IngentaConnect Sleep apnea in hemodialysis patients: Risk factors and effect on ...

Abstract:

Sleep disorders are common in patients with end-stage renal disease (ESRD). Using a simple questionnaire, we estimate the probability of sleep apnea in ESRD patients, determine the factors associated with a higher probability of sleep apnea, and determine the association between the probability of sleep apnea and cardiovascular and all-cause mortality. Study design: Prospective cohort study. Setting and participants: prevalent hemodialysis patients (n=270) in 7 urban outpatient hemodialysis units. Predictor: Probability of sleep apnea as quantified by the Flemons questionnaire. Outcomes and measurements: Clinical, demographic, and dialysis-related characteristics were obtained at baseline. Total and cardiovascular mortality was ascertained after a median follow-up of 34 months. The probability of sleep apnea was low in 79 (29%) patients, moderate in 116 (43%) patients, and high in 75 (28%) patients. Male gender (odds ratio [OR] 5.13, p<0.001), obesity (BMI >30, OR 7.58, p<0.01), and interdialytic weight gain (OR 1.72/kg change, p<0.004) were independently associated with a high probability of sleep apnea. A high probability of sleep apnea at baseline did not predict total (hazard ratio [HR] 0.81, p=NS) or cardiovascular mortality (HR 0.9, p=NS). The Flemons questionnaire is validated in the general population, but has not been tested specifically in hemodialysis patients. The study may not be adequately powered to detect a difference in mortality. A high proportion of hemodialysis patients are likely to have sleep apnea; a simple bedside questionnaire can be used for screening to identify these patients. Excessive interdialytic weight gain is a potentially modifiable factor that increases the likelihood of sleep apnea. Despite the presence of a strong association between sleep apnea and mortality in the general population, a similar association could not be demonstrated in ESRD patients with a high prevalence of this condition.

Keywords: Sleep apnea; hemodialysis; interdialytic weight gain

Document Type: Research article

DOI: 10.1111/j.1542-4758.2007.00214.x

Affiliations: 1: University Hospitals of Cleveland, Cleveland, Ohio, U.S.A.;

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Sleep apnea in hemodialysis patients: Risk factors and effect on survival