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. 2021 May;9(9):e14837.
doi: 10.14814/phy2.14837.

REM sleep latency as an independent risk for cardiovascular events in hemodialysis patients

Shigeichi Shoji  1 , Masaaki Inaba  2 , Koichiro Yoda  2 , Hisanori Okazaki  1 , Mio Toyokawa  2 , Kyoko Norimine  1 , Tomoyuki Yamakawa  1 , Senji Okuno  1
Affiliations

REM sleep latency as an independent risk for cardiovascular events in hemodialysis patients

Shigeichi Shoji et al. Physiol Rep. 2021 May.

Abstract

Background: Clinical significance of objectively measured poor sleep quality (SQ) as a risk for cardiovascular disease (CVD) events is not well known in hemodialysis (HD) patients, independently of sleep-related breathing disorders (SRBDs) and sleep-related metabolic abnormality.

Methods: The present study investigated baseline levels of objective sleep architecture together with obstructive sleep apnea (OSA) and central sleep apnea (CSA) using polysomnography in 88 HD study participants (M/F, 56/32; age 68.4 ± 9.3). Then, HD study participants were monitored for the occurrence of new-onset CVD events with a median (range) follow-up period of 33 (1-64) months.

Results: Among various measures of SQ, log (REM sleep latency [REM-SL]) (interval between sleep-onset and the first REM period) alone correlated in negative manners with triglycerides and non-HDL-C in all study participants and with fasting plasma glucose and HbA1c in study participants with type-2 diabetes mellitus. In the Kaplan-Meier analysis, HD study participants with shorter REM-SL had a significantly higher rate of new-onset CVD events than those with longer REM-SL. Stepwise logistic regression analysis and multivariate Cox proportional hazard regression analysis identified shorter REM-SL as an independent risk factor for the development of a new-onset CVD events, independent of mean oxygen saturation, log (AHI+1), log (central AHI+1), diabetes mellitus, CVD history, systolic blood pressure, statins use, and non-HDL-C.

Conclusions: The present study demonstrated that reduction of REM-SL is independently associated with a higher rate of new-onset of CVD events, independent of SRBDs (OSA and CSA) and diabetes mellitus, non-HDL-C in HD study participants, suggesting impaired SQ as a potential CVD risk factor, and thus a definite treatment target to protect against CVD specifically in HD study participants. REM-SL might be a new risk factor of CVD events in HD patients with SRBDs.

Keywords: REM sleep latency; cardiovascular event; hemodialysis; sleep apnea; sleep quality.

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Conflict of interest statement

We declare that we have no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Univariate correlation of TGs and non‐HDL‐c with REM sleep latency in all patients (n = 88)
FIGURE 2
FIGURE 2
Univariate correlation of TGs, non‐HDL‐c, FPG, and HbA1c with REM sleep latency in diabetes patients (n = 36)
FIGURE 3
FIGURE 3
Kaplan–Meier CVD Event‐free survival curves with REM sleep latency above and below the group median
See this image and copyright information in PMC

References

    1. Aeschbach, D. , & Borbely, A. A. (1993). All‐night dynamics of the human sleep EEG. Journal of Sleep Research, 2, 70–81. - PubMed
    1. Berry, R. B. , Budhiraja, R. , Gottlieb, D. J. , Gozal, D. , Iber, C. , Kapur, V. K. , Marcus, C. L. , Mehra, R. , Parthasarathy, S. , Quan, S. F. , Redline, S. , Strohl, K. N. P. , Ward, S. L. D. , & Tangredi, M. M. (2012). Rules for scoring respiratory events in sleep: Update of the 2007 AASM manual for the scoring of sleep and associated events. Journal of Clinical Sleep Medicine, 8, 597–619. - PMC - PubMed
    1. Bruehl, H. , Rueger, M. , Dziobek, I. , Sweat, V. , Tirsi, A. , Javier, E. , Arentoft, A. , Wolf, O. T. , & Convit, A. (2007). Hypotheramic‐pituitary‐adrenal axis dysregulation and memory impairments in type 2 diabetes. Journal of Clinical Endocrinology and Metabolism, 92, 2439–2445. - PubMed
    1. Campbell, P. J. , Bolli, G. B. , Cryer, P. E. , Gerich, J. E. (1985). Sequence of events during development of the dawn phenomenon in insulin‐dependent bdiabetes mellitus. Metabolism, 34, 1100–1104. - PubMed
    1. Carskadon, M. A. , & Dement, W. C. (1985). Sleep loss in elderly volunteers. Sleep, 8, 207–221. - PubMed

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