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

Sleep apnoea is common in patients with end-stage renal disease (ESRD). It was hypothesised that this is related to a narrower upper airway. Upper airway dimensions in patients with and without ESRD and sleep apnoea were compared, in order to determine whether upper airway changes associated with ESRD could contribute to the development of sleep apnoea. An acoustic reflection technique was used to estimate pharyngeal cross-sectional area. Sleep apnoea was assessed by overnight polysomnography. A total of 44 patients with ESRD receiving conventional haemodialysis and 41 subjects with normal renal function were studied. ESRD and control groups were further categorised by the presence or absence of sleep apnoea (apnoea/hypopnoea index > or =10 events.h(-1)). The pharyngeal area was smaller in patients with ESRD compared with subjects with normal renal function: 3.04 +/- 0.84 versus 3.46 +/- 0.80 cm(2) for the functional residual capacity and 1.99 +/- 0.51 versus 2.14 +/- 0.58 cm(2) for the residual volume. The pharynx is narrower in patients with ESRD than in subjects with normal renal function. In conclusion, since a narrower upper airway predisposes to upper airway occlusion during sleep, it is suggested that this factor contributes to the pathogenesis of sleep apnoea in dialysis-dependent patients.
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PMID:Pharyngeal narrowing in end-stage renal disease: implications for obstructive sleep apnoea. 1762 7

The prevalence of sleep disorders is significantly higher (up to 80%) in patients with chronic uremia compared to the general population. Sleep disorders appear even in the early stages of chronic kidney disease. These disturbances are complex, including difficulties in falling asleep and awakening, interrupted sleep, nightmares, restless legs syndrome, sleep apnea syndrome, etc. There are still disagreements on the major etiological factors of sleep disorders in the uremic patient. Older age, long dialysis vintage, alcohol and tobacco abuse and, particularly, the presence of significant comorbidities are major determinants of sleep disorders in dialysis patients. Proper assessment of sleep disorders in the renal population is still under investigation; recent studies have mostly addressed patients' perception based on questionnaires. More precise polysomnographic assessments are less studied in renal patients. Sleep disorders significantly affect quality of life in dialysis patients. An accurate and early identification of such disturbances would lead to a significant improvement in quality of life, and probably also in outcome, in uremic patients. Sleep apnea syndrome is extremely frequent in dialysis patients, with obvious consequences for cardiovascular morbidity and mortality. Proper diagnosis and therapy of sleep apnea syndrome could significantly reduce cardiovascular risk. Although sleep quality improves after renal transplantation, allograft recipients still have significantly more sleep disorders than healthy individuals. Here, we review recent data on sleep disturbances in renal patients, focusing on the end-stage renal disease patient treated by dialysis.
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PMID:Sleep disorders: a systematic review of an emerging major clinical issue in renal patients. 1791 60

Sleep apnea has been linked to excessive daytime sleepiness, depressed mood, hypertension, and cardiovascular disease in the general population. The prevalence of severe sleep apnea in the conventional thrice-weekly hemodialysis population has been estimated to be more than 50%. Sleep apnea leads to repetitive episodes of hypoxemia, hypercapnia, sleep disruption, and activation of the sympathetic nervous system. The hypoxemia, arousals, and intrathoracic pressure changes associated with sleep apnea lead to sympathetic activation, endothelial dysfunction, oxidative stress, and inflammation. Because sleep apnea has been shown to be widespread in the conventional dialysis population, it may be that sleep apnea contributes substantially to the sleepiness, poor quality of life, and cardiovascular disease found in this population. The causal links between conventional dialysis and sleep apnea remain speculative, but there are likely multiple factors related to volume status and azotemia that contribute to the high rate of severe sleep apnea in dialysis patients. Both nocturnal automated peritoneal dialysis and nocturnal hemodialysis have been associated with reduced severity of sleep apnea. Nocturnal dialysis modalities may provide tools to increase our understanding of the uremic sleep apnea and may also provide therapeutic alternatives for end-stage renal disease patients with severe sleep apnea. In conclusion, sleep apnea is an important, but overlooked, public health problem for the dialysis population. The impact of sleep apnea treatment in this high-risk population may include reduced sleepiness, better mood and blood pressure, and lowered risk of cardiovascular disease.
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PMID:Sleep apnea and dialysis therapies: things that go bump in the night? 1792 30

Patients with a blunted fall in nocturnal BP (known as non-dippers) have a high risk of micro- and macrovascular complications, particularly if they have hypertension, but also in normotensive patients with diabetes. A blunted fall in nocturnal BP reflects the high level of CV risk in these patients. ABPM data indicating an altered circadian BP rhythm reverse circadian BP profile should alert the physician to the potential risk of complications and should lead to efforts to treat hypertension effectively, especially at night, and to check for sleep apnoea syndrome, particularly in cases of resistant hypertension, or autonomic neuropathy (postural hypotension), a well known risk factor for cardiovascular (CV) events. Patients should be carefully screened for nephropathy. However, the definitions of "non-dipper" vary widely. Suitable treatments are poorly defined, but angiotensin-converting enzyme inhibitors (ACEi), diuretics, salt restriction and the maintenance of continuous positive airway pressure (CPAP) can be used as non-specific treatments. The efficacy of taking blood pressure-lowering drugs at bedtime rather than in the morning is still debated but deserves attention. In the diabetic population, brachial pulse pressure (PP) is an independent predictor of cardiovascular mortality, but not of all-cause mortality. It is also associated with complications of both type 2 and type 1 diabetes, this effect being stronger for nocturnal than for diurnal PP, and is strongly predictive of coronary heart disease in patients with type 2 diabetes. The stronger association between PP and age in diabetic than in non-diabetic populations suggests that diabetes accelerates vascular ageing. In patients with incipient nephropathy or overt renal failure, PP increases CV risk. However, misinterpretation could be related to confusion between brachial PP and central PP. The therapeutic implications of PP measurement remain poorly documented in diabetes.
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PMID:Should pulse pressure and day/night variations in blood pressure be seen as independent risk factors requiring correction or simply as markers to be taken into account when evaluating overall vascular risk? 1793 63

Sleep apnea syndrome, a sleep-related breathing disorder (SRBD) of which obstructive sleep apnea syndrome (OSAS) is representative, is often associated with obesity, and therefore patients with SRBD might have a high prevalence of chronic kidney disease (CKD). However, the relationship between obesity and the prevalence of CKD has not yet been investigated in a large cohort of patients with SRBD. The Okinawa Nakamura Clinic Sleep Apnea Syndrome (ONSLEEP) registry contains records for all patients evaluated by full-scale polysomnography (PSG) from September 1990 to the end of 2003 (n=5,651). We studied the total of 4,056 (71.8%) of these patients who had an apnea hypopnea index (AHI) of more than 5 events per hour. The glomerular filtration rate (GFR) was estimated using the abbreviated Modification of Diet in Renal Disease equation in the 1,624 patients for whom serum creatinine data was obtained at the time of the PSG. We defined CKD as a GFR of less than 60 mL/min/1.73 m2. The mean age was 49.9+/-13.5 (mean+/-SD) years; the mean body mass index (BMI) was 28.4+/-5.0 (mean+/-SD) kg/m2. We compared the findings with those from participants in the 1993 general screening registry in Okinawa (n=94,267). From among the total 94,267 screening participants, we selected 7,454 subjects who were age- and sex-matched to the experimental group with SRBD; the ratio of cases to controls was thus approximately 1:4. CKD was detected in 496 (30.5%) patients, with SRBD a higher incidence than that in the screened population (9.1%); the adjusted odds ratio (95% confidence interval) was 4.542 (3.922-5.260, p<0.0001). In contrast to the screened population, the prevalence of CKD decreased as BMI increased (it was 35.7% in SRBD patients with a BMI<25.0 kg/m2, 31.4% in those with a BMI 25.0 to 29.9 kg/m2, and 25.2% in those with a BMI > or =30.0 kg/m2); in the controls the values were 8.1%, 10.5%, and 10.6%, respectively. Taken together, these results suggest that surveillance of CKD is warranted among SRBD patients, particularly those who are not obese.
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PMID:High Prevalence of chronic kidney disease among patients with sleep related breathing disorder (SRBD). 1836 44

Sleep disturbances manifesting as insomnia, daytime sleepiness, fatigue, and other symptoms are frequently found in patients with end-stage renal disease that is being treated with dialysis. Many factors, including neurosis, uremic symptoms, dialysis drugs, and sleep-wake rhythms have been suggested as potential causes for these sleep disturbances. We examined sleep apnea/hypopnea and heart rate variability (HRV) reflecting autonomic activity in hemodialysis patients on their hemodialysis and non-hemodialysis days using a home medical care device (Morpheus C, TEIJIN). Eleven hemodialysis patients and 14 healthy adults were enrolled in this study. We calculated the number of apnea/hypopnea episodes per hour (apnea/hypopnea index: AHI) and HRV (percentage of R-R intervals that differ by at least 50 ms from the previous interval: pNN50, very low frequency: VLF, low frequency: LF, high frequency: HF and LF/ HF). There was no significant difference in the AHI between hemodialysis and non-hemodialysis days. The heart rate in hemodialysis patients on non-hemodialysis days was significantly higher than in the controls, whereas the pNN50 was significantly lower in hemodialysis patients on non-hemodialysis days than in the controls. Although VLF was significantly lower in hemodialysis patients on non-hemodialysis days compared to the controls, there were no significant differences in LF, HF or LF/HF between the two groups. Hemodialysis itself might not be an important contributing factor in sleep-related breathing disturbances. The simultaneous analysis of HRV reflecting autonomic activity and sleep-disordered breathing on both hemodialysis and non-hemodialysis days provides important information.
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PMID:Comparison of sleep-disordered breathing and heart rate variability between hemodialysis and non-hemodialysis days in hemodialysis patients. 1895 26

A lowering of the glomerular filtration rate (GFR) and/or the presence of albuminuria are signs of chronic renal disease. Both variables are for the most part independently associated with an increased risk of cardiovascular morbidity and mortality. Albuminuria is a marker of endothelial dysfunction. A decrease of the GFR is associated with non-traditional risk factors, e.g. renal anaemia, uraemic toxins due to a decrease of the renal clearance, hyperhomocysteinaemia caused by a diminished homocysteine metabolism, excessive activation of the sympathetic nervous system which is related to sleep apnoea syndrome, oxidative stress and dyslipidaemia associated with the formation of vasotoxic, oxidised LDL cholesterol. These non-traditional risk factors may, alone or in combination with traditional atherogenic risk factors (e.g. age, male gender, smoking, hypercholesterolaemia, hypertension, obesity, positive family history and diabetes mellitus), partially via endothelial dysfunction, result in harmful effects on arterial function, increasing cardiovascular morbidity and mortality. Different stages of chronic kidney disease are associated with specific risk factors, making a specific therapeutic approach essential.
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PMID:[Chronic renal disease as cardiovascular risk factor]. 1899 67

Poor sleep and sleep-related breathing disorders are common in patients with end-stage renal disease (ESRD) but are often unrecognized and undertreated. Sleep disorders are known negative prognostic factors for morbidity and mortality. The most frequent sleep disorders seen in patients with ESRD are conditioned insomnia, excessive daytime sleepiness, obstructive or central sleep apnea (SA), as well as restless legs syndrome (RLS) and periodic limb movement disorder (PLMD). Several uremic and nonuremic factors are thought to participate in the pathogenesis of sleep disorders in patients with ESRD. The therapy of sleeping disorders includes nonpharmacological and pharmacological measures that can improve the functionality and quality of life in patients with ESRD.
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PMID:Sleep disorders in dialysis patients. 1908 93

Common medical problems are often associated with abnormalities of sleep. Patients with chronic medical disorders often have fewer hours of sleep and less restorative sleep compared to healthy individuals, and this poor sleep may worsen the subjective symptoms of the disorder. Individuals with lung disease often have disturbed sleep related to oxygen desaturations, coughing, or dyspnea. Both obstructive lung disease and restrictive lung diseases are associated with poor quality sleep. Awakenings from sleep are common in untreated or undertreated asthma, and cause sleep disruption. Gastroesophageal reflux is a major cause of disrupted sleep due to awakenings from heartburn, dyspepsia, acid brash, coughing, or choking. Patients with chronic renal disease commonly have sleep complaints often due to insomnia, insufficient sleep, sleep apnea, or restless legs syndrome. Complaints related to sleep are very common in patients with fibromyalgia and other causes of chronic pain. Sleep disruption increases the sensation of pain and decreases quality of life. Patients with infectious diseases, including acute viral illnesses, HIV-related disease, and Lyme disease, may have significant problems with insomnia and hypersomnolence. Women with menopause have from insomnia, sleep-disordered breathing, restless legs syndrome, or fibromyalgia. Patients with cancer or receiving cancer therapy are often bothered by insomnia or other sleep disturbances that affect quality of life and daytime energy. The objective of this article is to review frequently encountered medical conditions and examine their impact on sleep, and to review frequent sleep-related problems associated with these common medical conditions.
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PMID:Sleep-related problems in common medical conditions. 1920 22

Sleep disorders, such as restless legs, periodic limb movements and sleep apnea, and sleep complaints such as insomnia and daytime sleepiness, are very common in end-stage renal disease patients despite treatment with 3-times-a-week conventional hemodialysis. If left untreated, they are likely to impair quality of life and may alter cardiovascular outcomes in this patient population. Home dialysis has the potential to improve sleep disorders by offering more effective dialysis than conventional modalities. Although there has been little direct comparison between the impact of home dialysis and conventional dialysis on sleep disorders, there is evidence that both nocturnal peritoneal dialysis and nocturnal hemodialysis improve sleep apnea. The impact of home dialysis on other sleep disorders and sleep complaints is less impressive, but the data, thus far, have been limited. Further research is required to evaluate the impact of home dialysis on all sleep disorders and sleep complaints in this patient population and to determine whether this improves quality of life and cardiovascular morbidity and mortality.
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PMID:Sleep disorders and home dialysis. 1939 68


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