Sleep-disordered breathing and excessive daytime sleepiness in chronic kidney disease and hemodialysis

Abstract

Background and objectives: Sleep-disordered breathing (SDB) and excessive daytime sleepiness (EDS) are highly prevalent among hemodialysis (HD) patients. It is unclear to what extent SDB is associated with advanced chronic kidney disease (CKD; stages 4 to 5). This paper describes and compares the prevalence, severity, and patterns of SDB and EDS among patients with advanced CKD, HD-dependent patients, and community individuals without known renal disease.

Design, setting, participants, & measurements: Eighty-nine CKD and 75 HD patients were compared with 224 participants from the Sleep-Strategies Concentrating on Risk Evaluation Sleep-SCORE study of sleep and cardiovascular risk. Participants had in-home unattended polysomnography for quantifying SDB. EDS was defined by a score ≥10 on the Epworth Sleepiness Scale.

Results: The sample had a median age 58.1 years, was predominantly male (57.4%) and white (62.5%), and had a median body mass index of 28.1 kg/m(2). Controls and Sleep-SCORE Study CKD patients had significantly higher median total sleep time and sleep efficiency compared with HD patients. The adjusted odds of severe SDB were higher for CKD and HD groups compared with the controls. Nocturnal hypoxemia was significantly elevated in the HD group compared with the CKD group. There were similar proportions of participants with EDS between the controls (33%), the CKD patients (29.3%), and the HD patients (40.6%).

Conclusions: Severe SDB (predominantly obstructive) and EDS are common among advanced CKD and HD patients. EDS correlated modestly with severe SDB and its obstructive and mixed patterns in the HD group.

Figure 1.

Association of treatment (CKD or HD) with polysomnographic parameters and EDS after adjustment for age, gender, and BMI. Error horizontal lines represent the 95% CIs and black dots represent the ORs. CKD and HD were significantly (P < 0.05) associated with an AH ≥ 30 and with nocturnal hypoxemia (oxyhemoglobin saturation [SaO₂] < 90%) for ≥3% of the TST. Reference group is the control group.

Figure 2.

Association of HD treatment with polysomnographic parameters and EDS after adjustment for age, gender, and BMI. Error horizontal lines represent the 95% CIs and black dots represent the ORs. HD was significantly (P < 0.05) associated with nocturnal hypoxemia (SaO₂ < 90%) for ≥3% of the TST. Reference group is the advanced CKD group.