eighteen patients undergoing thrice-weekly hemodialysis (HD) for ESRD at the transplant clinic of All India Institute of Medical Sciences (AIIMS), New Delhi, underwent detailed clinical, laboratory, and polysomnographic evaluation. The average number of apneas and hypopneas per hour of sleep, ie, ApneaeHypopnea Index (AHI), was used to define the severity of sleep apnea. All patients underwent polysomnography (PSG) within 24 h of the last HD and after three months of living-donor transplant. Results: Of 18 patients, there were 14 males and four females. The median age was 28 years (range 19–50 years). They had already spent a median period of six months (range 3–31 months) on HD before inclusion. The prevalence of SDB (AHI 5/h) was 44.4% (8/18) before transplant, which decreased to 5.6% (1/18) after transplant (p = 0.016). The oxygen desaturation index had a median value of 5.8 events/h (range 0.1–35.4) in the pretransplant stage, which decreased to 0 events/h (range 0–6.6) in the post-transplant stage (p = 0.035). Conclusion: There was a significant improvement in the prevalence and severity of SDB after transplant. Whether improvement in SDB is sustained on a long-term follow-up remains to be seen.

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Section: Discussionmentioning

confidence: 99%

“…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]. …”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…57 REM latency was only reported in one study (133 ± 76 minutes). 57 Interestingly, the proportion of REM sleep was also associated with declining renal function in patients with CKD, however, this association diminished after controlling for covariables. 54 Depressive symptoms were not considered in any of the previously mentioned studies.…”

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confidence: 84%

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

Rónai

Szentkirályi

Lázár

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: Both depression and sleep complaints are very prevalent among kidney transplant (kTx) recipients. However, details of the complex relationship between sleep and depression in this population are not well documented. Thus, we investigated the association between depressive symptoms and sleep macrostructure parameters among prevalent kTx recipients. Methods: Ninety-five kTx recipients participated in the study (54 males, mean ± standard devation age 51 ± 13 years, body mass index 26 ± 4 kg/m 2 , estimated glomerular filtration rate 53 ± 19 ml/min/1.73 m 2 ). Symptoms of depression were assessed by the Center for Epidemiologic Studies -Depression Scale (CES-D). After 1-night polysomnography each recording was visually scored and sleep macrostructure was analyzed. Results: The CES-D score was significantly associated with the amount of stage 2 sleep (r = 0.20, P < .05), rapid eye movement (REM) latency (r = 0.21, P < .05) and REM percentage (r = −0.24, P < .05), but not with the amount of slow wave sleep (r = −0.12, P > .05). In multivariable linear regression models the CES-D score was independently associated with the amount of stage 2 sleep (β: 0.205; confidence interval: 0.001-0.409; P = .05) and REM latency (β: 0.234; confidence interval: 0.001-0.468; P = .05) after adjustment for potential confounders. I NTRO DUCTI O NDepression is one of the most prevalent mental health conditions in patients with chronic kidney disease (CKD) [1][2][3][4] ; furthermore, it is an important determinant of impaired quality of life. 5,6 Among kidney transplant (kTx) recipients, depression is associated with reduced adherence and also with increased morbidity, graft loss, and mortality. [7][8][9][10][11][12][13] Poor sleep and various sleep problems are also frequent complaints among kTx recipients.14,15 Earlier we reported that chronic insomnia was independently associated with the presence of depression in kTx recipients. 16 In the general population there is a strong and bidirectional relationship between depression and sleep.17 This is also reflected in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition definition of major depression (MD), 18 as sleep complaints are core symptoms of MD. Several objective sleep parameters are different in patients with MD than in healthy control patients. Patients with MD have decreased amounts of slow wave sleep (SWS) and shortened rapid eye movement (REM) latency with increased amounts of REM sleep. The exact mechanisms and factors that may link depression to poor clinical outcomes among kTx recipients are not yet well defined. In a recent review focusing on kTx and depression, 23 sleep is not mentioned. This may be due to the complete lack of polysomnography (PSG) studies that assess the association between sleep and depression in this population. The frequent co-occurrence of subjective sleep complaints and depression among kTx recipients 16 suggests that the relationship between the two conditions may be similar to the association described in the g...

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“…In addition to the clinical associations with these sleep disorders, advanced CKD has been linked to the suppression of the melatonin surge that is integrally linked to the regulation of the circadian rhythm [32,33]. Further evidence that advanced CKD exacerbates sleep disturbance is the observation that kidney transplantation and long nocturnal hemodialysis partially correct sleep apnea in dialysis patients [34,35,36]. …”

Section: Discussionmentioning

confidence: 99%

Sleep Duration and Chronic Kidney Disease: Analysis of the National Health Interview Survey

Salifu¹,

Tedla²,

Pandey³

et al. 2014

Cardiorenal Med

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Background: Patients with chronic kidney disease (CKD) have a high prevalence of sleep disorders. The association between sleep duration and self-reported CKD was examined in a population of Americans who participated in a national survey over a 3-year period. Study Design: A cross-sectional study using survey data from theNational Health Interview Survey (NHIS) from the year 2004-2006 was carried out. A retrospective examination of data from acommunity-based survey of 128,486 noninstitutionalized US civilian residents over the age of 18 years was conducted. Self-reportedCKD was defined as having ‘weak or failing kidneys'. The sleep duration was defined by a self-reported estimate of habitual sleep duration. Results: The prevalence of participants self-reporting kidney disease was higher in those with short (≤6 h per night) and long (≥8 h per night) sleep durations when compared to those sleeping 7 h per night. Self-reported information about sleep, demographic information, and information on comorbidities were assessed using standardized validated questionnaires which reported no kidney disease. A multivariate logistic regression analysis showed increased odds of self-reported kidney disease in study participants with both short and long sleep durations compared to healthy sleepers (sleeping >7-8 h per night). Observational data do not permit examination of causality, although possible confounders in observations of interest can be adjusted. Conclusion: AmongAmericans surveyed in the NHIS (2004-2006), those with short or long sleep duration had higher odds of reporting that they had CKD. i 2014 S. Karger AG, Basel

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Kidney Transplantation Improves Sleep-Related Breathing in Hemodialysis Patients

Cited by 21 publications

References 47 publications

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

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

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

Sleep Duration and Chronic Kidney Disease: Analysis of the National Health Interview Survey

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