Sleep Apnea with Intermittent Hemodialysis

Chan, Christopher T.

doi:10.1681/asn.2006101110

Cited by 9 publications

(10 citation statements)

References 17 publications

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“…In our study, 28% of the patients had a high probability of sleep apnea, 43% had a moderate probability, and 29% had a low probability of sleep apnea. Thus, our data support other studies demonstrating a high prevalence of sleep apnea in ESRD patients 14,22,23 . We chose the Flemons questionnaire because of its simplicity of use in a busy dialysis unit; in addition, this technique has been carefully validated in the general population.…”

Section: Discussionsupporting

confidence: 86%

“…Our data, in the context of these studies, support an important role for volume overload in the development of sleep apnea in hemodialysis patients. Conventional hemodialysis, thrice weekly, may not allow for optimal ultrafiltration with persistent expanded intravascular volume and upper airway edema 22 . Further studies, perhaps in the setting of a sleep lab with careful hemodynamic monitoring, may allow an additional insight into this area.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, our data support other studies demonstrating a high prevalence of sleep apnea in ESRD patients. 14,22,23 We chose the Flemons questionnaire because of its simplicity of use in a busy dialysis unit; in addition, this technique has been carefully validated in the general population. Given the high prevalence of sleep apnea, such a tool may be used to screen patients at high risk for sleep apnea, and subsequently identify patients in whom a formal sleep study may be helpful for definitive diagnosis and planning appropriate treatment.…”

Section: Discussionmentioning

confidence: 99%

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

Argekar

Griffin

Litaker

et al. 2007

Hemodialysis International

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Clinical, demographic, and dialysis-related characteristics were obtained at baseline. Total and cardiovascular mortality was ascertained after a median follow-up of 34 months. The probability of sleep apnea was low in 79 (29%) patients, moderate in 116 (43%) patients, and high in 75 (28%) patients. Male gender (odds ratio [OR] 5.13, p<0.001), obesity (BMI >30, OR 7.58, p<0.01), and interdialytic weight gain (OR 1.72/kg change, p<0.004) were independently associated with a high probability of sleep apnea. A high probability of sleep apnea at baseline did not predict total (hazard ratio [HR] 0.81, p=NS) or cardiovascular mortality (HR 0.9, p=NS). The Flemons questionnaire is validated in the general population, but has not been tested specifically in hemodialysis patients. The study may not be adequately powered to detect a difference in mortality. A high proportion of hemodialysis patients are likely to have sleep apnea; a simple bedside questionnaire can be used for screening to identify these patients. Excessive interdialytic weight gain is a potentially modifiable factor that increases the likelihood of sleep apnea. Despite the presence of a strong association between sleep apnea and mortality in the general population, a similar association could not be demonstrated in ESRD patients with a high prevalence of this condition.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Argekar

Griffin

Litaker

et al. 2007

Hemodialysis International

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“…In the nonuremic pop- ulation, SAS was casually related to a plethora of cardiovascular complications and has emerged as a major medical problem associated with important social and financial implications [25] . In the dialysis population, the unadjusted prevalence of SAS ranged from 53 to 75% [14][15][16][17][18][26][27][28] . One recent large study has demonstrated that the prevalence of severe sleep apnea in the HD patients was fourfold higher than in the age-, sex-, and BMImatched comparison group [28] .…”

Section: Discussionmentioning

confidence: 99%

“…More recently, sleep apnea has been linked to an increased risk of cardiovascular disease in ESRD [12][13] . Due to the high prevalence of SAS (53-75%) in dialysis patients [14][15][16][17][18] , SAS should be considered as an important CVD risk factor and needs aggressive medical intervention. Moreover, oxidative stress also has been found to be increased and associated with the severity of SAS [6] .…”

Section: Introductionmentioning

confidence: 99%

Increased Oxidative Stress in Hemodialysis Patients with High Risk for Sleep Apnea Syndrome

Lim

Chen²,

Wu³

et al. 2009

Blood Purif

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Background: In recent years, sleep apnea syndrome (SAS) has been widely considered to be a cardiovascular disease (CVD) risk factor. Although several plausible mechanisms have been put forth to explain such association in patients with SAS, oxidative stress has been suggested to play a major role. In patients with SAS, the repetitive ischemia-reperfusion state causes excessive production of oxygen free radicals and may subsequently lead to oxidative injury of various biomolecules. Due to the high prevalence of SAS in dialysis patients, this possible uremia-specific CVD risk factor may definitely need more medical attention. Methods: We, therefore, performed a case control study to investigate the relationship between oxidative stress and SAS in a group of dialysis patients, using some well-established oxidative biomarkers. Results: Our results showed that plasma nitrotyrosine, protein carbonyl and malonaldehyde levels were significantly elevated in patients with SAS. Markers of endothelial activation such as soluble CD40 ligand were also increased in this subgroup of patients. However, there was no significant difference in serum C-reactive protein levels between these groups. Conclusions: Our results indicate that patients with SAS manifest evidence for higher oxidative stress and endothelial activation. Thus, intermittent hypoxia represents a form of oxidative stress and low-grade chronic inflammatory state that may be associated with increased cardiovascular disease in these patients.

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