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Predictors of successful completion of diagnostic home sleep testing in patients with chronic kidney disease

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Abstract

Purpose

Obstructive sleep apnea (OSA) is common among patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). Home sleep testing is used to diagnose OSA in many studies investigating sleep-disordered breathing in this population. However, failure to successfully complete the test is a significant source of participant exclusion from research studies and delayed diagnosis in clinical practice. The objective of the study was to identify potential factors impeding acceptance and successful completion of home sleep testing in patients with kidney disease.

Methods

Four hundred and nineteen patients were recruited from nephrology clinics and dialysis units. Following completion of a sleep and medical history questionnaire, all patients were invited to perform a single night, home sleep study. Acceptance or refusal of the test was noted, as well as the success of the sleep study, as determined by a review of the raw data by a sleep medicine physician.

Results

Male gender (OR = 1.61, CI = 1.02–2.53), hypertension (OR = 2.01, CI = 1.17–3.45), and snoring (OR = 1.75, CI = 1.11-2.77) were associated with sleep test acceptance. Older patients were less likely to accept the test (OR = 0.48, CI = 0.30–0.76). Diabetics were less likely to complete the sleep test successfully (OR = 0.28, CI = 0.12–0.66).

Conclusions

Advanced age is an important factor in test refusal and complications of diabetes contributes to test failure. Symptom matching may be a source of selection bias, as patients with risk factors for OSA are more likely to accept the diagnostic test.

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Abbreviations

OSA:

Obstructive sleep apnea

CKD:

Chronic kidney disease

ESRD:

End-stage renal disease

PSG:

Polysomnography

HTN:

Hypertension

CAD:

Coronary artery disease

CHF:

Congestive heart failure

CVD:

Cerebrovascular disease

COPD:

Chronic obstructive pulmonary disease

ESS:

Epworth Sleepiness Scale

PSQI:

Pittsburgh Sleep Quality Index

ANC:

Adjusted neck circumference

GIS:

Geographic information system

eGFR:

Estimated glomerular filtration rate

CKD-EPI:

Chronic Kidney Disease Epidemiology Collaboration

RSR:

Remmers Sleep Recorder

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Acknowledgments

The authors thank the Southern Alberta Renal Program for patient recruitment, as well as Ms. Patty Nielsen and Ms. Leah Howson for their clerical assistance. This research was supported by Alberta Innovates—Health Solutions, and the University of Calgary, Faculty of Medicine Sleep Research Program.

Ethical standards

The study was approved by the University of Calgary Conjoint Health Research Ethics Board. Written informed consent was obtained from all participants in accordance with the Declaration of Helsinki.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada

    Jonathan Lee, David D. M. Nicholl, Sofia B. Ahmed, Andrea H. S. Loewen, Brenda R. Hemmelgarn & Patrick J. Hanly

  2. Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, AB, Canada

    Tanvir C. Turin & Brenda R. Hemmelgarn

  3. Alberta Kidney Disease Network, Calgary, AB, Canada

    Sofia B. Ahmed & Brenda R. Hemmelgarn

  4. Sleep Centre, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada

    Andrea H. S. Loewen & Patrick J. Hanly

  5. Department of Geomatics Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada

    Abul K. Azad

  6. 1421 HSC, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada

    Patrick J. Hanly

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  1. Jonathan Lee
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  2. Tanvir C. Turin
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Correspondence to Patrick J. Hanly.

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Lee, J., Turin, T.C., Nicholl, D.D.M. et al. Predictors of successful completion of diagnostic home sleep testing in patients with chronic kidney disease. Sleep Breath 19, 669–675 (2015). https://doi.org/10.1007/s11325-014-1074-x

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  • DOI: https://doi.org/10.1007/s11325-014-1074-x

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