Declining Kidney Function Increases the Prevalence of Sleep Apnea and Nocturnal Hypoxia
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 . Schober and colleagues  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. "
ABSTRACT: An increasing body of evidence suggests that obstructive sleep apnoea (OSA) is independently associated with an increased risk of cardiovascular disease, glucose intolerance, and deteriorations in glycaemic control. Despite the knowledge of a multifactorial pathogenesis of long-term diabetes complications, there is a paucity of information on impact of comorbidities associated with chronic intermittent hypoxemia on development and progression of chronic diabetes complications. This review explores the clinical and scientific overlap of OSA and type 2 diabetes mellitus (T2DM) and its possible impact on the development and progression of diabetes macrovascular and microvascular complications. Multiple prospective observational cohort studies have demonstrated that OSA significantly increases the risk of cardiovascular disease independent of potential confounding risk factors. The current evidence further suggests that OSA with concurrent T2DM is associated with an increased risk of oxidative stress-induced damage of vulnerable endothelial and mesangial cells and peripheral nerves. Further studies are needed to validate the impact of OSA treatment on diabetes micro- and macrovascular complications. Since it is presently still unknown whether OSA treatment may provide a diabetes-modifying intervention that could delay or halt the progression of chronic diabetes complications, the emphasis is on early diagnosis and satisfactory treatment of both OSA and T2DM.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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ABSTRACT: Die chronische Niereninsuffizienz ist ein starker kardiovaskulärer Risikofaktor. Nicht nur renale, sondern auch kardiale Schädigungen werden durch eine Mikroalbuminurie früh angezeigt. Eine optimale Blutdrucktherapie sowie Senkung der Proteinurie sind wichtige Maßnahmen zur Reduktion der deutlich erhöhten kardiovaskulären Morbidität und Mortalität bei diesem speziellen Kollektiv. Sowohl eine medikamentöse Sekundärprophylaxe als auch interventionelle Verfahren bei Vorliegen einer koronaren Herzerkrankung kommen bei Nierenkranken vielfach nur in unzureichendem Maße zum Einsatz. Patienten mit Niereninsuffizienz sollten zur Verbesserung des kardiovaskulären Outcomes auch großzügig auf das Vorliegen einer schlafbezogenen Störung untersucht und ggf. entsprechend behandelt werden. Prospektive Daten zu neuen Therapieansätzen wie oralen Faktor-Xa- oder Thrombininhibitoren bei Vorhofflimmern liegen nicht vor. Selbst für Vitamin-K-Antagonisten ist die Situation bei Dialysepatienten unklar. Auch Studien zur Transkatheteraortenklappenimplantation bei schwerer Aortenklappenstenose und fortgeschrittener Niereninsuffizienz oder Dialysepflichtigkeit fehlen bislang.Der Internist 07/2012; 53(7). DOI:10.1007/s00108-011-3010-5 · 0.27 Impact Factor
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ABSTRACT: Obstructive sleep apnea (OSA) is an important and common comorbidity in patients with chronic kidney disease (CKD). However, few studies have addressed how OSA presents in this patient population and whether it is clinically apparent. The objectives of this study were to determine if the prevalence and severity of sleep related symptoms distinguished CKD patients with OSA from those without apnea, and whether the clinical presentation of OSA in CKD patients differed from the general OSA population. One hundred nineteen patients were recruited from outpatient nephrology clinics. All patients completed a sleep history questionnaire, the Epworth Sleepiness Scale (daytime sleepiness, ESS > 10), the Pittsburgh Sleep Quality Index (poor sleep quality, PSQI > 5), and underwent overnight cardiopulmonary monitoring for determination of sleep apnea (respiratory disturbance index ≥ 15). CKD patients with OSA (n = 46) were compared to (1) CKD patients without OSA (n = 73) and (2) OSA patients without CKD (n = 230) who were referred to the sleep centre. The prevalence of OSA symptoms and PSQI scores did not differ between CKD patients with OSA and CKD patients without apnea. Although the prevalence of daytime sleepiness was higher in CKD patients with OSA compared to CKD patients without apnea (39% vs. 19%, p = 0.033), both daytime sleepiness and other symptoms of sleep apnea were considerably less frequent than in OSA patients without a history of kidney disease. The presence of OSA in patients with CKD is unlikely to be clinically apparent. Consequently, objective cardiopulmonary monitoring during sleep is required to reliably identify this comorbidity.Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 01/2012; 8(4):381-7. DOI:10.5664/jcsm.2028 · 2.83 Impact Factor