Sleep disordered breathing and cardiovascular risk in older patients initiating dialysis in the United States: a retrospective observational study using medicare data

Tuohy, C Vaughan; Montez‐Rath, Maria E.; Turakhia, Mintu P.; Chang, Tara I.; Winkelman, John W.; Winkelmayer, Wolfgang C.

doi:10.1186/s12882-016-0229-3

Cited by 26 publications

(20 citation statements)

References 42 publications

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“…Three studies compared cardiovascular outcomes in patients with atrial fibrillation according to presence/absence of OSA [62][63][64]. A retrospective study assessed incident stroke in patients with previously diagnosed OSA and end-stage renal disease [65]. A retrospective study analysed the incidence of stroke in community-dwelling men who underwent comprehensive sleep studies [66].…”

Section: Results Of Literature Searchmentioning

confidence: 99%

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

et al. 2020

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@ERSpublicationsEvidence suggests a bidirectional relationship between sleep and stroke. However, the pathophysiological base of the associations and the possibilities of improving prevention and outcome through sleep-related interventions require further evaluation.ABSTRACT Sleep disorders are highly prevalent in the general population and may be linked in a bidirectional fashion to stroke, which is one of the leading causes of morbidity and mortality.Four major scientific societies established a task force of experts in neurology, stroke, respiratory medicine, sleep medicine and methodology, to critically evaluate the evidence regarding potential links and the impact of therapy. 13 research questions were evaluated in a systematic literature search using a stepwise hierarchical approach: first, systematic reviews and meta-analyses; second, primary studies postdating the systematic reviews/meta-analyses. A total of 445 studies were evaluated and 88 included. Statements were generated regarding current evidence and clinical practice.Severe obstructive sleep apnoea (OSA) doubles the risk for incident stroke, especially in young to middle-aged patients. Continuous positive airway pressure (CPAP) may reduce stroke risk, especially in treatment-compliant patients. The prevalence of OSA is high in stroke patients and can be assessed by polygraphy. Severe OSA is a risk factor for recurrence of stroke and may be associated with stroke mortality, while CPAP may improve stroke outcome. It is not clear if insomnia increases stroke risk, while pharmacotherapy of insomnia may increase it. Periodic limb movements in sleep (PLMS), but not restless limb syndrome (RLS), may be associated with an increased risk of stroke. Preliminary data suggest a high frequency of post-stroke insomnia and RLS and their association with a less favourable stroke outcome, while treatment data are scarce.Overall, the evidence base is best for OSA relationship with stroke and supports active diagnosis and therapy. Research gaps remain especially regarding insomnia and RLS/PLMS relationships with stroke. This article has an editorial commentary: https://doi.

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Section: Results Of Literature Searchmentioning

confidence: 99%

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

et al. 2020

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“… 123 , 124 However, in a claims-based study of older patients in the USA, sleep-disordered breathing in haemodialysis patients was not associated with AF. 125 …”

Section: Rate Vs Rhythm Control Of Atrial Fibrillationmentioning

confidence: 99%

Chronic kidney disease and arrhythmias: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Turakhia

Blankestijn

Carrero

et al. 2018

European Heart Journal

216

146

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“…In addition, overweight/obesity may play a role in the discrepancies as obesity may be a confounding factor in the associations of OSA with CVD in general, and some of the previous studies did not accurately ascertain BMI or the diagnosis of overweight and obesity. Interestingly, patients with sleep-disordered breathing by ICD-9 had a significantly higher BMI, and in the outcomes models that were adjusted for BMI, sleep-disordered breathing diagnosis was associated with an increased risk of death and atrial fibrillation [30]. In the analysis that examines BMI as an exposure in our study, BMI plays a protective role against cardiovascular mortality and hence appears to be a negative confounder of the associations.…”

Section: Discussionmentioning

confidence: 80%

“…In incident peritoneal dialysis patients, a diagnosis of sleep apnea by polysomnography (measuring both obstructive and central apneic events) was associated with an increased risk of all-cause mortality and cardiovascular events [25]. On the other hand, a recently published report provides contradictory information [30]. The investigators studied 184,217 Medicare recipients older than 67 years of age who were initiating dialysis and found that a diagnosis of sleep-disordered breathing as determined by the international classification of disease, ninth version (ICD-9) was associated with a slightly lower risk of death, myocardial infarction, and ischemic stroke.…”

Section: Discussionmentioning

confidence: 99%

Obstructive Sleep Apnea Increases Sudden Cardiac Death in Incident Hemodialysis Patients

et al. 2018

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Background: Mortality in end-stage renal disease (ESRD) occurs predominantly from cardiovascular disease (CVD) and sudden cardiac death (SCD). Obstructive sleep apnea (OSA) is characterized by periodic airflow limitation associated with sleep arousal and oxygen desaturation and is prevalent in patients with ESRD. Whether OSA increases the risk for SCD, cardiovascular and all-cause mortality among hemodialysis patients remains unknown. Methods: In a prospective cohort of 558 incident hemodialysis patients, we examined the association of OSA with all-cause mortality, cardiovascular mortality, and SCD using Cox proportional hazards models controlling for traditional CVD risk factors. Results: Sixty-six incident hemodialysis patients (12%) had OSA. Mean age (56 years) and percentage of males (56%) were identical in OSA and no-OSA groups. Fewer African Americans had OSA than non-African Americans (9 vs. 18%, respectively). Participants with OSA had higher body-mass index, Charlson comorbidity score, and left ventricular mass index and greater prevalence of diabetes and coronary artery disease. During 1,080 person-years of follow-up, 104 deaths occurred, 29% of which were cardiovascular. OSA was associated with a higher risk of all-cause mortality (HR 1.90 [95% CI 1.04–3.46]) and cardiovascular mortality (HR 3.62 [95% CI 1.36–9.66]) after adjusting for demographics and body-mass index. OSA was associated with a higher risk of SCD after adjusting for demographics (HR 3.28 [95% CI 1.12–9.57]) and multiple cardiovascular risk factors. Conclusions: Incident hemodialysis patients with OSA are at increased risk of all-cause and cardiovascular mortality and SCD. Future studies should assess the impact of screening for OSA and OSA-targeted interventions on mortality in ESRD.

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Sleep disordered breathing and cardiovascular risk in older patients initiating dialysis in the United States: a retrospective observational study using medicare data

Cited by 26 publications

References 42 publications

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

Chronic kidney disease and arrhythmias: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Obstructive Sleep Apnea Increases Sudden Cardiac Death in Incident Hemodialysis Patients

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