Sleep-Disordered Breathing in Nondialyzed Patients with Chronic Renal Failure

Abstract

The prevalence and significance of sleep-disordered breathing (SDB) in dialysis-independent chronic renal failure (CRF) remains unknown. We studied the presence of SDB in nondialyzed CRF patients. Diagnostic polysomnography was performed in consecutive stable nondialyzed CRF patients. Inclusion criteria were age <or=70 years, absence of systolic dysfunction or history of pulmonary edema, FEV(1) > 70% pr, absence of neurologic disease or hypothyroidism, and calculated creatinine clearance <40 ml/min. Thirty-five patients (19 male, 16 female) were studied. An apnea-hypopnea index (AHI) >or=5/h was present in 54.3% (almost exclusively obstructive events). AHI correlated with urea (r = 0.35, p = 0.037), age (r = 0.379, p = 0.025), and body mass index (BMI) (r = 0.351, p = 0.038), but not with creatinine clearance. AHI or SDB were unrelated to gender. In nondiabetics (n = 25), AHI correlated with urea (r = 0.608, p = 0.001) and creatinine clearance (r = -0.50, p = 0.012). Nondiabetics with severe CRF (calculated GFR < 15 ml/min/1.73 m(2)) had a significantly higher AHI compared with less severe CRF. Restless legs syndrome (RLS) was present in 37.1% and periodic limb movements in 28.6%. Daytime sleepiness was not associated with respiratory events, but was more common in patients with RLS. The prevalence of SDB and RLS is high in dialysis-independent CRF. SDB weakly correlates with indices of kidney function and this association becomes stronger in nondiabetics.

High Prevalence of Obstructive Sleep Apnea and Its Association with Renal Function among Nondialysis Chronic Kidney Disease Patients in Japan

“…These results are consistent with the findings of Markou et al (23) but inconsistent with those of Canales et al (24). Markou et al enrolled 35 nondialysis CKD patients (54.3% of the subjects had OSA) with creatinine clearance Ͻ40 ml/min and demonstrated that AHI was significantly correlated with serum urea concentrations but not with creatinine clearance (23). However, their study was limited by its small sample size, with a relatively narrow range of renal function and lack of adjustment for potent covariates including age, BMI, and diabetes mellitus.…”

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

“…OSAS is reportedly associated with higher risk for stroke, hypertension, diabetes, congestive hearth failure, arrhythmias, and the metabolic syndrome and also with fatal and nonfatal cardiovascular events (4)(5)(6)(7) Previous studies have shown high prevalence of OSA (16 to 54%) in patients with chronic kidney disease (CKD) (8,9). Unruh et al (10) showed that OSA is more common in hemodialysis patients than in general population.…”

Sleep Disorders Associated with Chronic Kidney Disease

“…Thus dialysis patients have both reduced quantity and quality of sleep. Changes in sleep patterns in advanced CKD patients who are not on dialysis are similar to patients on dialysis (21) …”

“…RLS has been reported in 14-23% in patient on CHD and 20-57% in CKD patients (21,36). The prevalence of PLMD is greater than 50% in CHD and CAPD(see glossary) population (1, 2, [35][36][37][38].…”