Sleep-Disordered Breathing and Excessive Daytime Sleepiness in Chronic Kidney Disease and Hemodialysis

Roumelioti, Maria‐Eleni; Buysse, Daniel J.; Sanders, Mark H.; Strollo, Patrick J.; Newman, Anne B.; Unruh, Mark

doi:10.2215/cjn.05720710

Cited by 104 publications

(76 citation statements)

References 42 publications

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“…Although hypoxemia is the common terminal pathway of multiple pathologies, congestive heart failure (CHF) and sleep apnea are particularly prevalent in patients on hemodialysis (8)(9)(10). Additionally, there is growing literature about the prevalence of chronic obstructive pulmonary disease (COPD) in patients with CKD (11,12).…”

Section: Introductionmentioning

confidence: 99%

Intradialytic Hypoxemia and Clinical Outcomes in Patients on Hemodialysis

Meyring-Wösten

Zhang

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background and objectives Intradialytic hypoxemia has been recognized for decades, but its associations with outcomes have not yet been assessed in a large patient cohort.Design, setting, participants, & measurements Our retrospective cohort study was conducted between January of 2012 and January of 2015. We recorded blood oxygen saturation every minute during hemodialysis in patients with arteriovenous access. A 6-month baseline period with at least 10 treatments with oxygen saturation measurements preceded a 12-month follow-up. Patients were stratified by the presence or absence of prolonged intradialytic hypoxemia defined as oxygen saturation ,90% for at least one third of the treatment time. Demographic, laboratory, and treatment data and hospitalization and mortality rates were compared between the groups. Multivariate Cox regression analysis was used to assess baseline predictors of all-cause mortality during follow-up.Results In total, 100 (10%) of 983 patients had prolonged intradialytic hypoxemia. These patients were older (+3.6 years; 95% confidence interval, 0.8 to 6.3), had longer dialysis vintage (+1.2 years; 95% confidence interval, 0.3 to 2.1), and had higher prevalence of congestive heart failure (+10.8%; 95% confidence interval, 1.6 to 20.7) and chronic obstructive pulmonary disease (+13%; 95% confidence interval, 5 to 21.2). They also resembled an inflammatory phenotype, with lower serum albumin levels (20.1 g/dl; 95% confidence interval, 20.2 to 0) and higher neutrophil-to-lymphocyte ratios (+1; 95% confidence interval, 0.5 to 1.6). They had lower hemoglobin levels (20.2 g/dl; 95% confidence interval, 20.4 to 0) and required more erythropoietin (+1374 U per hemodialysis treatment; 95% confidence interval, 343 to 2405). During follow-up, all-cause hospitalization (1113 hospitalizations; univariate hazard ratio, 1.46; 95% confidence interval, 1.22 to 1.73) and mortality (89 deaths; adjusted hazard ratio, 1.98; 95% confidence interval, 1.14 to 3.43) were higher in patients with prolonged intradialytic hypoxemia.Conclusions Prolonged intradialytic hypoxemia was associated with laboratory indicators of inflammation, higher erythropoietin requirements, and higher all-cause hospitalization and mortality.

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Section: Introductionmentioning

confidence: 99%

Intradialytic Hypoxemia and Clinical Outcomes in Patients on Hemodialysis

Meyring-Wösten

Zhang

et al. 2016

Clinical Journal of the American Society of Nephrology

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“…Sleep disordered breathing (SDB) is a common clinical condition among patients with CKD; its prevalence has been reported to be as high as 65% (1)(2)(3)(4) compared with approximately 20% in the general population (5,6). The hallmark of SDB is its recurrent episodes of hypoxia-reoxygenation sequence coupled with the majority of apnea events throughout the night.…”

Section: Introductionmentioning

confidence: 99%

Association of Nocturnal Hypoxemia with Progression of CKD

Sakaguchi¹,

Hatta

Hayashi

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Nocturnal hypoxemia is highly prevalent among patients with CKD. Nocturnal hypoxemia contributes to systemic inflammation, oxidative stress, endothelial cell dysfunction, and activation of the renin-angiotensin system, which are common pathologic mechanisms of CKD progression. This study investigated whether nocturnal hypoxemia is independently associated with CKD progression.Design, setting, participants, & measurements This two-center retrospective cohort study included 161 patients with stages 3-4 CKD enrolled from January of 2009 to July of 2011 with a body mass index less than 25.0 kg/m 2 . The 4% oxygen desaturation index, the number of events per hour in which oxygen saturation decreases by .4% during sleep, was measured, and the declining rate of the estimated GFR was followed over 1 year. The severity of nocturnal hypoxemia was categorized as none (oxygen desaturation index,5.0), mild (5.0#oxygen desaturation index,15.0), or moderate to severe (15.0#oxygen desaturation index).Results The mean estimated GFR of the total cohort at baseline was 31 ml/min per 1.73 m 2 . Eighty patients (49.7%) were diagnosed with nocturnal hypoxemia; 64 patients were diagnosed with mild nocturnal hypoxemia, and 16 patients were diagnosed with moderate-to-severe nocturnal hypoxemia. The estimated GFR declined three-to fourfold faster in patients with moderate-to-severe nocturnal hypoxemia than patients with no or mild nocturnal hypoxemia ( per year in the no, mild, and moderate-to-severe nocturnal hypoxemia groups, respectively; P=0.003). Nocturnal hypoxemia remained a significant predictor of decline in estimated GFR after adjustment for various baseline clinical factors.Conclusions In nonobese patients with CKD, nocturnal hypoxemia is an independent risk factor of a rapid decline in kidney function.

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“…20 A study by Roumelioti et al, with a median age of 58.1 years in stage IV to V CKD patients demonstrated a high incidence of OSA. 18 The increase in age has been attributed as an independent risk factor for OSA in various studies. 28,29 The median age of our study population was 56.5 years which was low when compared to other studies done in non-dialysis patient.…”

Section: Discussionmentioning

confidence: 99%

“…16 The increased prevalence of OSA in CKD patients can be attributed to reduction in upper airway dimensions in patients with renal failure. 1,14,[17][18][19][20] Beecroft et al reported that the pharyngeal cross-sectional area measured by pharyngometry in ESRD patients was 12% less than that in the normal renal function control group matched for BMI. 21 Such pharyngeal narrowing was considered to occur because of upper airway edema due to systemic fluid overload and upper airway dilator muscle dysfunction due to neuropathy or myopathy associated with chronic uremia.…”

Section: Introductionmentioning

confidence: 99%

Obstructive sleep apnea in non-dialysis chronic kidney disease patients

et al. 2014

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There is an enormous increase in the burden of chronic kidney disease both in developing and developed countries. There is a paucity of data on obstructive sleep apnea (OSA) in chronic kidney disease (CKD) patients in India. We used a cross-sectional prospective observational study to determine the prevalence of OSA in non-dialysis CKD patients. Of the 647 CKD patients 302 patients were in stage II, III and IV. The study population was screened using the Berlin questionnaire and 87 patients were positive for OSA (28%). Among the 87, 37 patients were excluded based on the exclusion criteria. Fifty patients underwent a split night sleep study. Stage II, III CKD patients were clubbed as early CKD or group one and stage IV CKD patients were clubbed as late CKD or group two. The spilt night study revealed an 88% incidence of OSA of varying severity. A sub group analysis was done to assess the severity of OSA. A statistical significance (p50.05) between early and late CKD group was observed with respect to AHI and ODI. An improvement in the late CKD is observed and the Z values for AHI and ODI are 4.273 and 2.307, respectively. The prevalence and incidence of OSA was found to be 28% and 88% in non-dialysis CKD patients, respectively and the risk and severity of OSA increased with the progression of CKD stages and thus necessitating the need for screening the non-dialysis CKD population. KeywordsBerlin questionnaire, non-dialysis CKD, obstructive sleep apnea, sleep apnea and renal function, sleep study in CKD History

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Sleep-Disordered Breathing and Excessive Daytime Sleepiness in Chronic Kidney Disease and Hemodialysis

Cited by 104 publications

References 42 publications

Intradialytic Hypoxemia and Clinical Outcomes in Patients on Hemodialysis

Intradialytic Hypoxemia and Clinical Outcomes in Patients on Hemodialysis

Association of Nocturnal Hypoxemia with Progression of CKD

Obstructive sleep apnea in non-dialysis chronic kidney disease patients

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