Left ventricular hypertrophy and nocturnal hypoxemia in hemodialysis patients

Zoccali, Carmine; Benedetto, Francesco; Mallamaci, Francesca; Tripepi, Giovanni; Candela, Vincenzo; Labate, C.; Tassone, F.

doi:10.1097/00004872-200102000-00016

Cited by 55 publications

(38 citation statements)

References 35 publications

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“…In MHD patients, it has been demonstrated that impaired sleep may worsen the cardiovascular profile [4]and may negatively affect the immune system function [5], thus influencing the two leading causes of death of uremic patients. The possibility to cure some of the dialysis-related problems causing insomnia such as pruritus, bone pain, and congestive heart failure and the availability of new hypnotics which associate a good clinical response with minor side effects open new encouraging perspectives to the nephrologist in this field.…”

Section: Introductionmentioning

confidence: 99%

Zaleplon Improves Sleep Quality in Maintenance Hemodialysis Patients

et al. 2004

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Background/Aim: A recent survey has shown that insomnia is still a very common problem in maintenance hemodialysis (MHD) patients. The aim of the present study was to test the effects of zaleplon (ZAL), a new nonbenzodiazepine hypnotic drug, on the sleep quality of MHD patients with insomnia. Methods: The sleep quality was assessed by the Pittsburgh questionnaire in 10 patients (6 males/4 females) with insomnia on MHD; these patients underwent a randomized double-blind crossover study versus placebo (PLA). The main exclusion criterion was the presence of any possible cause of insomnia related to other concurrent diseases. Results: Treatment with ZAL significantly improved the total score of sleep quality (p < 0.03 vs. PLA). The analysis of the single components revealed that treatment with ZAL was associated with a higher subjective sleep quality (p < 0.01 vs. PLA) and a reduced sleep latency (p < 0.01 vs. PLA). The duration of sleep was not modified by ZAL, whereas a significant improvement was detected in habitual sleep efficacy (p < 0.05 vs. PLA). No peculiar side effect was recorded on ZAL. Blood parameters did not change, nor were differences recorded in the dialysis parameters (body weight gain, blood pressure) throughout the study. Conclusions: This study suggests that ZAL has a positive effect on the sleep quality in MHD patients. The absence of side effects and its pharmacodynamic properties make ZAL a useful drug in uremic patients.

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Section: Introductionmentioning

confidence: 99%

Zaleplon Improves Sleep Quality in Maintenance Hemodialysis Patients

et al. 2004

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“…Studies of patients with ESRD have shown that nocturnal hypoxemia is associated with left-ventricular hypertrophy (6), coronary artery disease (3), and a higher risk for cardiovascular events (7). However, limited evidence exists as to whether sleep disorders increase the risk for death in patients with ESRD.…”

mentioning

confidence: 99%

Nocturnal Hypoxemia and Periodic Limb Movement Predict Mortality in Patients on Maintenance Hemodialysis

Jung¹,

Lee

Baek³

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: Sleep disorders, including sleep-disordered breathing and periodic limb movements during sleep, are associated with an increased risk for cardiovascular diseases, which are the leading causes of death in patients with ESRD. This study investigated the association between sleep disorders and mortality in patients with ESRD.Design, setting, participants, & measurements: Thirty patients on maintenance hemodialysis, who were clinically stable for >2 months, underwent overnight polysomnography to evaluate sleep parameters.Results: All patients were followed for a median of 48 months (range: 14 to 62 months), and 14 of them died during the follow-up period. Among the sleep parameters, the percent of sleep time with arterial oxygen saturation <90% (T <90%), mean arterial oxygen saturation, and periodic limb movement index score were associated with significant increases in the risk of death. However, associations of the apnea-hypopnea index or oxygen desaturation index with mortality were NS. The hazard ratios (95% confidence intervals) for death per one SD increment in the log-transformed T <90% and periodic limb movement index score were 2.10 (1.06 to 4.15) and 2.48 (1.11 to 5.52), respectively, after adjusting for age.Conclusions: We found that nocturnal hypoxemia and periodic limb movement during sleep, rather than apnea itself, were associated with an increased risk for death in patients with ESRD. However, conclusions from this study should be drawn with caution, because they are limited by the small sample size.

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“…Therefore, autonomic dysfunction in ESRD may be considered another facet of the complex cardiovascular sequelae of nocturnal hypoxemia. Nocturnal hypoxemia in dialysis patients is also associated with nocturnal hypertension [31] and even more strongly with concentric hypertrophy and remodeling [32]. Thus, several intermediate mechanisms may conjure in determining the adverse cardiovascular outcomes of SA we observed in dialysis patients.…”

Section: Cardiovascular Sequelae Of Sa In Esrdmentioning

confidence: 72%

Nocturnal Hypoxemia: A Neglected Cardiovascular Risk Factor in End-Stage Renal Disease?

2002

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Its is well established that sleep apnea (SA) is a health problem of paramount importance because it disrupts sleep and quality of life and may induce serious neuroendocrine and cardiovascular complications. There is little doubt that chronic renal failure is an independent cause of SA. The hypothesis that SA may depend on the accumulation of endogenous opioids still remains to be tested.Cytokines, particularly TNF-α and IL-6 which are much elevated in end-stage renal disease (ESRD), may also be implicated in the pathogenesis of SA. Nocturnal hypoxemia is an independent predictor of cardiovascular events in ESRD and the prediction power of this parameter remains strong and substantially unmodified after statistical adjustment for established cardiovascular risk factors in the dialysis population. Left ventricular hypertrophy and dysautonomia appear to be most likely intermediate mechanisms mediating the adverse cardiovascular effects of SA in ESRD.

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Left ventricular hypertrophy and nocturnal hypoxemia in hemodialysis patients

Abstract: Nocturnal hypoxemia is an important correlate of LVH in hemodialysis patients. Such an association is largely independent of arterial pressure. These data further underscore the importance of disturbed respiratory control as a cardiovascular risk factor in dialysis patients.

Cited by 55 publications

References 35 publications

Zaleplon Improves Sleep Quality in Maintenance Hemodialysis Patients

Zaleplon Improves Sleep Quality in Maintenance Hemodialysis Patients

Nocturnal Hypoxemia and Periodic Limb Movement Predict Mortality in Patients on Maintenance Hemodialysis

Nocturnal Hypoxemia: A Neglected Cardiovascular Risk Factor in End-Stage Renal Disease?

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