OBSTRUCTIVE SLEEP APNEA IN ESRD PATIENTS ON MAINTENANCE HEMODIALYSIS: A CROSS SECTIONAL OBSERVATIONAL STUDY
Main Article Content
Keywords
Obstructive sleep apnea, End stage renal disease, Chronic kidney disease
Abstract
Introduction: Approximately 10–36% of the general population have moderate-severe OSA..OSA is far more common in CKD populations, with prevalence rates of over 40% .Furthermore, it has been shown that the prevalence of OSA is further increased in more advanced stages of CKD .Although this does not necessarily imply a causal relationship given that both conditions are associated with similar comorbidities such as hypertension, diabetes, and obesity, there is definite biological plausibility to support a role for OSA in the pathogenesis of accelerated decline in kidney function.
The prevalence is higher in patients with chronic kidney disease (CKD) due to the presence of classical risk factors like obesity but also to factors peculiar to uremia and dialysis
Material and Methods: This study was conducted in the department of Nephrology in a tertiary care institute in South India. Patients of End stage renal disease on maintainance hemodialysis were interviewed for OSA questionaires including Stop Bang Questionnaire, Berlin Questionnaire and Epsworth Sleepiness Score. 152 cases were studied in the study.
Results: Of the three questionnaires, the risk of OSA as per Stop Bang Questionnaire was 27% (41/152); as per Berlin questionnaire and Epworth sleepiness score were 21.7% (33/152) and 21.1% (32/152), respectively.
Conclusion: Obstructive sleep apnea is more common among ESRD patients on hemodialysis. Stage 5 chronic kidney disease patients should be screened for OSA risk with questionairres, preferably Stop Bang Questionaire.
References
1. Novak M, Mendelssohn D, Shapiro CM, Mucsi I. Diagnosis and management of sleep apnea syndrome and restless legs syndrome in dialysis patients. Semin Dial 2006;19: 210-6.
2. Muller ME, Heinzer R, Pruijm M, WuerznerG, Burnier M. Rev Med Suisse 2012;8:458-6.
3. Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328:1230-5.
4. Hanly P. Sleep apnea and daytime sleepiness in end-stage renal disease. Semin Dial 2004;17:109-14.
5. Engleman HM, Martin SE, Deary IJ, et al. Effect of CPAP therapy on day-time function in patients with mild sleep apnoea/hypopnea syndrome. Thorax 1997;52:114.
6. Peppard PE, Young T, Barnet JH, et al. Increased prevalence of sleep disordered breathing in adults. Am J Epidemiol 2013; 177:1006–1014.
7. Heinzer R, Vat S, Marques-Vidal P, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med 2015; 3:310–318.
8. Markou N, Kanakaki M, Myrianthefs P, et al. Sleep-disordered breathing in nondialyzed patients with chronic renal failure. Lung 2006; 184:43–49.
9. Sakaguchi Y, Shoji T, Kawabata H, et al. High prevalence of obstructive sleep apnea and its association with renal function among nondialysis chronic kidney disease patients in Japan: a cross-sectional study. Clin J Am Soc Nephrol 2011; 6:995–1000.
10. Nicholl DDM, Ahmed SB, Loewen AHS, et al. Declining kidney function increases the prevalence of sleep apnea and nocturnal hypoxia. Chest 2012;141:1422–1430.
11. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. AnnIntern Med. 1999;131(7):485-491.
12. Chung F, Yegneswaran B, Liao P, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108 (5):812-821.
13. JohnsMW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep. 1991;14(6):540-545.
14. Chiu HY, Chen PY, Chuang LP, et al. Diagnostic accuracy of the Berlin Questionnaire, STOP-BANG, STOP, and Epworth Sleepiness Scale in detecting obstructive sleep apnea: a bivariate meta-analysis. Sleep Med Rev. 2017;36:57-70.
15. Peppard PE, Young T, Barnet JH, Palta M,Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006-1014.
16. Tufik S, Santos-Silva R, Taddei JA, Bittencourt LR. Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study. Sleep Med. 2010; 11(5):441-446.
17. Fietze I, Laharnar N, Obst A, et al. Prevalence and association analysis of obstructive sleep apnea with gender and age differences: results of SHIP-Trend. J Sleep Res. 2019;28(5):e12770.
18. Heinzer R, Vat S, Marques-Vidal P, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. 2015;3(4):310-318.
19. Jonas DE, Amick HR, Feltner C, et al. Screening for obstructive sleep apnea in adults: evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2017;317(4):415-433.
20. Colvin LJ, Collop NA. Commercial motor vehicle driver obstructive sleep apnea screening and treatment in the United States: an update and recommendation overview. J Clin Sleep Med. 2016; 12(1):113-125.
21. Eduard A. Iliescu, Helen Coo et al,(2003),Quality of sleep and health-related quality of life in haemodialysis patients.Nephrol Dial Transplant (2003) 18: 126–132
22. Kathy P. Parker, Donald L. Bliwise, James L. Bailey et al (2005) Polysomnographic measures of nocturnal sleep in patients on chronic, intermittent daytime haemodialysis vs those with chronic kidney disease. Nephrol Dial Transplant (2005) 20: 1422–1428
23. Mark L. Unruh,* Mark H. Sanders,† Susan Redline et al (2006) , Sleep Apnea in Patients on Conventional Thrice-Weekly Hemodialysis: Comparison with Matched Controls from the Sleep Heart Health Study, J Am Soc Nephrol 17: 3503–3509, 2006.
24. Maria-Eleni Roumelioti, Daniel J. Buysse, Mark H. Sanders et al 27, (2010) Sleep-Disordered Breathing and Excessive Daytime Sleepiness in Chronic Kidney Disease and Hemodialysis ,Clin J Am Soc Nephrol 6: 986 –994, 2011.
25. Hamdan Al-Jahdali 28 (2012), Prevalence of Sleep Apnea and Excessive Day Time Sleepiness in Patients with End-Stage Renal Disease on Dialysis, Saudi J Kidney Dis Transpl 2012;23(2):251-261 © 2012 Saudi Center for Organ Transplantation
26. Valentina Forni Ogna, Adam Ogna, Menno Pruijm, Isabelle Bassi et al 29 (2015): Prevalence and Diagnostic Approach to Sleep Apnea in Hemodialysis Patients: A Population Study, BioMed Research International Volume 2015, Article ID 103686,
27. Chou-Han Lin, Elisa Perger et al 30 (2018): Prevalence and Diagnostic Approach to Sleep Apnea in Hemodialysis Patients: A Population Study , Curr Opin Pulm Med 2018, 24:549–554
28. Sidy Mohamed Seck, Zeinabou Maiga Moussa Tondi et al 31 (2019): Risk of Obstructive Sleep Apnea among Senegalese Dialysis Patients , Saudi J Kidney Dis Transpl 2019;30(5):1097-1102 © 2019 Saudi Center for Organ Transplantation
29. Jurado-Gamez B, Martin-Malo A, Alvarez-Lara MA, et al. Sleep disorders are underdiagnosed in patients on maintenance hemodialysis.Nephron Clin Pract 2007;105:c35-42.
30. Pfister M, Jakob SM, Marti HP, Frey FJ, Gugger M. Ambulatory nocturnal oximetry and sleep questionnaire-based findings in 38 patients with end-stage renal disease. Nephrol Dial Transplant 1999;14:1496-502.
31. Wali SO, Alkhouli A, Howladar M, et al. Risk of obstructive sleep apnea among Saudis with chronic renal failure on hemodialysis. Ann Thorac Med 2015;10:263-8.
32. Sim JJ, Rasgon SA, Kujubu DA, et al. Sleep apnea in early and advanced chronic kidney disease: Kaiser permanente Southern California cohort. Chest 2009;135:710-6.
33. Hui DS, Wong TY, Li TS, et al. Prevalence of sleep disturbances in Chinese patients with end stage renal failure on maintenance hemodialysis. Med Sci Monit 2002;8:CR331-6.
34. Sabry AA, Abo-Zenah H, Wafa E, et al. Sleep disorders in hemodialysis patients. Saudi J Kidney Dis Transpl 2010;21:300-5.
35. Losso RL, Minhoto GR, Riella MC. Sleep disorders in patients with end-stage renal disease undergoing dialysis: Comparison between hemodialysis, continuous ambulatory peritoneal dialysis and automated peritoneal dialysis. Int Urol Nephrol 2015;47: 369-75.
36. Kuhlmann U, Becker HF, Birkhahn M, et al. Sleep-apnea in patients with end-stage renal disease and objective results. Clin Nephrol 2000;53:460-6.
37. Merlino G, Piani A, Dolso P, et al. Sleep disorders in patients with end-stage renal disease undergoing dialysis therapy. Nephrol Dial Transplant 2006;21:184-90.
38. Kuhlmann U, Becker HF, Birkhahn M, Peter JH, von Wichert P, Schütterle S, et al. Sleep-apnea in patients with end-stage renal disease and objective results. Clin Nephrol 2000;53:460-6.
39. Mucsi I, Molnar MZ, Rethelyi J, Vamos E, Csepanyi G, Tompa G, et al. Sleep disorders and illness intrusiveness in patients on chronic dialysis. Nephrol Dial Transplant 2004;19:1815-22.
40. Chen WC, Lim PS, Wu WC, Chiu HC, Chen CH, Kuo HY, et al. Sleep behavior disorders in a large cohort of chinese (Taiwanese) patients maintained by long-term hemodialysis. Am J Kidney Dis 2006;48:277-84.
41. Merlino G, Piani A, Dolso P, Adorati M, Cancelli I, Valente M, et al. Sleep disorders in patients with end-stage renal disease undergoing dialysis therapy. Nephrol Dial Transplant 2006;21: 184-90.
42. Argekar P, Griffin V, Litaker D, Rahman M. Sleep apnea in hemodialysis patients: Risk factors and effect on survival. Hemodial Int 2007;11:435-41.
43. Szentkiralyi A, Czira ME, Molnar MZ, Kovesdy CP, Remport A, Szeifert L, et al. High risk of obstructive sleep apnea is a risk factor of death censored graft loss in kidney transplant recipients: An observational cohort study. Sleep Med 2011;12:267-73.
44. Wali SO, Alkhouli A, Howladar M, Ahmad I, Alshohaib S, Al-Ghamdi S, et al. Risk of obstructive sleep apnea among Saudis with chronic renal failure on hemodialysis. Ann Thorac Med 201510:263-8.
2. Muller ME, Heinzer R, Pruijm M, WuerznerG, Burnier M. Rev Med Suisse 2012;8:458-6.
3. Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328:1230-5.
4. Hanly P. Sleep apnea and daytime sleepiness in end-stage renal disease. Semin Dial 2004;17:109-14.
5. Engleman HM, Martin SE, Deary IJ, et al. Effect of CPAP therapy on day-time function in patients with mild sleep apnoea/hypopnea syndrome. Thorax 1997;52:114.
6. Peppard PE, Young T, Barnet JH, et al. Increased prevalence of sleep disordered breathing in adults. Am J Epidemiol 2013; 177:1006–1014.
7. Heinzer R, Vat S, Marques-Vidal P, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med 2015; 3:310–318.
8. Markou N, Kanakaki M, Myrianthefs P, et al. Sleep-disordered breathing in nondialyzed patients with chronic renal failure. Lung 2006; 184:43–49.
9. Sakaguchi Y, Shoji T, Kawabata H, et al. High prevalence of obstructive sleep apnea and its association with renal function among nondialysis chronic kidney disease patients in Japan: a cross-sectional study. Clin J Am Soc Nephrol 2011; 6:995–1000.
10. Nicholl DDM, Ahmed SB, Loewen AHS, et al. Declining kidney function increases the prevalence of sleep apnea and nocturnal hypoxia. Chest 2012;141:1422–1430.
11. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. AnnIntern Med. 1999;131(7):485-491.
12. Chung F, Yegneswaran B, Liao P, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108 (5):812-821.
13. JohnsMW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep. 1991;14(6):540-545.
14. Chiu HY, Chen PY, Chuang LP, et al. Diagnostic accuracy of the Berlin Questionnaire, STOP-BANG, STOP, and Epworth Sleepiness Scale in detecting obstructive sleep apnea: a bivariate meta-analysis. Sleep Med Rev. 2017;36:57-70.
15. Peppard PE, Young T, Barnet JH, Palta M,Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006-1014.
16. Tufik S, Santos-Silva R, Taddei JA, Bittencourt LR. Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study. Sleep Med. 2010; 11(5):441-446.
17. Fietze I, Laharnar N, Obst A, et al. Prevalence and association analysis of obstructive sleep apnea with gender and age differences: results of SHIP-Trend. J Sleep Res. 2019;28(5):e12770.
18. Heinzer R, Vat S, Marques-Vidal P, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. 2015;3(4):310-318.
19. Jonas DE, Amick HR, Feltner C, et al. Screening for obstructive sleep apnea in adults: evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2017;317(4):415-433.
20. Colvin LJ, Collop NA. Commercial motor vehicle driver obstructive sleep apnea screening and treatment in the United States: an update and recommendation overview. J Clin Sleep Med. 2016; 12(1):113-125.
21. Eduard A. Iliescu, Helen Coo et al,(2003),Quality of sleep and health-related quality of life in haemodialysis patients.Nephrol Dial Transplant (2003) 18: 126–132
22. Kathy P. Parker, Donald L. Bliwise, James L. Bailey et al (2005) Polysomnographic measures of nocturnal sleep in patients on chronic, intermittent daytime haemodialysis vs those with chronic kidney disease. Nephrol Dial Transplant (2005) 20: 1422–1428
23. Mark L. Unruh,* Mark H. Sanders,† Susan Redline et al (2006) , Sleep Apnea in Patients on Conventional Thrice-Weekly Hemodialysis: Comparison with Matched Controls from the Sleep Heart Health Study, J Am Soc Nephrol 17: 3503–3509, 2006.
24. Maria-Eleni Roumelioti, Daniel J. Buysse, Mark H. Sanders et al 27, (2010) Sleep-Disordered Breathing and Excessive Daytime Sleepiness in Chronic Kidney Disease and Hemodialysis ,Clin J Am Soc Nephrol 6: 986 –994, 2011.
25. Hamdan Al-Jahdali 28 (2012), Prevalence of Sleep Apnea and Excessive Day Time Sleepiness in Patients with End-Stage Renal Disease on Dialysis, Saudi J Kidney Dis Transpl 2012;23(2):251-261 © 2012 Saudi Center for Organ Transplantation
26. Valentina Forni Ogna, Adam Ogna, Menno Pruijm, Isabelle Bassi et al 29 (2015): Prevalence and Diagnostic Approach to Sleep Apnea in Hemodialysis Patients: A Population Study, BioMed Research International Volume 2015, Article ID 103686,
27. Chou-Han Lin, Elisa Perger et al 30 (2018): Prevalence and Diagnostic Approach to Sleep Apnea in Hemodialysis Patients: A Population Study , Curr Opin Pulm Med 2018, 24:549–554
28. Sidy Mohamed Seck, Zeinabou Maiga Moussa Tondi et al 31 (2019): Risk of Obstructive Sleep Apnea among Senegalese Dialysis Patients , Saudi J Kidney Dis Transpl 2019;30(5):1097-1102 © 2019 Saudi Center for Organ Transplantation
29. Jurado-Gamez B, Martin-Malo A, Alvarez-Lara MA, et al. Sleep disorders are underdiagnosed in patients on maintenance hemodialysis.Nephron Clin Pract 2007;105:c35-42.
30. Pfister M, Jakob SM, Marti HP, Frey FJ, Gugger M. Ambulatory nocturnal oximetry and sleep questionnaire-based findings in 38 patients with end-stage renal disease. Nephrol Dial Transplant 1999;14:1496-502.
31. Wali SO, Alkhouli A, Howladar M, et al. Risk of obstructive sleep apnea among Saudis with chronic renal failure on hemodialysis. Ann Thorac Med 2015;10:263-8.
32. Sim JJ, Rasgon SA, Kujubu DA, et al. Sleep apnea in early and advanced chronic kidney disease: Kaiser permanente Southern California cohort. Chest 2009;135:710-6.
33. Hui DS, Wong TY, Li TS, et al. Prevalence of sleep disturbances in Chinese patients with end stage renal failure on maintenance hemodialysis. Med Sci Monit 2002;8:CR331-6.
34. Sabry AA, Abo-Zenah H, Wafa E, et al. Sleep disorders in hemodialysis patients. Saudi J Kidney Dis Transpl 2010;21:300-5.
35. Losso RL, Minhoto GR, Riella MC. Sleep disorders in patients with end-stage renal disease undergoing dialysis: Comparison between hemodialysis, continuous ambulatory peritoneal dialysis and automated peritoneal dialysis. Int Urol Nephrol 2015;47: 369-75.
36. Kuhlmann U, Becker HF, Birkhahn M, et al. Sleep-apnea in patients with end-stage renal disease and objective results. Clin Nephrol 2000;53:460-6.
37. Merlino G, Piani A, Dolso P, et al. Sleep disorders in patients with end-stage renal disease undergoing dialysis therapy. Nephrol Dial Transplant 2006;21:184-90.
38. Kuhlmann U, Becker HF, Birkhahn M, Peter JH, von Wichert P, Schütterle S, et al. Sleep-apnea in patients with end-stage renal disease and objective results. Clin Nephrol 2000;53:460-6.
39. Mucsi I, Molnar MZ, Rethelyi J, Vamos E, Csepanyi G, Tompa G, et al. Sleep disorders and illness intrusiveness in patients on chronic dialysis. Nephrol Dial Transplant 2004;19:1815-22.
40. Chen WC, Lim PS, Wu WC, Chiu HC, Chen CH, Kuo HY, et al. Sleep behavior disorders in a large cohort of chinese (Taiwanese) patients maintained by long-term hemodialysis. Am J Kidney Dis 2006;48:277-84.
41. Merlino G, Piani A, Dolso P, Adorati M, Cancelli I, Valente M, et al. Sleep disorders in patients with end-stage renal disease undergoing dialysis therapy. Nephrol Dial Transplant 2006;21: 184-90.
42. Argekar P, Griffin V, Litaker D, Rahman M. Sleep apnea in hemodialysis patients: Risk factors and effect on survival. Hemodial Int 2007;11:435-41.
43. Szentkiralyi A, Czira ME, Molnar MZ, Kovesdy CP, Remport A, Szeifert L, et al. High risk of obstructive sleep apnea is a risk factor of death censored graft loss in kidney transplant recipients: An observational cohort study. Sleep Med 2011;12:267-73.
44. Wali SO, Alkhouli A, Howladar M, Ahmad I, Alshohaib S, Al-Ghamdi S, et al. Risk of obstructive sleep apnea among Saudis with chronic renal failure on hemodialysis. Ann Thorac Med 201510:263-8.
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Dec 22, 2022
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Nadia Bashir, Abid Ahmad Kuchay, Shamsudeen M P, Raja Karthik Kalindidi, & Gangadhar Taduri. (2022). OBSTRUCTIVE SLEEP APNEA IN ESRD PATIENTS ON MAINTENANCE HEMODIALYSIS: A CROSS SECTIONAL OBSERVATIONAL STUDY. Journal of Population Therapeutics and Clinical Pharmacology, 29(04), 4926-4931. https://doi.org/10.53555/838dab44
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Author Biographies
Nadia Bashir
Senior Resident ,Department of Obstetrics and Gynaecology, SKIMS Srinagar India
Abid Ahmad Kuchay
Registrar ,Department of Nephrology,GMC Srinagar India.
Shamsudeen M P
Senior Resident ,Department of Nephrology,NIMS Hyderabad India.
Raja Karthik Kalindidi
Associate Professor , Department of Nephrology,NIMS Hyderabad India.
Gangadhar Taduri
Professor and Head,Department of Nephrology,NIMS Hyderabad India.
How to Cite
Nadia Bashir, Abid Ahmad Kuchay, Shamsudeen M P, Raja Karthik Kalindidi, & Gangadhar Taduri. (2022). OBSTRUCTIVE SLEEP APNEA IN ESRD PATIENTS ON MAINTENANCE HEMODIALYSIS: A CROSS SECTIONAL OBSERVATIONAL STUDY. Journal of Population Therapeutics and Clinical Pharmacology, 29(04), 4926-4931. https://doi.org/10.53555/838dab44