Nocturnal haemodialysis increases pharyngeal size in patients with sleep apnoea and end-stage renal disease

Beecroft, Jaime M.; Hoffstein, V.; Pierratos, Andreas; Chan, Christopher T.; McFarlane, Philip A.; Hanly, Patrick J.

doi:10.1093/ndt/gfm598

Cited by 77 publications

(67 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Beecroft et al (19) recently showed that pharyngeal narrowing contributes to the pathogenesis of OSA in dialysis-dependent patients. Furthermore, in patients converted from conventional to nocturnal hemodialysis, there was an increase in pharyngeal size together with improvement in sleep apnea (20). This study is the first to show a reduction in airway diameter on conversion from NPD to CAPD.…”

Section: Discussionmentioning

confidence: 52%

Improvement in Sleep Apnea during Nocturnal Peritoneal Dialysis Is Associated with Reduced Airway Congestion and Better Uremic Clearance

Tang¹,

Lam²,

Lai³

et al. 2009

Clinical Journal of the American Society of Nephrology

107

View full text Add to dashboard Cite

Background and objectives: Among peritoneal dialysis (PD) patients, nocturnal PD (NPD) is known to improve sleep apnea compared with continuous ambulatory peritoneal dialysis (CAPD), but the contributing factors are unclear.Design, setting, participants, and measurements: Thirty-eight incident ESRD patients underwent overnight polysomnography (PSG) during NPD and CAPD. Bioelectrical impedance analysis, magnetic resonance imaging of the upper airway, and urea kinetics (Kt/V) during sleep were measured on both occasions.Results: The prevalence of severe sleep apnea (apnea-hypopnea index, AHI > 15/h) was 21.1% during NPD, and 42.1% during CAPD. Mean AHI increased from 9.6 ؎ 2.7/h during NPD to 21.5 ؎ 4.2/h during CAPD. Both obstructive and central apnea worsened after conversion to CAPD. NPD achieved greater reductions in total body water, hydration fraction, and net ultrafiltration than CAPD during sleep. Overnight peritoneal Kt/V and creatinine clearance were lower after conversion. Both peritoneal Kt/V and peritoneal creatinine clearance correlated with AHI, as did their changes after conversion. Volumetric magnetic resonance imaging revealed reduced pharyngeal volumes and cross-sectional area, and tongue enlargement after conversion.Conclusions: Improvement in sleep apnea during NPD versus CAPD is associated with better fluid and uremic clearance and reduced upper airway congestion during sleep.

show abstract

Section: Discussionmentioning

confidence: 52%

Improvement in Sleep Apnea during Nocturnal Peritoneal Dialysis Is Associated with Reduced Airway Congestion and Better Uremic Clearance

Tang¹,

Lam²,

Lai³

et al. 2009

Clinical Journal of the American Society of Nephrology

107

View full text Add to dashboard Cite

show abstract

“…56 Furthermore, changes in the pharyngeal cross-sectional area was assessed after conversion from conventional hemodialysis (4 h/day, 3 days/week) to nocturnal hemodialysis (8 h/night, 3-6 nights/week) in 24 ESRD patients, of whom 16 had AHI ≥ 15/h (predominantly obstructive). 57 There were significant increases in the average pharyngeal cross-sectional area at functional residual capacity (3.29 cm 2 vs 3.39 cm 2 ) and at residual volume (1.91 cm 2 vs 2.13 cm 2 ) (p < 0.05) after conversion to nocturnal hemodialysis, with a 19% (3 of 16) response rate (AHI reduced to 15/h) in apneic patients.…”

Section: Pharyngeal Narrowingmentioning

confidence: 88%

“…Other mechanism include reduction in lung volume secondary to pulmonary edema, especially during sleep, which can reduce the upper airway size. 57 Finally, uremic myopathy or neuropathy can directly affect the upper airway dilator muscles and so reduce the airway size, [60][61] although this mechanism has not been investigated in patients with ESRD.…”

Section: Pharyngeal Narrowingmentioning

confidence: 99%

Obstructive Sleep Apnea and Kidney Disease: A Potential Bidirectional Relationship?

Abuyassin

Sharma

Ayas

et al. 2015

Journal of Clinical Sleep Medicine

109

View full text Add to dashboard Cite

“…115 This group also reported an improvement in pharyngeal size among nocturnally dialyzed patients. 117 This may improve sleep apnea and consequently ambulatory BP. Another mechanism of BP reduction with frequent dialysis is suggested to be an increase in arterial compliance and consequently improvement in baroreflex sensitivity.…”

Section: Frequent Dialysis and Its Effect On Bpmentioning

confidence: 99%

Assessment and Management of Hypertension in Patients on Dialysis

Agarwal

Flynn

Pogue

et al. 2014

Journal of the American Society of Nephrology

157

156

View full text Add to dashboard Cite

Hypertension is common, difficult to diagnose, and poorly controlled among patients with ESRD. However, controversy surrounds the diagnosis and treatment of hypertension. Here, we describe the diagnosis, epidemiology, and management of hypertension in dialysis patients, and examine the data sparking debate over appropriate methods for diagnosing and treating hypertension. Furthermore, we consider the issues uniquely related to hypertension in pediatric dialysis patients. Future clinical trials designed to clarify the controversial results discussed here should lead to the implementation of diagnostic and therapeutic techniques that improve long-term cardiovascular outcomes in patients with ESRD. Hypertension is common among patients with ESRD. In this review, we discuss the diagnosis, epidemiology, and management of hypertension among dialysis patients. We also review areas of existing controversies and briefly discuss the issue of hypertension in pediatric dialysis patients. EPIDEMIOLOGYThe prevalence, treatment, and control of hypertension among people on hemodialysis (HD) have used varying definitions to diagnose hypertension. The epidemiology differs based on how BP is measured: either before and after dialysis or using ambulatory BP recordings. Epidemiology with Routine BP MeasurementsThe prevalence of hypertension (defined as 1-week average predialysis systolic BP [SBP] measurements .150 mmHg or diastolic BP [DBP].85 mmHg or the use of antihypertensive medications) was 86% among 2535 clinically stable adult HD patients participating in a multicenter trial. 1 Among hypertensive patients, 12% did not receive antihypertensive drugs, 58% were treated but not controlled, and only 30% were controlled. The use of antihypertensive drugs has been reported to vary from 59% to 83%. [2][3][4][5] Furthermore, even among children on long-term HD, similar findings have been reported. 6 Several studies have confirmed greater antihypertensive drug use to be associated with poorer control. 7,8 It should be noted that antihypertensive drug use per se do not lead to worse BP control; in the absence of adequate volume control, increasing antihypertensive drug use may simply reflect difficult-to-control BP. Epidemiology Using Ambulatory BP MeasurementsThe prevalence of hypertension (defined by either a 44-hour interdialytic ambulatory BP of $135/85 mmHg or the prescription of any antihypertensive agent) was 86% among 369 chronic HD patients. 8 Although hypertension was being treated with antihypertensive drugs in 89% of patients, it was adequately controlled only in 38%. The independent determinants of poor control were the use of antihypertensive drugs and an expanded extracellular volume state. If patients were volume overloaded, nearly 80% became hypertensive when medications were Published online ahead of print. Publication date available at www.jasn.org.

show abstract

Nocturnal haemodialysis increases pharyngeal size in patients with sleep apnoea and end-stage renal disease

Abstract: Conversion from CHD to NHD is associated with an increase in pharyngeal cross-sectional area. This may play a role in some patients whose sleep apnoea improves on NHD.

Cited by 77 publications

References 33 publications

Improvement in Sleep Apnea during Nocturnal Peritoneal Dialysis Is Associated with Reduced Airway Congestion and Better Uremic Clearance

Improvement in Sleep Apnea during Nocturnal Peritoneal Dialysis Is Associated with Reduced Airway Congestion and Better Uremic Clearance

Obstructive Sleep Apnea and Kidney Disease: A Potential Bidirectional Relationship?

Assessment and Management of Hypertension in Patients on Dialysis

Contact Info

Product

Resources

About