Sleep-Disordered Breathing in Nondialyzed Patients with Chronic Renal Failure

Department of Pulmonary Medicine, A Fleming General Hospital, 2 Pigis St., 15126, Mellisia, Athens, Greece.
Beiträge zur Klinik der Tuberkulose (Impact Factor: 2.27). 02/2006; 184(1):43-9. DOI: 10.1007/s00408-005-2563-2
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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.

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    • "Previous studies involving patients with chronic kidney disease (CKD) have shown RLS as highly prevalent and associated with anemia, GFR reduction, serum parathormone and iron status [14,15]. Of importance, in our data, 79/99 of patients had an eGFR greater than 60 mL/min/1.73 "
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    ABSTRACT: Background Despite a confirmed association between restless legs syndrome (RLS) and end-stage renal disease (ESRD), there is no study on patients presenting with nephrotic syndrome (NS). To investigate the frequency of RLS and poor quality sleep in NS-patients secondary to primary glomerulopathy with nearly normal glomerular filtration rate (GFR) and its associated factors. Methods Patients with NS, defined as 24 h-urine protein greater than 3.5 g/1.73 m2 and hypoalbuminemia, (n = 99, 53 women) and a mean age of 36±11 years were studied. Age and sex-matched controls were used to compare RLS and poor sleep quality prevalence. Standardized RLS questionnaire formulated by the International Restless Legs Syndrome and Pittsburgh Sleep Quality Index (PSQI) were used. Results RLS was more frequent in NS-patients than in controls (22.8 vs. 4.0%, p = 0.01). Mean time since diagnosis (52.2±34.1 vs. 28.6±22.5 months, p < 0.01) and 24 h-proteinuria (3.7±1.3 vs. 2.6±0.6 g/1.73 m2, p = 0.001) were greater in NS-patients with RLS those not presenting RLS. Association between RLS with 24 h-proteinuria [OR = 2.31; p = 0.007; 95% CI 1.87-2.89] and time since diagnosis [OR = 1.10; p = 0.003; CI = 1.02-1.39] were identified even after controlling for age, GFR and diabetes. Sleep quality was poor in NS-patients than in controls (mean PSQI score 7.35±3.7 vs. 5.2±3.0, p = 0.003). In NS-patients, only RLS was associated with poor sleep quality (OR = 1.20; p = 0.004). Conclusion Poor quality sleep and RLS are frequent in NS-patients without ESRD. Pathophysiology of this association must be further investigated.
    BMC Nephrology 05/2013; 14(1):113. DOI:10.1186/1471-2369-14-113 · 1.69 Impact Factor
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    • "In a cross-sectional study of 35 patients with chronic kidney diseases, the majority of patients (54%) had OSA (Markou et al. 2006). Despite a high overall oxygen supply, the tissue oxygen tension in the kidney is comparatively low that renders the kidney prone to hypoxic injury (Eckardt et al. 2003). "
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    ABSTRACT: Obstructive sleep apnea causes cardiovascular disease via chronic intermittent hypoxia (IH), which may be related to oxidative stress. Nuclear factor-erythroid 2-related factor 2 (Nrf2) is an important cellular defense mechanism against oxidative stress by regulating its down-stream multiple antioxidants. The present study was to define whether IH can induce renal pathogenic damage and if so, whether Nrf2 and its down-stream antioxidants are involved in IH-induced pathogenic changes. Mice were culled for exposure to intermittent air as control or IH that consisted of 20.9% O2/ 8% O2 FIO2 alternation cycles (30 episodes per h) with 20 seconds at the nadir FIO2 for 12 h a day during daylight. Short-term IH exposure (3 - 7 days) induced significant increases in renal inflammatory response and antioxidant levels along with a reduction of the spontaneous content of malondialdehyde while long-term IH exposure (8 weeks) induced a significant decrease of antioxidant levels and significant increases of renal inflammation, oxidative damage, cell death, and fibrosis. This study suggests that IH induces a hormetic response, i.e.: short-term IH exposure is able to induce a protective response to protect the kidney from oxidative damage while long-term IH exposure is able to induce a damage effect on the kidney.
    Dose-Response 01/2012; 11(3):385-400. DOI:10.2203/dose-response.12-027.Cai · 1.22 Impact Factor
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    • "In addition, it has been reported that over 50% of patients with severe CKD, who do not require dialysis, have mild SDB [9]. However, most of these investigations are limited by small sample sizes with no comparison group or lack of applicability to patients with mild renal disease [9] [10]. To our knowledge, no prior study has evaluated the association between mild to moderate impairments in renal function and SDB in community-dwelling older adults. "
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    Sleep Medicine 09/2008; 9(6):637-45. DOI:10.1016/j.sleep.2007.08.021 · 3.15 Impact Factor
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