Skip to main content
SpringerLink
Log in

Schlafapnoesyndrom bei chronischer Niereninsuffizienz

Sleep apnea syndrome in chronic renal failure

  • Leitthema
  • Published:
Der Nephrologe Aims and scope

Zusammenfassung

Bei Patienten mit Nierenfunktionseinschränkung treten schlafbezogene Atemstörungen signifikant häufiger auf, im Vergleich mit Nierengesunden mit gleichen Risikofaktoren ist das Risiko für obstruktive Schlafapnoe bei terminaler Niereninsuffizienz vierfach erhöht. Die typischen Symptome Tagesmüdigkeit oder -schläfrigkeit werden bei Nierenpatienten häufig der Anämie oder Urämie zugeschrieben. Dies erklärt wahrscheinlich, warum die Schlafapnoe bisher bei diesem Kollektiv noch zu selten diagnostiziert wird. Niereninsuffizienz und Schlafapnoe haben gemeinsame pathophysiologische Angriffspunkte. Sie führen über die Aktivierung des Sympathikus und des Renin-Angiotensin-Aldosteron-Systems zu endothelialer Dysfunktion und potenzieren so das Risiko für Herz-Kreislauf-Erkrankungen. Für die Allgemeinbevölkerung ist die Reduktion der kardiovaskulären Mortalität und Morbidität durch nächtliche Maskentherapie mit kontinuierlichem positivem Atemwegsdruck gut belegt, eine Risikoreduktion ist auch für Patienten mit Niereninsuffizienz zu erwarten. Die Verfügbarkeit valider ambulanter Polygraphieverfahren ermöglicht nun eine einfachere Diagnostik. Diskutiert wird, bei welchen Patienten mit Hypertonie und/oder Niereninsuffizienz sich ein Screening empfiehlt. Wird die Diagnose eines Schlafapnoesyndroms gestellt, ist die Überdruckbeatmungsbehandlung die Therapie der Wahl.

Abstract

The prevalence of sleep apnea is significantly increased in patients with all stages of chronic kidney disease. In end-stage renal disease the risk to suffer from obstructive sleep apnea is approximately 4 times higher compared to patients with the same risk factors but healthy kidneys. Renal patients often lack the typical constitution of sleep apnea patients. Furthermore, symptoms, such as daytime sleepiness, are often interpreted as consequences of anemia or uremia. This might explain why sleep apnea is currently underdiagnosed. Sleep apnea and chronic kidney disease potentiate the cardiovascular risk by targeting the same important systems, such as sympathetic nerve activity or the renin-angiotensin-aldosterone cascade. Continuous positive airway pressure therapy is the treatment of choice. There is a growing body of evidence that therapy of sleep apnea leads to a significant reduction of the cardiovascular risk in patients with normal kidney function. Looking at the pathomechanism it can be assumed that renal patients also benefit from therapy of sleep-related disorders. Therefore, validated out-patient screening devices should be used to identify renal patients at risk and initiate early treatment.

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

Abb. 1
Abb. 2
Abb. 3

Literatur

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

    Article  CAS  PubMed  Google Scholar 

  2. Bradley TD, Floras JS (2009) Obstructive sleep apnoea and its cardiovascular consequences. Lancet 373:82–93

    Article  PubMed  Google Scholar 

  3. Sim JJ, Rasgon SA, Kujubu DA et al (2009) Sleep apnea in early and advanced chronic kidney disease: Kaiser Permanente Southern California cohort. Chest 135:710–716

    Article  PubMed  Google Scholar 

  4. Beecroft JM, Hoffstein V, Pierratos A et al (2007) Pharyngeal narrowing in end-stage renal disease: implications for obstructive sleep apnoea. Eur Respir J 30:965–971

    Article  CAS  PubMed  Google Scholar 

  5. 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 

  6. 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 

  7. Gusbeth-Tatomir P, Boisteanu D, Seica A et al (2007) Sleep disorders: a systematic review of an emerging major clinical issue in renal patients. Int Urol Nephrol 39:1217–1226

    Article  PubMed  Google Scholar 

  8. Unruh ML, Sanders MH, Redline S et al (2006) Sleep apnea in patients on conventional thrice-weekly hemodialysis: comparison with matched controls from the Sleep Heart Health Study. J Am Soc Nephrol 17:3503–3509

    Article  PubMed  Google Scholar 

  9. DGSM (2009) S3 Leitlinie: Nicht erholsamer Schlaf. Somnologie 12:4–160

    Google Scholar 

  10. Yumino D, Bradley TD (2008) Central sleep apnea and Cheyne-Stokes respiration. Proc Am Thorac Soc 5:226–236

    Article  PubMed  Google Scholar 

  11. Peppard PE, Young T, Palta M, Skatrud J (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342:1378–1384

    Article  CAS  PubMed  Google Scholar 

  12. Tanriverdi H, Evrengul H, Kara CO et al (2006) Aortic stiffness, flow-mediated dilatation and carotid intima-media thickness in obstructive sleep apnea: non-invasive indicators of atherosclerosis. Respiration 73:741–750

    Article  PubMed  Google Scholar 

  13. Munoz R, Duran-Cantolla J, Martinez-Vila E et al (2006) Severe sleep apnea and risk of ischemic stroke in the elderly. Stroke 37:2317–2321

    Article  PubMed  Google Scholar 

  14. Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365:1046–1053

    PubMed  Google Scholar 

  15. Markou N, Kanakaki M, Myrianthefs P et al (2006) Sleep-disordered breathing in nondialyzed patients with chronic renal failure. Lung 184:43–49

    Article  PubMed  Google Scholar 

  16. 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 

  17. Tang SC, Lam B, Ku PP et al (2006) Alleviation of sleep apnea in patients with chronic renal failure by nocturnal cycler-assisted peritoneal dialysis compared with conventional continuous ambulatory peritoneal dialysis. J Am Soc Nephrol 17:2607–2616

    Article  PubMed  Google Scholar 

  18. Molnar MZ, Szentkiralyi A, Lindner A et al (2007) High prevalence of patients with a high risk for obstructive sleep apnoea syndrome after kidney transplantation – association with declining renal function. Nephrol Dial Transplant 22:2686–2692

    Article  PubMed  Google Scholar 

  19. Beecroft JM, Hoffstein V, Pierratos A et al (2008) Nocturnal haemodialysis increases pharyngeal size in patients with sleep apnoea and end-stage renal disease. Nephrol Dial Transplant 23:673–679

    Article  PubMed  Google Scholar 

  20. Beecroft J, Duffin J, Pierratos A et al (2006) Enhanced chemo-responsiveness in patients with sleep apnoea and end-stage renal disease. Eur Respir J 28:151–158

    Article  CAS  PubMed  Google Scholar 

  21. Buchner NJ, Henning BF, Hagele KF et al (2004) Renal function in hypertensive patients with obstructive sleep apnea. Dtsch Med Wochenschr 129:305–309

    Article  CAS  PubMed  Google Scholar 

  22. Fleischmann G, Fillafer G, Matterer H et al (2009) Prevalence of chronic kidney disease in patients with suspected sleep apnoea. Nephrol Dial Transplant

  23. Wissing KR, Buchner NJ, Stegbauer J, Rump LC (2007) Renal resistance index in patients with obstructive sleep apnea. Dtsch Med Wochenschr 132:1815–1819

    Article  CAS  PubMed  Google Scholar 

  24. Smith I, Lasserson TJ, Wright J (2006) Drug therapy for obstructive sleep apnoea in adults. Cochrane Database Syst Rev CD003002

  25. Topfer V, El-Sebai M, Wessendorf TE et al (2004) Adaptive servoventilation: effect on Cheyne-Stokes-Respiration and on quality of life. Pneumologie 58:28–32

    Article  CAS  PubMed  Google Scholar 

  26. Perl J, Unruh ML, Chan CT (2006) Sleep disorders in end-stage renal disease: ‚Markers of inadequate dialysis’? Kidney Int 70:1687–1693

    Article  CAS  PubMed  Google Scholar 

  27. Tang SC, Lam B, Lai AS et al (2009) Improvement in sleep apnea during nocturnal peritoneal dialysis is associated with reduced airway congestion and better uremic clearance. Clin J Am Soc Nephrol 4:410–418

    Article  PubMed  Google Scholar 

  28. Beecroft JM, Duffin J, Pierratos A et al (2009) Decreased chemosensitivity and improvement of sleep apnea by nocturnal hemodialysis. Sleep Med 10:47–54

    Article  PubMed  Google Scholar 

  29. 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

    Article  CAS  PubMed  Google Scholar 

  30. 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

    Article  CAS  PubMed  Google Scholar 

  31. Jurado-Gamez B, Martin-Malo A, Rodriguez-Benot A et al (2008) Kidney transplantation improves sleep-related breathing in hemodialysis patients. Blood Purif 26:485–490

    Article  PubMed  Google Scholar 

  32. Beecroft JM, Zaltzman J, Prasad R et al (2007) Impact of kidney transplantation on sleep apnoea in patients with end-stage renal disease. Nephrol Dial Transplant 22:3028–3033

    Article  PubMed  Google Scholar 

  33. Grotz W, Buchner N, Wessendorf T et al (2006) Sleep apnea – treatment improves hypertension. Med Klin (Munich) 101:880–885

    Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klink für Nephrologie, Universitätsklinik der Heinrich-Heine-Universität, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    I. Quack, A. Fritz & L.C. Rump

Authors
  1. I. Quack
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Fritz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L.C. Rump
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to I. Quack.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Quack, I., Fritz, A. & Rump, L. Schlafapnoesyndrom bei chronischer Niereninsuffizienz. Nephrologe 5, 43–48 (2010). https://doi.org/10.1007/s11560-009-0340-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11560-009-0340-6

Schlüsselwörter

Keywords

Search

Navigation