Risk, Severity, and Predictors of Obstructive Sleep Apnea in Hemodialysis and Peritoneal Dialysis Patients.

Shih-Ting Huang,Wen-Miin Liang,Chen-Li Lin,Chia-Hung Kao,Tzu-Chieh Chou,Tung-Min Yu

doi:10.3390/ijerph15112377

Abstract

Our study aimed to determine the incidence and severity of obstructive sleep apnea (OSA) in patients with end-stage renal disease (ESRD) and also whether different dialysis modalities confer different risk and treatment response for OSA. We used Taiwan’s National Health Insurance Research Database for analysis and identified 29,561 incident dialysis patients as the study cohort between 2000 and 2011. Each dialysis patient was matched with four non-dialysis control cases by age, sex, and index date. Cox regression hazard models were used to identify the risk of OSA. The incidence rate of OSA was higher in the peritoneal dialysis (PD) cohort than the hemodialysis (HD) and control cohort (18.9, 7.03 vs. 5.5 per 10,000 person-years, respectively). The risk of OSA was significantly higher in the PD (crude subhazard ratio (cSHR) 3.50 [95% CI 2.71–4.50], p < 0.001) and HD cohort (cSHR 1.31 [95% CI 1.00–1.72], p < 0.05) compared with the control cohort. Independent risk factors for OSA in this population were age, sex, having coronary artery disease (CAD), hyperlipidemia, chronic obstructive pulmonary disease (COPD), and hypertension. Major OSA (MOSA) occurred in 68.6% in PD and 50.0% in HD patients with OSA. In the PD subgroup, the incidence of mortality was significantly higher in OSA patients without continuous positive airway pressure (CPAP) treatment compared with OSA patients undergoing CPAP treatment. The results of this study indicate that ESRD patients were at higher risk for OSA, especially PD patients, compared with control. The severity of OSA was higher in PD patients than HD patients. Treatment of MOSA with CPAP was associated with reduced mortality in PD patients.

Highlights

Obstructive sleep apnea (OSA) is associated with significantly increased cardiovascular morbidity and mortality, and OSA incidence has been increasing dramatically in the last two decades with theInt
Our study showed the survival benefits of continuous positive airway pressure (CPAP) on mortality in peritoneal dialysis (PD) patients with Major OSA (MOSA), and that the protective effect of CPAP was not observed in HD patients
Patients with end-stage renal disease (ESRD) have higher risk of new onset OSA, and PD patients are at higher risk than

Summary

Introduction

Obstructive sleep apnea (OSA) is associated with significantly increased cardiovascular morbidity and mortality, and OSA incidence has been increasing dramatically in the last two decades with theInt. Obstructive sleep apnea (OSA) is associated with significantly increased cardiovascular morbidity and mortality, and OSA incidence has been increasing dramatically in the last two decades with the. Res. Public Health 2018, 15, 2377; doi:10.3390/ijerph15112377 www.mdpi.com/journal/ijerph. Res. Public Health 2018, 15, 2377 growth in obesity rates [1,2,3,4]. OSA contributes to the pathogenesis of arterial hypertension and heart failure [2,5], while chronic kidney disease (CKD) is another OSA comorbidity and contributes to its course [6]. Sleep apnea has been identified in both hemodialysis (HD) and peritoneal dialysis (PD)

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Discussion

Conclusion