Sleep Apnea Syndrome and End-stage Renal Disease

Langevin, Brigitte; Fouque, Denis; Léger, P; Robert, Dominique

doi:10.1378/chest.103.5.1330

Cited by 107 publications

(75 citation statements)

References 26 publications

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“…Previous case studies (23,24) and one recent study (13) suggested that OSA may improve after kidney transplantation. Our previous results (11) and a case series (12), however, suggested that the risk for OSA may not improve substantially after transplantation.…”

Section: Discussionmentioning

confidence: 96%

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

Molnar¹,

Lázár²,

Lindner³

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives:We assessed the prevalence of obstructive sleep apnea (OSA) and its clinical correlates in a large sample of patients who received a kidney transplant (Tx). We also compared the prevalence of the disorder between dialysis patients who were on the waiting list for a Tx (WL) and Tx patients. Conclusions: The prevalence of OSA is similar in Tx and WL patients and it may contribute to presence of hypertension in patients who receive a Tx.

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Section: Discussionmentioning

confidence: 96%

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

Molnar¹,

Lázár²,

Lindner³

et al. 2010

Clinical Journal of the American Society of Nephrology

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“…Another line of evidence to assess causality would require demonstrating that restoration of normal kidney function, for example, by transplantation, and subsequent demonstration of improvement in SDB. Several case reports suggested the reversal of SDB with kidney transplantation (33,34). Further work to examine the change in sleep apnea with intensive renal replacement therapy would be helpful in understanding the high rate of sleep apnea among those with kidney failure that is treated with thrice-weekly HD.…”

Section: Discussionmentioning

confidence: 99%

Sleep Apnea in Patients on Conventional Thrice-Weekly Hemodialysis

Unruh

Sanders

Redline

et al. 2006

Journal of the American Society of Nephrology

158

106

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Sleep-disordered breathing (SDB) has been noted commonly in hemodialysis (HD) patients, but it is not known whether this is related directly to the treatment of kidney failure with HD or to the higher prevalence of obesity and older age. Forty-six HD patients were compared with 137 participants from the Sleep Heart Health Study (SHHS) who were matched for age, gender, body mass index (BMI), and race. Home unattended polysomnography was performed and scored using similar protocols. The study sample was 62.7 ؎ 10.1 yr, was predominantly male (72%) and white (63%), and had an average BMI of 28 ؎ 5.3 kg/m 2 . The HD sample had a higher systolic BP (137 versus 121 mmHg; P < 0.01) and a higher prevalence of diabetes (33 versus 9%; P < 0.01) and cardiovascular disease (33 versus 13%; P < 0.01) compared with the SHHS sample. The HD group had significantly less sleep time (320 versus 379 min; P < 0.0001) but similar sleep efficiency. HD patients had a higher frequency of arousals per hour (25.1 versus 17.1; P < 0.0001) and apnea-hypopneas per hour (27.2 versus 15.2; P < 0.0001) and greater percentage of the total sleep time below an oxygen saturation of 90% (7.2 versus 1.8; P < 0.0001). HD patients were more likely to have severe SDB (>30 respiratory events per hour) compared with the SHHS sample (odds ratio 4.07; 95% confidence interval 1.83 to 9.07). There was a strong association of HD with severe SDB and nocturnal hypoxemia independent of age, BMI, and the higher prevalence of chronic disease. The potential mechanisms for the higher likelihood of SDB in the HD population must be identified to provide specific prevention and therapy. P oor sleep and fatigue are common in older adults who undergo hemodialysis (HD), with HD patients reporting sleep problems more than twice as frequently as healthy control subjects (1,2). Despite this association, the extent and the severity of sleep disorders among the HD population and their cause both remain unclear (3-6). Although polysomnographic information in HD patients is limited, the available data do suggest that sleep-disordered breathing (SDB) may affect a significant percentage of dialysis patients (2,7). Although a number of studies have shown that a substantial proportion of HD patient have sleep apnea, these studies were limited by very small study samples (8 -12), by the use of partial channel polysomnography (PSG) (12)(13)(14), by the study of populations with limited generalizability to HD patients who are cared for in the United States (15), by very selected subpopulation of dialysis patients without sleep symptoms (16), or by study samples that largely were composed of symptomatic patients (7,8,17).Because a growing number of HD patients who are cared for in the United States are older than 65 yr (18), it is possible that reports of high rates of SDB and sleep problems in HD patients represent an aging effect, uremia effect, or some combination of the two. In particular, the prevalence of SDB and daytime sleepiness both increase with age (19), with SDB estimated to ...

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“…Although sleep apnea is not corrected by conventional hemodialysis or peritoneal dialysis (9,10), it has been reversed both by nocturnal hemodialysis (7) and kidney transplantation (6,8). Recently, we also reported improvement of sleep apnea by nocturnal cycler-assisted peritoneal dialysis (NPD) compared with conventional continuous ambulatory peritoneal dialysis (CAPD) (12) through better fluid clearance during sleep.…”

mentioning

confidence: 99%

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

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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.

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Sleep Apnea Syndrome and End-stage Renal Disease

Cited by 107 publications

References 26 publications

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

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

Sleep Apnea in Patients on Conventional Thrice-Weekly Hemodialysis

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

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