A CASE OF SLEEP DISORDERS BREATHING AND CHRONIC KIDNEY FAILURE TREATED WITH AUTO SERVO-VENTILATION

Abstract

TYPE: Case Report TOPIC: Sleep Disorders INTRODUCTION: Changes in sleep quality and sleep disorders breathing (SDB) have been reported in patients with chronic kidney failure (CKF), contributing to worse the prognosis. SDB can contribute to hypertension, diabetes, cardiovascular disease and worsening obesit, all of which are implicated in the etiopathogenesis of CKF. CASE PRESENTATION: A 57 years-old male, with BMI 30 Kg/m2 , CKF in peritoneal dialysis, un-controlled hypertension in pharmacological polytherapy, was admitted to Stroke Unit due to intracerebral hemmorhage. To the resolution of acute condition and at follow up, he reported loud snoring, excessive daytime sleepiness, fatigue for several years, with Epworth Sleepiness Scale (ESS) of 19/24. He underwent a nocturnal cardiorespiratory monitoring, that showed central and obstructive apneas (Ah index 80/h, central apnea index 40/h, obstructive apnea index 15/h)(fig.1). Echocardiography showed left ventricular ejection of 50%. He was subjected to auto servo-ventilation (ASV: EPAP max 11 cmH2O, EPAP min 4 cmH2O, PS max 7 cmH2O, PS min 2 cmH2O). At the three months follow up, ASV treatment significantly improved the apnea hypopnea index, central and obstructive indeces, compared to baseline (residual Ah index 3/h), ESS was 4/24, blood pression values are well controlled. Fig.1 DISCUSSION: In our case, the patient with obesity and CKF, had un-controlled hypertension and undiagnosed SDB, which may have increased the risk of intracerebral hemorrhage. CONCLUSIONS: ASV might be a valid non pharmacotherapy improving the symtoms and with cardio-renal protection. DISCLOSURE: Nothing to declare. KEYWORD: sleep disorders breathing, auto servo-ventilation, chronic kidney failure