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

Abstract

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.

Sleep apnea prevalence in chronic kidney disease - association with total body water and symptoms

“…These prevalence figures are higher than most previous reports [12, 14–16] Central sleep apnea was much more common in haemodialysis compared to non-dialysis participants (31% versus 7%), but CAI ≥ 30 was present in only a single patient. The reported prevalence for central sleep apnea in subjects with CKD was 0 to 75% in a recent systematic review [35].…”

“…A high prevalence of sleep apnea has been recognized in patients with CKD since the 1980s with the prevalence of severe sleep apnea (AHI ≥ 30) reported to be present in 20% of those with severe non-dialysis CKD and 26% of those on hemodialysis [12]. Other studies, of varying quality, have reported a prevalence for AHI ≥ 5 in those on hemodialysis of between 50 and 83% [13–16] and there is data to suggest that a lower estimated glomerular filtration rate (eGFR) is associated with more severe sleep apnea in CKD patients [17]. …”

Hypoxia: The Force that Drives Chronic Kidney Disease

“…310 The profound consequences of atherosclerosis induced by sleep apnea are evident by it being an independent risk factor for cardiovascular mortality both in the general population and in patients with ESRD. 76,84,[311][312][313][314][315][316] Renal Figure 1. The hypoxia cycle driving chronic kidney disease.…”

Chronic Kidney Disease and Sleeping Disordered Breathing (SDB)

“…Several reports in the literature are corroborating to this: risk of atrial fibrillation in patients with left ventricular systolic dysfunction [17], the snoring per si increasing the risk of heart failure and mortality [18], increasing mortality risk in patients with CKD on hemodialysis [15] and peritoneal dialysis [16] and increasing mortality risk associated with hypoxemia [19]. …”