Skip to main content

Advertisement

SpringerLink
Log in

Sleep-Disordered Breathing in Nondialyzed Patients with Chronic Renal Failure

  • Published:
Lung Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. American Academy of Sleep Medicine (1999) Sleep-related breathing disorders in adults: Recommendations for syndrome definition and measurement techniques in clinical research. Sleep 22:667–689

    Google Scholar 

  2. Anonymous (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:S1–S246

    Google Scholar 

  3. Atlas Task Force of the American Sleep Disorders Association (1993) EEG arousals, scoring rules and examples. Sleep 16:173–184

    Google Scholar 

  4. Auckley DH, Schmidt-Nowara W, Brown LK (1999) Reversal of sleep apnea hypopnea syndrome in end–stage renal disease after kidney transplantation. Am J Kidney Dis 34:739–744

    CAS  PubMed  Google Scholar 

  5. Benz RL, Pressman MR, Hovick ET, Peterson DD (1999) A preliminary study of the effects of correction of anemia with recombinant human erythropoietin therapy on sleep, sleep disorders, and daytime sleepiness in hemodialysis patients (The Sleepo Study). Am J Kidney Dis 34:1089–1095

    CAS  PubMed  Google Scholar 

  6. Benz RL, Pressman MR, Hovick ET, Peterson DD (2000) Potential novel predictors of mortality in end-stage renal disease patients with sleep disorders. Am J Kidney Dis 35:1052–1060

    CAS  PubMed  Google Scholar 

  7. Chan CT, Hanly P, Gabor J, et al (2004) Impact of nocturnal hemodialysis on the variability of heart rate and duration of hypoxemia during sleep. Kidney Int 65:661–665

    Article  PubMed  Google Scholar 

  8. De Backer WA, Heyrman RM, Wittesaele WM, et al (1987) Ventilation and breathing patterns during hemodialysis-induced carbon dioxide unloading. Am Rev Respir Dis 136:406–410

    CAS  PubMed  Google Scholar 

  9. Diagnostic Classification Steering Committee of the American Sleep Disorders Association (1990) The International Classification of Sleep Disorders: Diagnostic and coding manual. American Sleep Disorders Association, Rochester, MN

    Google Scholar 

  10. Fein AM, Niederman MS, Imbriano L, Rosen H (1987) Reversal of sleep apnea in uremia by dialysis. Arch Intern Med 147:1355–1356

    Article  CAS  PubMed  Google Scholar 

  11. Ficker JH, Dertinger SH, Siegfried W, et al (1998) Obstructive sleep apnea and diabetes mellitus: the role of cardiovascular autonomic neuropathy. Eur Respir J 11:14–19

    Article  CAS  PubMed  Google Scholar 

  12. Fraser CL, Arieff AI (1988) Nervous system complications in uremia. Ann Intern Med 109:143–153

    CAS  PubMed  Google Scholar 

  13. Hallett M, Burden S, Stewart D, Mahony J, Farrell P (1995) Sleep apnea in end-stage renal disease patients on hemodialysis and continuous ambulatory peritoneal dialysis. ASAIO J 41:M435–M441

    CAS  PubMed  Google Scholar 

  14. Hamilton R, Epstein P, Henderson L, Edelman NH, Fishman AP (1976) Control of breathing in uremia: ventilatory response to CO2 after hemodialysis. J Appl Physiol 41:216–222

    CAS  PubMed  Google Scholar 

  15. Hanly PJ, Pierratos A (2001) Improvement of sleep apnea in patients with chronic renal failure who undergo nocturnal hemodialysis. N Engl J Med 344:102–107

    Article  CAS  PubMed  Google Scholar 

  16. Hanly PJ, Gabor JY, Chan C, Pierratos A (2003) Daytime sleepiness in patients with CRF: impact of nocturnal hemodialysis. Am J Kidney Dis 41:403–410

    Article  PubMed  Google Scholar 

  17. Hedner J, Grote L (2001) The link between sleep apnea and cardiovascular disease: time to target the nonsleepy sleep apneics? Am J Respir Grit Care Med 163:5–6

    CAS  Google Scholar 

  18. Heyrman RM, De Backer WA, Van Waeleghem JP, et al (1989) Effect of oxygen administration on the breathing pattern during haemodialysis in man. Eur Respir J 2:972–976

    CAS  PubMed  Google Scholar 

  19. Holley JL, Nespor S, Rault R (1992) A comparison of reported sleep disorders in patients on chronic hemodialysis and continuous peritoneal dialysis. Am J Kidney Dis 19:156–161

    CAS  PubMed  Google Scholar 

  20. Iliescu EA, Yeates KE, Holland DC (2004) Quality of sleep in patients with chronic kidney disease. Nephrol Dial Transplant 19:95–99

    PubMed  Google Scholar 

  21. Kimmel PL, Miller G, Mendelson WB (1989) Sleep apnea syndrome in chronic renal disease. Am J Med 86:308–314

    Article  CAS  PubMed  Google Scholar 

  22. Kuhlmann U, Becker HF, Birkhahn M, et al (2000) Sleep-apnea in patients with end-stage renal disease and objective results. Clin Nephrol 53:460–466

    CAS  PubMed  Google Scholar 

  23. Langevin B, Fouque D, Leger P, Robert D (1993) Sleep apnea syndrome and end-stage renal disease: Cure after renal transplantation. Chest 103:1330–1335

    CAS  PubMed  Google Scholar 

  24. Mendelson WB, Wadhwa NK, Greenberg HE, Gujavarty K, Bergofsky E (1990) Effects of hemodialysis on sleep apnea syndrome in end-stage renal disease. Clin Nephrol 33:247–251

    CAS  PubMed  Google Scholar 

  25. Millman RP, Kimmel PL, Shore ET, Wasserstein AG (1985) Sleep apnea in hemodialysis patients: the lack of testosterone effect on its pathogenesis. Nephron 40:407–410

    CAS  PubMed  Google Scholar 

  26. Parker KP, Bliwise DL, Bailey JL, Rye DB (2003) Daytime sleepiness in stable hemodialysis patients. Am J Kidney Dis 41:394–402

    Article  PubMed  Google Scholar 

  27. Phillips B, Young T, Finn L, et al (2000) Epidemiology of restless legs symptoms in adults. Arch Intern Med 160:2137–2141

    Article  CAS  PubMed  Google Scholar 

  28. Rechtshaffen A, Kales A (eds) (1968) A manual of standardized terminology, techniques and scoring systems for sleep stages of human subjects. Brain Information Service/Brain Research Institute, UCLA, Los Angeles

  29. Sebert P, Bellet M, Girin E, Cledes J, Barthelemy L (1984) Ventilatory and occlusion pressure responses to hypercapnia in patients with chronic renal failure. Respiration 45:191–196

    CAS  PubMed  Google Scholar 

  30. Shaver-Lewis M (2002) Renal disorders and sleep. In Lee-Chiong TL, Sateia MJ, Carskadon MA (eds) Sleep Medicine, 1st ed. Hanley and Belfus, Philadelphia, pp 455–462

    Google Scholar 

  31. Silverberg DS, Iaina A, Ocksenberg A (1997) Sleep-related breathing disturbances: their pathogenesis and potential interest to the nephrologist. Nephrol Dial Transplant 12:680–683

    CAS  PubMed  Google Scholar 

  32. Sklar AH, Chaudhari BA, Harp R (1989) Nocturnal urinary protein excretion rates in patients with sleep apnea. Nephron 51:35–38

    CAS  PubMed  Google Scholar 

  33. Stepanski E, Faber M, Zorick F, Basner R, Roth T (1995) Sleep disorders in patients on continuous ambulatory peritoneal dialysis. J Am Soc Nephrol 6:192–197

    CAS  PubMed  Google Scholar 

  34. Timio M, Venanzi S, Lolli S, et al (1995) Non-dipper hypertensive patients and progressive renal insufficiency: A three year longitudinal study. Clin Nephrol 43:382–387

    CAS  PubMed  Google Scholar 

  35. Unruh ML, Hartunian MG, Chapman MM, Jaber BL (2003) Sleep quality and clinical correlates in patients on maintenance dialysis. Clin Nephrol 59:280–288

    CAS  PubMed  Google Scholar 

  36. U.S. Renal Data System (2002) Annual Data Report. National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD

    Google Scholar 

  37. Wadhwa NK, Mendelson WB (1992) A comparison of sleep-disordered respiration in ERSD patients receiving hemodialysis and peritoneal dialysis. Adv Perit Dial 8:195–198

    CAS  PubMed  Google Scholar 

  38. Wadhwa NK, Seliger M, Greenberg HE, Bergofsky E, Mendelson WB (1992) Sleep related respiratory disorders in end-stage renal disease patients on peritoneal dialysis. Perit Dial Int 12:51–56

    CAS  PubMed  Google Scholar 

  39. Walker S, Fine A, Kryger MH (1995) Sleep complaints are common in a dialysis unit. Am J Kidney Dis 26:751–756

    CAS  PubMed  Google Scholar 

  40. Winkelman JW, Chertow GM, Lazarus JM (1996) Restless legs syndrome in end-stage renal disease. Am J Kidney Dis 28:372–378

    CAS  PubMed  Google Scholar 

  41. Wolk R, Somers VK (2003) Cardiovascular consequences of obstructive sleep apnea. Clin Chest Med 24:195–205

    Article  PubMed  Google Scholar 

  42. Yap JC, Wang YT, Poh SC (1998) Effect of oxygen on breathing irregularities during haemodialysis in patients with chronic uraemia. Eur Respir J 12:420–425

    Article  CAS  PubMed  Google Scholar 

  43. Young T, Palta M, Dempsey J, et al (1993) The occurrence of sleep-disordered breathing in middle aged adults. N Engl J Med 328:1230–1235

    Article  CAS  PubMed  Google Scholar 

  44. Young T, Finn L, Austin D, Peterson A (2003) Menopausal status and sleep-disordered breathing in the Wisconsin Sleep Cohort Study. Am J Respir Crit Care Med 167:1181–1185

    Article  PubMed  Google Scholar 

  45. Zoccali C, Benedetto FA, Tripepi G, et al (1998) Nocturnal hypoxemia, night-day arterial pressure changes and left ventricular geometry in dialysis patients. Kidney Int 53:1078–1084

    Article  CAS  PubMed  Google Scholar 

  46. Zoccali C, Benedetto FA, Mallamaci F, et al (2001) Left ventricular hypertrophy and nocturnal hypoxemia in hemodialysis patients. J Hypertens 19:287–293

    Article  CAS  PubMed  Google Scholar 

  47. Zoccali C, Mallamaci F, Tripepi G, Benedetto FA (2001) Autonomic neuropathy is linked to nocturnal hypoxaemia and to concentric hypertrophy and remodelling in dialysis patients. Nephrol Dial Transplant 16:70–77

    CAS  PubMed  Google Scholar 

  48. Zoccali C, Mallamaci F, Tripepi G (2002) Nocturnal hypoxemia predicts incident cardiovascular complications in dialysis patients. J Am Soc Nephrol 13:729–733

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pulmonary Medicine, “A Fleming” General Hospital, 2 Pigis St., 15126, Mellisia, Athens, Greece

    Nikolaos Markou, Maria Kanakaki & Anastasios Damianos

  2. Athens School of Nursing, ICU at KAT Hospital, 2 Nikis St., 14561, Kifisia, Athens, Greece

    Pavlos Myrianthefs

  3. Department of Nephrology, “A Fleming” General Hospital, 14 25th March St., 15126, Mellisia, Athens, Greece

    Dimitrios Hadjiyanakos & Dimosthenis Vlassopoulos

  4. Department of Nephrology, University Hospital of Ioannina, P.O. Box 1186, 45110, Ioannina, Greece

    Konstantinos Siamopoulos

  5. Department of Pulmonary Medicine, University Hospital of Ioannina, P.O. Box 1186, 45110, Ioannina, Greece

    Miltiadis Vasiliou & Stavros Konstantopoulos

Authors
  1. Nikolaos Markou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maria Kanakaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pavlos Myrianthefs
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dimitrios Hadjiyanakos
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dimosthenis Vlassopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anastasios Damianos
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Konstantinos Siamopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Miltiadis Vasiliou
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Stavros Konstantopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nikolaos Markou.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Markou, N., Kanakaki, M., Myrianthefs, P. et al. Sleep-Disordered Breathing in Nondialyzed Patients with Chronic Renal Failure. Lung 184, 43–49 (2006). https://doi.org/10.1007/s00408-005-2563-2

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00408-005-2563-2

Keywords

Search

Navigation