Sleep Apnea in Patients on Conventional Thrice-Weekly Hemodialysis

Abstract

Sleep-disordered breathing (SDB) has been noted commonly in hemodialysis (HD) patients, but it is not known whether this is related directly to the treatment of kidney failure with HD or to the higher prevalence of obesity and older age. Forty-six HD patients were compared with 137 participants from the Sleep Heart Health Study (SHHS) who were matched for age, gender, body mass index (BMI), and race. Home unattended polysomnography was performed and scored using similar protocols. The study sample was 62.7 ؎ 10.1 yr, was predominantly male (72%) and white (63%), and had an average BMI of 28 ؎ 5.3 kg/m 2 . The HD sample had a higher systolic BP (137 versus 121 mmHg; P < 0.01) and a higher prevalence of diabetes (33 versus 9%; P < 0.01) and cardiovascular disease (33 versus 13%; P < 0.01) compared with the SHHS sample. The HD group had significantly less sleep time (320 versus 379 min; P < 0.0001) but similar sleep efficiency. HD patients had a higher frequency of arousals per hour (25.1 versus 17.1; P < 0.0001) and apnea-hypopneas per hour (27.2 versus 15.2; P < 0.0001) and greater percentage of the total sleep time below an oxygen saturation of 90% (7.2 versus 1.8; P < 0.0001). HD patients were more likely to have severe SDB (>30 respiratory events per hour) compared with the SHHS sample (odds ratio 4.07; 95% confidence interval 1.83 to 9.07). There was a strong association of HD with severe SDB and nocturnal hypoxemia independent of age, BMI, and the higher prevalence of chronic disease. The potential mechanisms for the higher likelihood of SDB in the HD population must be identified to provide specific prevention and therapy. P oor sleep and fatigue are common in older adults who undergo hemodialysis (HD), with HD patients reporting sleep problems more than twice as frequently as healthy control subjects (1,2). Despite this association, the extent and the severity of sleep disorders among the HD population and their cause both remain unclear (3-6). Although polysomnographic information in HD patients is limited, the available data do suggest that sleep-disordered breathing (SDB) may affect a significant percentage of dialysis patients (2,7). Although a number of studies have shown that a substantial proportion of HD patient have sleep apnea, these studies were limited by very small study samples (8 -12), by the use of partial channel polysomnography (PSG) (12)(13)(14), by the study of populations with limited generalizability to HD patients who are cared for in the United States (15), by very selected subpopulation of dialysis patients without sleep symptoms (16), or by study samples that largely were composed of symptomatic patients (7,8,17).Because a growing number of HD patients who are cared for in the United States are older than 65 yr (18), it is possible that reports of high rates of SDB and sleep problems in HD patients represent an aging effect, uremia effect, or some combination of the two. In particular, the prevalence of SDB and daytime sleepiness both increase with age (19), with SDB estimated to ...

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