Declining Kidney Function Increases the Prevalence of Sleep Apnea and Nocturnal Hypoxia

Department of Medicine, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada.
Chest (Impact Factor: 7.48). 01/2012; 141(6):1422-30. DOI: 10.1378/chest.11-1809
Source: PubMed

ABSTRACT Sleep apnea is an important comorbidity in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). Although the increased prevalence of sleep apnea in patients with ESRD is well established, few studies have investigated the prevalence of sleep apnea in patients with nondialysis-dependent kidney disease, and no single study, to our knowledge, has examined the full spectrum of kidney function. We sought to determine the prevalence of sleep apnea and associated nocturnal hypoxia in patients with CKD and ESRD. We hypothesized that the prevalence of sleep apnea would increase progressively as kidney function declines.
Two hundred fifty-four patients were recruited from outpatient nephrology clinics and hemodialysis units. All patients completed an overnight cardiopulmonary monitoring test to determine the prevalence of sleep apnea (respiratory disturbance index ≥ 15) and nocturnal hypoxia (oxygen saturation < 90% for ≥ 12% of monitoring). Patients were stratified into three groups based on estimated glomerular filtration rate (eGFR) as follows: eGFR ≥ 60 mL/min/1.73 m(2) (n = 55), CKD (eGFR < 60 mL/min/1.73 m(2) not on dialysis, n = 124), and ESRD (on hemodialysis, n = 75).
The prevalence of sleep apnea increased as eGFR declined (eGFR ≥ 60 mL/min/1.73 m(2), 27%; CKD, 41%; ESRD, 57%; P = .002). The prevalence of nocturnal hypoxia was higher in patients with CKD and ESRD (eGFR ≥ 60 mL/min/1.73 m(2), 16%; CKD, 47%; ESRD, 48%; P < .001).
Sleep apnea is common in patients with CKD and increases as kidney function declines. Almost 50% of patients with CKD and ESRD experience nocturnal hypoxia, which may contribute to loss of kidney function and increased cardiovascular risk.

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    • "with a declining kidney function. Of importance, in this study, diabetes was strongly associated with OSA and was a significant predictor of nocturnal hypoxemia [54]. Schober and colleagues [49] examined the prevalence of OSA in 556 adults with diabetes (58 had type 1 diabetes) with an average diabetes duration of 9.3 AE 7.3 years (37.4% had an AH of !15 episodes/h) and found a higher prevalence of nephropathy in those with an AHI of !15 episodes/h. "
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    Diabetes Research and Clinical Practice 05/2014; 104(2). DOI:10.1016/j.diabres.2014.01.007 · 2.54 Impact Factor
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    • "Compared to subjects without nocturnal hypoxia, subjects with nocturnal hypoxia demonstrated an almost three-fold increase in the risk of accelerated loss of kidney function (Ahmed et al. 2011). However, there was also report that declining kidney function increased the prevalence of sleep apnea too (Nicholl et al. 2012). "
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