Sleep apnea in hemodialysis patients: Risk factors and effect on survival

Argekar, Pushkar A.; Griffin, V; Litaker, David; Rahman, Mahboob

doi:10.1111/j.1542-4758.2007.00214.x

Cited by 27 publications

(19 citation statements)

References 31 publications

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“…However, limited evidence exists as to whether sleep disorders increase the risk for death in patients with ESRD. A recent study of dialysis patients using a sleep questionnaire failed to demonstrate an association between sleep apnea and mortality (8), while another study using self-reported sleep quality scales found that the risk of death was significantly higher for dialysis patients with poor sleep quality (9). Although polysomnography is the gold standard for diagnosing sleep disorders, few studies using polysomnography have investigated this possible association.…”

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confidence: 97%

Nocturnal Hypoxemia and Periodic Limb Movement Predict Mortality in Patients on Maintenance Hemodialysis

Jung¹,

Lee

Baek³

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: Sleep disorders, including sleep-disordered breathing and periodic limb movements during sleep, are associated with an increased risk for cardiovascular diseases, which are the leading causes of death in patients with ESRD. This study investigated the association between sleep disorders and mortality in patients with ESRD.Design, setting, participants, & measurements: Thirty patients on maintenance hemodialysis, who were clinically stable for >2 months, underwent overnight polysomnography to evaluate sleep parameters.Results: All patients were followed for a median of 48 months (range: 14 to 62 months), and 14 of them died during the follow-up period. Among the sleep parameters, the percent of sleep time with arterial oxygen saturation <90% (T <90%), mean arterial oxygen saturation, and periodic limb movement index score were associated with significant increases in the risk of death. However, associations of the apnea-hypopnea index or oxygen desaturation index with mortality were NS. The hazard ratios (95% confidence intervals) for death per one SD increment in the log-transformed T <90% and periodic limb movement index score were 2.10 (1.06 to 4.15) and 2.48 (1.11 to 5.52), respectively, after adjusting for age.Conclusions: We found that nocturnal hypoxemia and periodic limb movement during sleep, rather than apnea itself, were associated with an increased risk for death in patients with ESRD. However, conclusions from this study should be drawn with caution, because they are limited by the small sample size.

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confidence: 97%

Nocturnal Hypoxemia and Periodic Limb Movement Predict Mortality in Patients on Maintenance Hemodialysis

Jung¹,

Lee

Baek³

et al. 2010

Clinical Journal of the American Society of Nephrology

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“…Therefore, it seemed to be possible that multifactorial mechanisms, such as improvement of extracellular fluid control, enhanced clearance of uraemic toxins and reduction of hypocapnea by correction of metabolic acidosis, are responsible for the improvement of OSA in nocturnal dialysis. A trend towards lower KT/V was observed in dialysis patients with OSA; however, the difference was not statistically significant and could be attributable to the generally higher body weight in this group [55]. Whether renal transplantation contributes to an improvement of the condition has not yet been completely clarified [56].…”

Section: Sleep Apnoea and Chronic Kidney Diseasementioning

confidence: 97%

“…Excess mortality in patients with OSA, while repeatedly demonstrated in the general population, has so far not been shown for persons with ESRD. In a prospective study including 270 HD patients, using a questionnaire to assess risk for OSA, no excess mortality was observed by the authors in the high or intermediate risk groups, though the authors concede that the study may have been underpowered [55]. Mortality studies of a sufficient sample size and using polysomnography rather than substitute methods to diagnose OSA are still missing.…”

Section: Sleep Apnoea and Chronic Kidney Diseasementioning

confidence: 99%

Obstructive sleep apnoea: clinical signs, diagnosis and treatment

Kuhlmann

Bormann

Becker

2008

Nephrology Dialysis Transplantation

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Normal and disturbed sleepHumans spend one-third of their lifetime sleeping. It has only been ∼50 years since it was recognized that sleep is not simply a passive state characterized by the absence of wakefulness, but rather a condition that has a typical structure with electrophysiologically, clearly distinguishable phases that follow one another according to a characteristic pattern in healthy subjects. Using electroencephalogram (EEG), electrooculogram (EOG) and electromyogram (EMG), sleep is classified as rapid eye movement (REM) sleep or one of four different non-REM sleep stages. Altogether, one spends ∼20-25% of the total sleep time in deep sleep and REM sleep, respectively, and ∼50% in light sleep. After the age of 50, the percentage of deep and REM sleep decreases, whereas light sleep and periods of wakefulness during the night increases.During the night, 4-6 sleep cycles are completed lasting 70-90 min and consisting of an initial period of light sleep, followed by deep sleep and finally REM sleep. Whereas deep sleep is predominantly present during the first hours of sleep, there is an increase in REM sleep in the second half of the night, often accompanied by dreaming. Breathing during sleep and sleep-disordered breathingThe transition from wakefulness to sleep is characterized by marked changes in all aspects of ventilation in healthy subjects. Upper airway resistance more than doubles, due to a reduction in pharyngeal muscle tone. Ventilatory drive as well as the ventilatory response to hypercapnia and hypoxia decreases. Minute ventilation decreases by ∼10%, and as Sleep apnoeaFour different patterns of sleep-disordered breathing can be determined: apnoeas, hypopnoea, hypoventilation and respiratory events that do not fulfil the criteria of apnoeas and hypopnoea but cause arousal from sleep. An airflow reduction by ≥90% for ≥10 s is called apnoea, and an airflow reduction of ≥50% to <90% for at least 10 s that causes oxygen desaturation of ≥4% is called hypopnoea. Hypoventilation is defined as a reduction in ventilation for at least 5 min with an increase in PCO 2 of >50 mmHg or a desaturation of <85% according to the most widely used definition.These respiratory events can be of the obstructive type with persisting breathing efforts or of the central type without any respiratory movements [1]. Clinically, mixed apnoeas are often present, in which the initial central apnoea develops into an obstructive one, but from a therapeutic point of view, mixed apnoeas are treated like obstructive ones, and therefore mixed apnoeas are part of obstructive sleep apnoea. To quantify breathing disorders, the mean number of apnoeas and hypopnoeas per hour of sleep, the apnoea-hypopnoea index (AHI), is calculated. More than five episodes of disturbed breathing per hour of sleep are considered pathological, because in epidemiological studies the risk of cardiovascular disorders started to increase from an AHI of 5.Apnoeas, hypopnoea and other respiratory events are terminated by a central nervous alarm reaction (aro...

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“…In patients with high JESS scores (≥16), lifestyle modifications such as exercise [37] and further evaluation of sleep disturbance would be warranted. Future studies are necessary to examine the causes of sleepiness and survival [38,39] and the impact of treatment of sleepiness on survival. Mechanisms of adverse effects of sleepiness on survival are unknown.…”

Section: Discussionmentioning

confidence: 99%

Effects of Sleepiness on Survival in Japanese Hemodialysis Patients: J-DOPPS Study

Iseki

Tsuruya²,

Kanda

et al. 2015

Nephron Clin Pract

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Sleep disorder and poor sleep quality are common in chronic hemodialysis (HD) patients. They have been claimed as a cause of morbidity and mortality. The relationship between the degree of sleepiness and survival has not been studied. We studied the degree of sleepiness in 1,252 adult HD patients (age ≥20 years) recruited into the Dialysis Outcomes Practice Pattern Study in Japan (J-DOPPS III), using the Japanese version of the Epworth Sleepiness Scale (JESS) questionnaire. Demographic data were presented for three subgroups: low, intermediate, and high JESS score. Cox proportional hazard regression analysis was performed to estimate the independent effect of several variables on survival. The hazard ratio for mortality was 2.312 (95% CI 1.267-4.220; p = 0.006) for those with a high JESS score (vs. those with a low JESS score) after adjusting for age, vintage (length of time on HD), sex, diabetes, body mass index, cardiovascular disease, HD treatment regimen (time, frequency, and single-pool Kt/V), laboratory data (serum albumin, creatinine, and total cholesterol), and medication (antihypertensive drugs, erythropoietin, vitamin D, and phosphate binders). Patients ≥70 years of age with comorbid conditions (congestive heart failure, stroke, and diabetes) showed a significantly higher JESS score (≥16). The JESS score did not show interaction by age. Results showed that the degree of sleepiness is related to survival in Japanese HD patients, particularly in elderly patients.

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Sleep apnea in hemodialysis patients: Risk factors and effect on survival

Cited by 27 publications

References 31 publications

Nocturnal Hypoxemia and Periodic Limb Movement Predict Mortality in Patients on Maintenance Hemodialysis

Nocturnal Hypoxemia and Periodic Limb Movement Predict Mortality in Patients on Maintenance Hemodialysis

Obstructive sleep apnoea: clinical signs, diagnosis and treatment

Effects of Sleepiness on Survival in Japanese Hemodialysis Patients: J-DOPPS Study

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