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Sleep Apnea in Patients on Conventional Thrice-Weekly Hemodialysis: Comparison with Matched Controls from the Sleep Heart Health Study

Mark L. Unruh^*, Mark H. Sanders, Susan Redline, Beth M. Piraino^*, Jason G. Umans, Terese C. Hammond^||, Imran Sharief^¶, Naresh M. Punjabi^** and Anne B. Newman

^* Renal-Electrolyte Division and Division of Pulmonary, Allergy & Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh Pennsylvania; Department of Pediatrics, Rainbow Babies and Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio; Penn Medical Laboratory, MedStar Research Institute and the Departments of Medicine and Obstetrics and Gynecology, Georgetown University, Washington, DC; ^|| Department of Medicine, Boston University, Boston, Massachusetts; ^¶ Division of Pulmonary, Sleep and Critical Care, University of Arizona, Tucson, Arizona; ^** Johns Hopkins University School of Medicine, Baltimore, Maryland; and Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania

Address correspondence to: Dr. Mark Unruh, University of Pittsburgh Medical Center, Renal-Electrolyte Division, 3550 Terrace Street, A909 Scaife Hall, Pittsburgh, PA 15261. Phone: 412-647-2561; Fax: 412-647-6891; E-mail: unruh{at}pitt.edu

Received for publication June 26, 2006. Accepted for publication September 26, 2006.

Sleep-disordered breathing (SDB) has been noted commonly in hemodialysis (HD) patients, but it is not known whether this is related directly to the treatment of kidney failure with HD or to the higher prevalence of obesity and older age. Forty-six HD patients were compared with 137 participants from the Sleep Heart Health Study (SHHS) who were matched for age, gender, body mass index (BMI), and race. Home unattended polysomnography was performed and scored using similar protocols. The study sample was 62.7 ± 10.1 yr, was predominantly male (72%) and white (63%), and had an average BMI of 28 ± 5.3 kg/m². The HD sample had a higher systolic BP (137 versus 121 mmHg; P < 0.01) and a higher prevalence of diabetes (33 versus 9%; P < 0.01) and cardiovascular disease (33 versus 13%; P < 0.01) compared with the SHHS sample. The HD group had significantly less sleep time (320 versus 379 min; P < 0.0001) but similar sleep efficiency. HD patients had a higher frequency of arousals per hour (25.1 versus 17.1; P < 0.0001) and apnea-hypopneas per hour (27.2 versus 15.2; P < 0.0001) and greater percentage of the total sleep time below an oxygen saturation of 90% (7.2 versus 1.8; P < 0.0001). HD patients were more likely to have severe SDB (>30 respiratory events per hour) compared with the SHHS sample (odds ratio 4.07; 95% confidence interval 1.83 to 9.07). There was a strong association of HD with severe SDB and nocturnal hypoxemia independent of age, BMI, and the higher prevalence of chronic disease. The potential mechanisms for the higher likelihood of SDB in the HD population must be identified to provide specific prevention and therapy.

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Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673