Obstructive sleep apnea is associated with interdialytic weight gain and increased long-term cardiovascular events in hemodialysis patients

Harmon, Rebeca R.; Lima, José Jayme Galvão de; Drager, Luciano F.; Portilho, Natanael P.; Costa-Hong, Valéria; Bortolotto, Luiz Aparecido; Lorenzi‐Filho, Geraldo; Canziani, María Eugênia Fernandes

doi:10.1007/s11325-017-1603-5

Cited by 11 publications

(13 citation statements)

References 32 publications

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“…From our exploratory analysis, the reduction of OSA may be associated with reduced IDWG in patients receiving OL-HDF. The relationship between fluid accumulation and OSA in patients with ESKD was reported by Harmon et al [25] who Values are model-estimated mean (95% CI) or difference (95% CI). Modelling includes fixed effects for treatment, treatment order, study period, and a random effect for patient identity.…”

Section: Discussionmentioning

confidence: 74%

Feasibility of Online Haemodiafiltration in Sleep Apnoea: A Randomized Crossover Study

et al. 2020

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Background: Sleep apnoea is prevalent in dialysis patients. Previous studies identified excessive inflammation in patients with sleep apnoea. Online haemodiafiltration (OL-HDF) may reduce systematic inflammation through better clearance of middle molecules. We aimed to determine the feasibility of OL-HDF in sleep apnoea management. Methods: Eligible dialysis patients were screened for risk of sleep apnoea by nocturnal oximetry followed by a diagnostic sleep study to assess apnoea-hypopnea index (AHI). Patients with AHI ≥15/h were invited to a randomized crossover trial. The intervention was 2-month high-flux haemodialysis (HF-HD) followed by 2-month OL-HDF or vice versa with 1-month washout via HF-HD. Feasibility was assessed by patient recruitment and the primary outcome, severity of sleep apnoea (AHI). Secondary outcomes were pro-inflam-matory cytokines, patient-reported daytime sleepiness, quality of sleep and health-related quality of life. Results: Of 65 participants at risk of sleep apnoea, only 15 were consented and randomized (mean age 70 years, 80% male, mean AHI 42.2/h). AHI was not statistically different between OL-HDF versus HF-HD (55.6/h vs. 48.3/h, p = 0.134); however, when sleep apnoea was stratified into obstructive and central apnoea, patients had less obstructive episodes after treated by OL-HDF (23.2/h vs. 18.6/h, p = 0.178); a sensitivity analysis was performed excluding outliers, and the treatment effect for obstructive episodes was found to be statistically significant (11.1 vs. 18.2/h, p = 0.019). Pro-inflammatory biomarkers and patient-reported outcomes were similar between OL-HDF and HF-HD. Conclusion: Patient recruitment was a major challenge in this feasibility study. OL-HDF may reduce obstructive sleep apnoea; however, the result needs to be confirmed by larger studies.

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Section: Discussionmentioning

confidence: 74%

Feasibility of Online Haemodiafiltration in Sleep Apnoea: A Randomized Crossover Study

et al. 2020

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“…Over an average 8-month time period, it was observed that remission of nephrotic syndrome was associated with a reduction in AHI that was attributed to remission of limb edema [46]. Two more recent studies found that patients with a high AHI had a higher extracellular fluid volume in nondialysis days [47] and a higher interdialytic weight gain [48].…”

Section: Fluid Overload Dialysis and Sleep-disordered Breathingmentioning

confidence: 99%

Sleep Apnea and the Kidney

Marrone

Bonsignore

2020

Curr Sleep Medicine Rep

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Purpose of Review There are some uncertainties about the interactions between obstructive sleep apnea (OSA) and chronic kidney disease (CKD). We critically reviewed recent studies on this topic with a focus on experimental and clinical evidence of bidirectional influences between OSA and CKD, as well as the effects of treatment of either disease. Recent Findings Experimental intermittent hypoxia endangers the kidneys, possibly through activation of inflammatory pathways and increased blood pressure. In humans, severe OSA can independently decrease kidney function. Treatment of OSA by CPAP tends to blunt kidney function decline over time, although its effect may vary. OSA may increase cardiovascular complications and mortality in patients with end-stage renal disease (ESRD), while it seems of little harm after renal transplantation. Excessive fluid removal may explain some of the improvements in OSA severity in ESRD and after transplantation. Summary Severe OSA and CKD do interact negatively, mainly through hypoxia and fluid retention. The moderate mutually interactive benefits that treatment of each disease exerts on the other one warrant further studies to improve patient management.

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“…2,3 Patients who suffer severe OSA may also experience psychological disorders. 4 Anxiety, depression, and other cognitive dysfunctions are all examples of psychological disorders in OSA patients, which can adversely affect their quality of life. 5 Anatomical risk factors that may increase the risk of OSA include obesity, hypertrophy of soft palate and tongue, steep mandibular plane, small mandible, or mandibular retrognathia.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Continuous Positive Airway Pressure Versus Mandibular Advancement Device in Severe Obstructive Sleep Apnea Patients With Mandibular Retrognathia: A Prospective Clinical Trial

et al. 2020

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Aim: Some obstructive sleep apnea (OSA) patients may have mandibular retrognathia (ANB > 4.7° and SNB < 76.2°). Currently, there are no studies that have compared the effectiveness of continuous positive airway pressure (CPAP) versus mandibular advancement device (MAD) in severe OSA patients with mandibular retrognathia. We explored the efficacy of CPAP versus MAD for the treatment of severe OSA patients with mandibular retrognathia. Methods: A total of 105 patients were enrolled. Outcomes were assessed by using polysomnography, Epworth Sleepiness Scale (ESS), Snore Scale (SS), Self-rating Anxiety Scale (SAS), and compliance, before treatment and after 6 and 12 months of treatment. Results: Continuous positive airway pressure was superior to MAD in improving polysomnographic outcomes and SS score, but reported compliance was higher on MAD. There is no significant difference between the 2 treatments in terms of ESS score and SAS score. Obstructive sleep apnea patients with mandibular retrognathia showed greater improvement than those without mandibular retrognathia in terms of apnea-hypopnea index and oxygen desaturation index after MAD. Conclusion: Continuous positive airway pressure and MAD are both effective in treating severe OSA patients with mandibular retrognathia. Mandibular advancement device is a good alternative to CPAP in severe OSA patients with mandibular retrognathia. Mandibular advancement device is more effective in treating OSA patients with mandibular retrognathia than those without. Trial registration: ChiCTR2000032541.

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Obstructive sleep apnea is associated with interdialytic weight gain and increased long-term cardiovascular events in hemodialysis patients

Abstract: OSA was associated with increased risk of CV events. Significant (> 2 kg) interdialytic weight gain was independently associated with OSA.

Cited by 11 publications

References 32 publications

Feasibility of Online Haemodiafiltration in Sleep Apnoea: A Randomized Crossover Study

Feasibility of Online Haemodiafiltration in Sleep Apnoea: A Randomized Crossover Study

Sleep Apnea and the Kidney

Effectiveness of Continuous Positive Airway Pressure Versus Mandibular Advancement Device in Severe Obstructive Sleep Apnea Patients With Mandibular Retrognathia: A Prospective Clinical Trial

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