Article

Lung

, Volume 184, Issue 1, pp 43-49

First online:

Sleep-Disordered Breathing in Nondialyzed Patients with Chronic Renal Failure

  • Nikolaos MarkouAffiliated withDepartment of Pulmonary Medicine, “A Fleming” General Hospital Email author 
  • , Maria KanakakiAffiliated withDepartment of Pulmonary Medicine, “A Fleming” General Hospital
  • , Pavlos MyrianthefsAffiliated withAthens School of Nursing, ICU at KAT Hospital
  • , Dimitrios HadjiyanakosAffiliated withDepartment of Nephrology, “A Fleming” General Hospital
  • , Dimosthenis VlassopoulosAffiliated withDepartment of Nephrology, “A Fleming” General Hospital
  • , Anastasios DamianosAffiliated withDepartment of Pulmonary Medicine, “A Fleming” General Hospital
  • , Konstantinos SiamopoulosAffiliated withDepartment of Nephrology, University Hospital of Ioannina
  • , Miltiadis VasiliouAffiliated withDepartment of Pulmonary Medicine, University Hospital of Ioannina
  • , Stavros KonstantopoulosAffiliated withDepartment of Pulmonary Medicine, University Hospital of Ioannina

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Abstract

The prevalence and significance of sleep-disordered breathing (SDB) in dialysis-independent chronic renal failure (CRF) remains unknown. We studied the presence of SDB in nondialyzed CRF patients. Diagnostic polysomnography was performed in consecutive stable nondialyzed CRF patients. Inclusion criteria were age ≤70 years, absence of systolic dysfunction or history of pulmonary edema, FEV1 > 70% pr, absence of neurologic disease or hypothyroidism, and calculated creatinine clearance <40 ml/min. Thirty-five patients (19 male, 16 female) were studied. An apnea–hypopnea index (AHI) ≥5/h was present in 54.3% (almost exclusively obstructive events). AHI correlated with urea (r = 0.35, p = 0.037), age (r = 0.379, p = 0.025), and body mass index (BMI) (r = 0.351, p = 0.038), but not with creatinine clearance. AHI or SDB were unrelated to gender. In nondiabetics (n = 25), AHI correlated with urea (r = 0.608, p = 0.001) and creatinine clearance (r = −0.50, p = 0.012). Nondiabetics with severe CRF (calculated GFR < 15 ml/min/1.73 m2) had a significantly higher AHI compared with less severe CRF. Restless legs syndrome (RLS) was present in 37.1% and periodic limb movements in 28.6%. Daytime sleepiness was not associated with respiratory events, but was more common in patients with RLS. The prevalence of SDB and RLS is high in dialysis-independent CRF. SDB weakly correlates with indices of kidney function and this association becomes stronger in nondiabetics.

Keywords

Chronic renal failure Dialysis Sleep-disordered breathing Restless legs syndrome Periodic limb movements