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. 2020 Sep 15;16(9):1475-1481.
doi: 10.5664/jcsm.8542.

Effects of sleep apnea and kidney dysfunction on objective sleep quality in nondialyzed patients with chronic kidney disease: an ESADA study

Oreste Marrone  1 , Fabio Cibella  1 , Gabriel Roisman  2 , Pawel Sliwinski  3 , Pavol Joppa  4 , Ozen K Basoglu  5 , Izolde Bouloukaki  6 , Sophia Schiza  6 , Athanasia Pataka  7 , Richard Staats  8 , Johan Verbraecken  9 , Jan Hedner  10 , Ludger Grote  10 , Maria R Bonsignore  1   11 ; ESADA study group
Affiliations

Effects of sleep apnea and kidney dysfunction on objective sleep quality in nondialyzed patients with chronic kidney disease: an ESADA study

Oreste Marrone et al. J Clin Sleep Med. .

Abstract

Study objectives: Patients with chronic kidney disease (CKD) often report poor sleep quality, but they commonly exhibit OSA. The aim of this study was to evaluate the influence of OSA severity and of estimated glomerular filtration rate impairment on objective sleep quality in nondialyzed patients with CKD, defined as an estimated glomerular filtration rate <60 mL/min/1.73m².

Methods: Polysomnographic sleep characteristics were compared between patients with (n = 430) and without CKD (n = 6,639) in the European Sleep Apnea Database cohort. Comparisons were repeated in 375 patients with CKD and 375 control patients without CKD matched for sleep center, age, sex, and AHI, and in 310 matched CKD and non-CKD patients without psychiatric disturbances.

Results: Among all patients with and without CKD, total sleep time was similar but sleep stage N1 (median 8.7% [IQR 4.8-18.0] vs 6.7% [3.6-12.7], respectively) and sleep stage R (12.6% [6.8-17.7] vs 14.2% [8.8-19.8], respectively) significantly differed (P < .0001). No difference in sleep characteristics was observed between matched patients either with or without psychiatric disturbances. After subdividing the matched patients according to AHI tertile (<25, ≥25 to <49, and ≥49 events/h) and estimated glomerular filtration rate (≥60, 45 to <60, <45 mL/min/1.73m²), we found a significant effect of AHI on sleep stages N2, N3, and R (P < .001), but there was no effect of CKD.

Conclusions: In nondialyzed patients with CKD, objective sleep quality is influenced similarly by AHI as in patients without CKD but is not affected by CKD severity. Previously reported poor sleep quality in CKD may partly result from the high prevalence of OSA in CKD.

Keywords: chronic kidney disease; estimated glomerular filtration rate; sleep apnea; sleep quality.

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Figures

Figure 1
Figure 1. Schematic representation of patients’ inclusion criteria.
Figure 2
Figure 2. Data distribution of polysomnographic variables, separately for patients with different eGFR and AHI classes.
Horizontal bars within each box represent median values. Bars closing inferiorly and superiorly each box represent, respectively, 25th and 75th percentiles. Values below 10th and above 90th percentiles are plotted as circles. P values were evaluated by two-way analysis of variance. CKD = chronic kidney disease, eGFR = estimated glomerular filtration rate.
See this image and copyright information in PMC

References

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