Abstract
BackgroundSleep apnea is common and associated with poor outcome in severe chronic kidney disease, but validated screening tools are not available. Our objectives were to determine the prevalence of sleep apnea in this population, to assess the validity of screening for sleep apnea using an ApneaLink device and to investigate the relationship of sleep apnea to; symptoms, spirometry and body water.MethodsPatients with glomerular filtration rate ≤30 mL/min/1.73 m2, whether or not they were receiving haemodialysis, were eligible for enrolment. Participants completed symptom questionnaires, performed an ApneaLink recording and had total body water measured using bioimpedance. This was followed by a multi-channel polysomnography recording which is the gold-standard diagnostic test for sleep apnea.ResultsFifty-seven participants were enrolled and had baseline data collected, of whom only 2 did not have sleep apnea. An apnea hypopnea index ≥30/h was found in 66% of haemodialysis and 54% of non-dialysis participants. A central apnea index ≥5/h was present in 11 patients, with only one dialysis patient having predominantly central sleep apnea. ApneaLink underestimated sleep apnea severity, particularly in the non-dialysis group. Neither total body water corrected for body size, spirometry, subjective sleepiness nor overall symptom scores were associated with sleep apnea severity.ConclusionsThis study demonstrates a very high prevalence of severe sleep apnea in patients with chronic kidney disease. Sleep apnea severity was not associated with quality of life or sleepiness scores and was unrelated to total body water corrected for body size. Routine identification of sleep apnea with polysomnography rather than screening is more appropriate in this group due to the high prevalence.
Highlights
Sleep apnea is common and associated with poor outcome in severe chronic kidney disease, but validated screening tools are not available
A high prevalence of sleep apnea has been recognized in patients with chronic kidney disease (CKD) since the 1980s with the prevalence of severe sleep apnea (AHI ≥ 30) reported to be present in 20% of those with severe nondialysis CKD and 26% of those on hemodialysis [12]
The objectives of this study were to determine the prevalence of sleep apnea in a severe CKD population, to assess the validity of screening for sleep apnea using an ApneaLink device and to investigate the relationship of sleep apnea to; symptoms, spirometry and body water
Summary
Sleep apnea is common and associated with poor outcome in severe chronic kidney disease, but validated screening tools are not available. Participants completed symptom questionnaires, performed an ApneaLink recording and had total body water measured using bioimpedance This was followed by a multi-channel polysomnography recording which is the gold-standard diagnostic test for sleep apnea. 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 nondialysis CKD and 26% of those on hemodialysis [12]. Of varying quality, have reported a prevalence for AHI ≥ 5 in those on hemodialysis of between 50 and 83% [13,14,15,16] 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]
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