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Query: UMLS:C0037315 (sleep apnea)
 8,000 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A high prevalence of sleep apnea syndrome has been reported in previous studies of patients with chronic renal failure. The possible effects of chronic hemodialysis on the magnitude and severity of sleep apnea have not yet been clarified. The present study was undertaken to understand this relationship, by examining subjective and objective measures of sleep on nights following hemodialysis compared to those without hemodialysis. Significant sleep apnea was noted in 6 of 11 patients. The percentage of apnea time comprised of obstructive apneas increased significantly on the nights following hemodialysis. No significant differences occurred between these nights in the subjective or EEG measures of sleep, or in the total number of disordered breathing events or level of arterial oxygen desaturation. The association between end-stage renal disease (ESRD) and sleep apnea syndrome remains highly significant, but seems not to be acutely altered by conventional hemodialysis treatment.
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PMID:Effects of hemodialysis on sleep apnea syndrome in end-stage renal disease. 235 61

A questionnaire was performed in order to classify the prevalence of sleep disorders in patients with end-stage renal disease treated with hemodialysis. 69 patients (41 male, 28 female) with a median age of 57 years completed the questionnaire. 67% of these patients complained of sleep disorders. 31 patients (45%) had evidence of periodic leg movement syndrome, 22 patients (32%) of restless legs syndrome. 29 patients (42%) had difficulties in falling asleep, 27 patients (39%) in maintaining sleep and 17 (25%) experienced both. Snoring was found in 25 patients (36%), 13 patients (19%) seemed to have sleep apnea. These data show an increased prevalence of sleep disorders in patients with end-stage renal disease on hemodialysis treatment. We conclude that these patients should consequently be asked for sleep disorders, as a specific diagnostic and therapeutic regime could improve quality of life and life expectancy. Especially sleep apnea is a disease that has a high prevalence in this patient group and which can be treated successfully.
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PMID:[Sleep disorders in patients with dialysis-dependent renal failure]. 761 3

Recent studies of obstructive sleep apnea and its comorbidity with other systemic diseases have stimulated interest in the relationship of apnea to renal disease and hypertension. Polysomnographic sleep studies in patients on dialysis who complain of day-time fatigue or sleepiness reveal significant apnea in up to 73% of those studied. Abnormalities in respiratory controller mechanisms from chronic hypocarbia, metabolic acidosis, and uremic toxins have been blamed for the occurrence of apnea in this setting. Proteinuria and sometimes nephrotic syndrome have been recognized in morbidly obese patients with sleep apnea syndrome. Renal biopsies of such patients have shown glomerulomegaly and focal segmental sclerosis. It is postulated that these lesions may result from increased glomerular filtration and blood flow. Elevated urine output, sodium and chloride excretion, and atrial natriuretic peptide have been well demonstrated in obstructive apnea patients and correct to control levels with treatment of the apnea. Both acute (with each apnea) and chronic daytime blood pressure elevation are frequently observed in sleep apnea patients, and occult sleep apnea is postulated as one possible cause of "primary" hypertension in middle-aged men. In younger patients, such hypertension seems to be more reversible with the elimination of apnea. In older patients, however, the cure of systemic hypertension cannot be guaranteed with the elimination of the apnea, and asymptomatic apnea patients tend not to tolerate the bother and discomfort of apnea treatment with nasal continuous positive airway pressure. Therefore, aside from a careful history regarding sleep symptomatology, polysomnographic studies of clinic populations with primary hypertension to search for apnea as a cause cannot be recommended.
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PMID:Obstructive sleep apnea and the kidney. 830 38

We report two patients undergoing maintenance hemodialysis who presented with sleep apnea syndrome (SAS). The first patient is a 36-year-old man with a terminal Berger's glomerulopathy and associated obstructive sleep apnea syndrome (OSAS) (apnea-hypopnea index [AHI] = 80). He was receiving home hemodialysis and was treated by nasal continuous positive airway pressure (CPAP). After successful renal transplantation, his symptoms completely disappeared, and control polysomnography greatly improved (AHI = 9). The second patient had hypokalemic nephropathy with severe, uncontrolled hypertension and hypertensive myocardiopathy. He was receiving home dialysis and showed a central sleep apnea syndrome with an AHI of 51. He also was successfully treated by nasal CPAP. After renal transplantation, his sleep improved, insomnia disappeared, and polysomnography showed great improvement (AHI = 5). We discuss the role of periodic breathing related to end-stage renal disease associated metabolic abnormalities, as a pathogenetic factor of these SASs. Respiratory correction of chronic metabolic acidosis, "uremic toxins," "middle molecules," and hemodialysis are all evoked as etiologic factors and their own roles are discussed.
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PMID:Sleep apnea syndrome and end-stage renal disease. Cure after renal transplantation. 848 6

Sleep disorders are relatively common in patients with end-stage renal disease, but the diagnosis may be difficult to establish because of the similarity of uremic symptoms to those of the sleep apnea syndrome. After excluding anatomic and metabolic disorders associated with excessive sleepiness and disordered breathing in sleep and after ensuring that the patient is receiving adequate dialysis, the sleep disorder should be diagnosed using polysomnography. Continuous positive pressure airway breathing is an effective treatment for hemodialysis patients with obstructive sleep apnea syndrome, but the use of this machinery requires patient compliance, as does the delivery of an adequate amount of dialysis. The difficulties adjusting to end-stage renal disease requiring dialysis can be multiplied by the coexistence of a sleep disorder that requires some ventilatory assistance at night; the case presented in this article characterizes precisely that circumstance.
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PMID:Disordered sleep and noncompliance in a patient with end-stage renal disease. 899 21

Sleep apnea is a surprisingly common disorder in end-stage renal disease (ESRD) and chronic renal failure. The symptoms of sleep apnea frequently go unreported or may be misdiagnosed as uremia, depression, chronic illness, or insomnia. A review of the literature was performed to define the prevalence, morbidity, and treatment of sleep apnea syndrome in the ESRD patient. Sleep apnea occurs in at least 60% of ESRD patients. The known complications of sleep apnea include arrhythmias, pulmonary hypertension, and systemic hypertension. In addition, sleep apnea has been implicated in coronary artery disease and strokes. The contribution of sleep apnea to the high mortality from cardiac disease and stroke in peritoneal dialysis and hemodialysis patients is unknown. The causes of the increased prevalence of sleep apnea in ESRD patients are unknown and likely differ from the general population, but the treatment is similar. The literature suggests that modality of renal replacement therapy does not matter; however, large nocturnal volume peritoneal dialysis may worsen sleep apnea. Renal transplantation may be curative. In conclusion, sleep apnea may be an under-diagnosed disease in patients on dialysis. There are significant reasons to suspect that sleep apnea may worsen the morbidity and mortality of ESRD, and there are potential successful therapies.
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PMID:Sleep apnea in renal failure. 936 Jun 57

Sleep apnea hypopnea syndrome (SAHS) is extremely common in patients with end-stage renal disease (ESRD). Although the underlying mechanisms linking these 2 conditions remain to be better defined, it is likely that multiple factors are involved. We report an individual with ESRD with severe SAHS that resolved after kidney transplantation. The improvement in SAHS paralleling the effective treatment of ESRD suggests the pathogenesis involves an unstable breathing pattern, possibly caused by an altered metabolic state, uremia, and changes in volume status. The possibility that elevations in cytokine levels could be involved also is discussed and deserves further attention.
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PMID:Reversal of sleep apnea hypopnea syndrome in end-stage renal disease after kidney transplantation. 1051 57

Patients with end-stage renal disease (ESRD) have an annual mortality rate exceeding 20%, although some survive many years. The ESRD population has a high incidence of sleep disorders, including sleep apnea and periodic limb movements in sleep (PLMS). Sleep disorders result in sleep deprivation, which can negatively affect immune function and cardiovascular-related outcomes, common causes of death in patients with ESRD. This study examined predictors of mortality in patients with ESRD with sleep problems. Twenty-nine consecutive patients with ESRD reporting disrupted sleep or daytime sleepiness were studied by all-night polysomnography. All patients were followed up until death, transplantation, or study termination. Among the variables studied, including such previously reported predictors as serum albumin level, urea reduction ratio, and hematocrit, only the PLMS index (PLMSI), arousing PLMSI (APLMSI), and total number of arousals per hour of sleep significantly predicted mortality. The 20-month survival rate with a PLMSI less than 20 was greater than 90% versus 50% for a PLMSI of 20 or greater (exact log-rank, P = 0.007). For the deceased versus survivor groups, mean PLMSI was 119.1 versus 19.8 (P = 0.01) and APLMSI was 48.1 versus 7.8 (P = 0.00006), with a mean survival of 10.3 versus greater than 25.5 months, respectively (P = 0.001). Median survival of patients with a PLMSI greater than 80 was only 6 months. PLMSI, APLMSI, and total arousals per hour of sleep were strongly associated with mortality in patients with ESRD with sleep disorders independent of other factors and may be novel predictors of near-term mortality.
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PMID:Potential novel predictors of mortality in end-stage renal disease patients with sleep disorders. 1084 39

The increase in obesity worldwide will have an important impact on the global incidence of cardiovascular disease, type 2 diabetes mellitus, cancer, osteoarthritis, work disability, and sleep apnea. Obesity has a more pronounced impact on morbidity than on mortality. Disability due to obesity-related cardiovascular diseases will increase particularly in industrialized countries, as patients survive cardiovascular diseases in these countries more often than in nonindustrialized countries. Disability due to obesity-related type 2 diabetes will increase particularly in industrializing countries, as insulin supply is usually insufficient in these countries. As a result, in these countries, an increase in disabling nephropathy, arteriosclerosis, neuropathy, and retinopathy is expected. Increases in the prevalence of obesity will potentially lead to an increase in the number of years that subjects suffer from obesity-related morbidity and disability. A 1% increase in the prevalence of obesity in such countries as India and China leads to 20 million additional cases of obesity. Prevention programs will stem the obesity epidemic more efficiently than weight-loss programs. However, only a few prevention programs have been developed or implemented, and the success rates reported to date have been low. Obesity prevention programs should be high on the scientific and political agenda in both industrialized and industrializing countries.
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PMID:The public health impact of obesity. 1127 26

Cardiovascular disease is the leading cause of morbidity and mortality in end-stage renal disease. Causes include those usually found in the general population, those related to the uremic status, and those related to dialytic treatment. Hypertension, hypotension, anemia, hypoalbuminemia, malnutrition, dyslipidemia, reactive C protein, calcium-phosphate product, dialysis modalities, and hyperhomocysteinemia are discussed extensively. Special emphasis is put on hyperparathyroidism as a traditional toxin. The emergent role of sleep apnea has been confirmed in animal models as well as in humans studied using polysomnography. There are difficulties in diagnosing coronary disease, because angiography is not risk-free, is expensive, and should be reserved for patients having symptoms of heart failure and/or patients having diabetes mellitus, and/or patients entering a transplantation list. This allows patients with coronary disease to undergo coronary artery bypass (preferably) or percutaneous transluminal angioplasty. Patients for whom surgery is not appropriate should be treated using more traditional medical procedures.
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PMID:The heart in uremia: role of hypertension, hypotension, and sleep apnea. 1157 20


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