Sleep Apnea in Early and Advanced Chronic Kidney Disease Kaiser Permanente Southern California Cohort
ABSTRACT Sleep apnea (SA) has been reported to be highly prevalent in the dialysis population. The reported rates of SA in dialysis are severalfold greater than the 2 to 4% estimated in the general population. This study sought to determine whether an association exists between SA and early stages of chronic kidney disease (CKD) where SA may represent an important comorbidity and potential risk factor in kidney disease.
Cross-sectional study of adults from an integrated health plan with documented serum creatinine levels in the period January 1, 2002, through December 31, 2004. SA diagnosis determined by International Classification of Diseases, ninth revision, coding for SA and Current Procedural Terminology coding for positive airway pressure devices. Kidney function was determined by the estimated glomerular filtration rate (eGFR). Logistic was regression used to estimate the relative risk for SA.
The overall prevalence of SA was 2.5% in the study population that included subjects with normal renal function and those with CKD. The odds ratios (ORs) for SA by eGFRs of 75 to 89, 60 to 74, 45 to 59, 30 to 44, and 15 to 29 mL/min per 1.73 m(2), respectively, compared to normal kidney function, after adjustment for age, sex, and number of visits, were as follows: 1.22 (95% confidence interval [CI], 1.18 to 1.25); 1.32 (95% CI, 1.27 to 1.37); 1.42 (95% CI, 1.35 to 1.50); 1.37 (95% CI, 1.25 to 1.50); and 1.32 (95% CI, 1.13 to 1.55). The increased ORs for eGFRs > 45 mL/min per 1.73 m(2) were sustained even after controlling for diabetes, heart failure, and hypertension.
This study demonstrated an increased risk of SA in patients with early CKD. Further evidence of a causal relationship should be sought in the hope that the detection and management of SA may improve the course of CKD.
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ABSTRACT: Bei Patienten mit Nierenfunktionseinschränkung treten schlafbezogene Atemstörungen signifikant häufiger auf, im Vergleich mit Nierengesunden mit gleichen Risikofaktoren ist das Risiko für obstruktive Schlafapnoe bei terminaler Niereninsuffizienz vierfach erhöht. Die typischen Symptome Tagesmüdigkeit oder -schläfrigkeit werden bei Nierenpatienten häufig der Anämie oder Urämie zugeschrieben. Dies erklärt wahrscheinlich, warum die Schlafapnoe bisher bei diesem Kollektiv noch zu selten diagnostiziert wird. Niereninsuffizienz und Schlafapnoe haben gemeinsame pathophysiologische Angriffspunkte. Sie führen über die Aktivierung des Sympathikus und des Renin-Angiotensin-Aldosteron-Systems zu endothelialer Dysfunktion und potenzieren so das Risiko für Herz-Kreislauf-Erkrankungen. Für die Allgemeinbevölkerung ist die Reduktion der kardiovaskulären Mortalität und Morbidität durch nächtliche Maskentherapie mit kontinuierlichem positivem Atemwegsdruck gut belegt, eine Risikoreduktion ist auch für Patienten mit Niereninsuffizienz zu erwarten. Die Verfügbarkeit valider ambulanter Polygraphieverfahren ermöglicht nun eine einfachere Diagnostik. Diskutiert wird, bei welchen Patienten mit Hypertonie und/oder Niereninsuffizienz sich ein Screening empfiehlt. Wird die Diagnose eines Schlafapnoesyndroms gestellt, ist die Überdruckbeatmungsbehandlung die Therapie der Wahl. The prevalence of sleep apnea is significantly increased in patients with all stages of chronic kidney disease. In end-stage renal disease the risk to suffer from obstructive sleep apnea is approximately 4 times higher compared to patients with the same risk factors but healthy kidneys. Renal patients often lack the typical constitution of sleep apnea patients. Furthermore, symptoms, such as daytime sleepiness, are often interpreted as consequences of anemia or uremia. This might explain why sleep apnea is currently underdiagnosed. Sleep apnea and chronic kidney disease potentiate the cardiovascular risk by targeting the same important systems, such as sympathetic nerve activity or the renin-angiotensin-aldosterone cascade. Continuous positive airway pressure therapy is the treatment of choice. There is a growing body of evidence that therapy of sleep apnea leads to a significant reduction of the cardiovascular risk in patients with normal kidney function. Looking at the pathomechanism it can be assumed that renal patients also benefit from therapy of sleep-related disorders. Therefore, validated out-patient screening devices should be used to identify renal patients at risk and initiate early treatment.Der Nephrologe 01/2010; 5(1):43-48. DOI:10.1007/s11560-009-0340-6
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ABSTRACT: In the simultaneous decomposition-simulation (SiDeS) method, efficiency of the decomposition process decreases rapidly as the sets get decomposed into smaller probability sets. This is because, the number of states being classified as acceptable sets or identical area loss-of-load sets in generation deficient areas is small and consequently, the number of sets which are generated for a given threshold probability is large. The number of sets generated has serious implications on the memory requirements and frequency calculations which depend on the examination of subset intersection. In the new preferential simultaneous decomposition-simulation (PreSiDeS) method, five concepts have been introduced which improve the efficiency of the decomposition process. A characteristic value is assigned to each of the areas for the maximum state of the set depending on excess generation or deficient generation. Then the maximal flow algorithm is performed to utilize generation, first from excess generation areas and then from deficient generation areas. This increases the states in deficient generation areas being classified as acceptable sets or identical area loss-of-load sets to more than one state. Also in the decomposition of loss-of-load sets, if all the areas which have deficient generation are loss-of-load, then the neighboring help to these areas is reduced to zero which increases the states in identical area loss-of-load set being generated. Application of these concepts to the decomposition process results in much fewer sets and improves the efficiency of the decomposition phaseIEEE Transactions on Power Systems 06/1994; DOI:10.1109/59.317679 · 3.53 Impact Factor
Article: „Nephro Update 2009“Der Nephrologe 09/2009; 4(5):449-452. DOI:10.1007/s11560-009-0320-x