Snoring Amplifies the Risk of Heart Failure and Mortality in Dialysis Patients

Abstract

Background: Snoring, an indicator of sleep-disordered breathing (SDB), associates with all-cause and cardiovascular (CV) mortality in high-risk conditions such as chronic heart failure (HF). Because SDB and HF are exceedingly frequent in end-stage kidney disease (ESKD), we hypothesized that SDB as detected by snoring may impact upon the relationship between chronic HF and all-cause and CV mortality in these patients. Methods: We tested this hypothesis in a cohort of 827 ESKD patients, followed up for 2.3 years. Results: In this population, snoring was a strong modifier of the risk of chronic HF for all-cause and CV death. In fully adjusted Cox models, the hazard ratio (HR) associated to chronic HF for the study outcomes was highest in heavy snorers [all-cause death: HR 2.6 (95% CI 1.6-4.3, p < 0.001); CV death: HR 4.0 (95% CI 2.1-7.6, p < 0.001)], intermediate in moderate snorers [all-cause death: HR 1.6 (95% CI 1.1-2.2, p = 0.01); CV death: HR 1.8 (95% CI 1.2-2.8, p = 0.01)], and lowest and not significant in non-snorers [all-cause death: HR 0.9 (95% CI 0.6-1.6, p = NS); CV death: HR 0.8 (95% CI 0.4-1.6, p = NS)]. Conclusions: Snoring is a strong and independent effect modifier of the relationship between chronic HF and all-cause and CV mortality in ESKD. Since SDB and snoring are in part attributable to reversible pharyngeal oedema, intensified surveillance and treatment of chronic HF snorers on dialysis may translate into better clinical outcomes in this very high-risk population, an issue which remains to be tested in specifically designed clinical trials.

Chronic Kidney Disease and Sleeping Disordered Breathing (SDB)

“…Several reports in the literature are corroborating to this: risk of atrial fibrillation in patients with left ventricular systolic dysfunction [17], the snoring per si increasing the risk of heart failure and mortality [18], increasing mortality risk in patients with CKD on hemodialysis [15] and peritoneal dialysis [16] and increasing mortality risk associated with hypoxemia [19]. …”

Serum Erythroferrone Levels Associate with Mortality and Cardiovascular Events in Hemodialysis and in CKD Patients: A Two Cohorts Study

“…The original study cohort included 1189 Caucasian hemodialysis (HD) patients enrolled from February 2009 to October 2010 in two regions (Calabria and Sicily) in Southern Italy (the PROspective Registry of the Working GRoup of Epidemiology of DIalysis REgion Calabria, PROGREDIRE [17]). Patients in this cohort represented about the 80% of the whole HD population in the geographical area covered by the 35 dialysis units participating into the study.…”

Briefly Noted

“…In a study of 827 dialysis patients (54 on PD), snoring amplified mortality risk among those with heart failure . In a Cox analysis, the hazard ratio for cardiovascular death in heart failure patients who snored heavily was 4.0; it was 1.8 in moderate snorers and 0.8 among nonsnorers.…”