Rostral overnight fluid shift in end-stage renal disease: relationship with obstructive sleep apnea

Rationale: End-stage renal disease (ESRD) patients have high annual mortality mainly due to cardiovascular causes. The acute effects of obstructive and central sleep apnea on cardiac function in ESRD patients have not been determined. We therefore tested, in patients with ESRD, the hypotheses that (1) sleep apnea induces deterioration in cardiac function overnight and (2) attenuation of sleep apnea severity by ultrafiltration (UF) attenuates this deterioration. Methods: At baseline, ESRD patients, on conventional hemodialysis, with left ventricular ejection fraction (LVEF) >45% had polysomnography (PSG) performed on a non-dialysis day to determine the apnea-hypopnea index (AHI). Echocardiography was performed at the bedside, before and after sleep. Isovolumetric contraction time divided by left ventricular ejection time (IVCT/ET) and isovolumetric relaxation time divided by ET (IVRT/ET) were measured by tissue doppler imaging. The myocardial performance index (MPI), a composite of systolic and diastolic function was also calculated. One week later, subjects with sleep apnea (AHI ≥15) had fluid removed by UF, followed by repeat PSG and echocardiography. Results: Fifteen subjects had baseline measurements, of which 7 had an AHI <15 (no–sleep-apnea group) and 8 had an AHI ≥15 (sleep-apnea group). At baseline, there was no overnight change in the LVEF in either the no-sleep-apnea group or the sleep-apnea group. In the no-sleep-apnea group, there was also no overnight change in MPI, IVCT/ET and IVRT/ET. However, in the sleep-apnea group there were overnight increases in MPI, IVCT/ET and IVRT/ET (p = 0.008, 0.007 and 0.031, respectively), indicating deterioration in systolic and diastolic function. Following fluid removal by UF in the sleep-apnea group, the AHI decreased by 48.7% (p = 0.012) and overnight increases in MPI, IVCT/ET and IVRT/ET observed at baseline were abolished. Conclusions: In ESRD, cardiac function deteriorates overnight in those with sleep apnea, but not in those without sleep apnea. This overnight deterioration in the sleep-apnea group may be at least partially due to sleep apnea, since attenuation of sleep apnea by UF was accompanied by elimination of this deleterious overnight effect.

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Pharyngeal narrowing in end-stage renal disease: implications for obstructive sleep apnoea

European Respiratory Journal ◽

10.1183/09031936.00161906 ◽

2007 ◽

Vol 30 (5) ◽

pp. 965-971 ◽

Cited By ~ 43

Author(s):

J. M. Beecroft ◽

V. Hoffstein ◽

A. Pierratos ◽

C. T. Chan ◽

P. A. McFarlane ◽

...

Keyword(s):

Renal Disease ◽

Obstructive Sleep Apnoea ◽

End Stage Renal Disease ◽

Sleep Apnoea ◽

Obstructive Sleep ◽

Stage Renal Disease ◽

End Stage

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RELATIONSHIP BETWEEN HYPERTENSION AND SLEEP APNEA IN END STAGE RENAL DISEASE

Journal of Hypertension ◽

10.1097/00004872-200402001-00891 ◽

2004 ◽

Vol 22 (Suppl. 1) ◽

pp. S207

Author(s):

O. Marson ◽

O. Kohlmann ◽

S. Tufic ◽

S. Togeiro ◽

A. Tavares ◽

...

Keyword(s):

Sleep Apnea ◽

Renal Disease ◽

End Stage Renal Disease ◽

Stage Renal Disease ◽

End Stage

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Sleep Related Respiratory Disorders in End-Stage Renal Disease Patients on Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686089201200112 ◽

1992 ◽

Vol 12 (1) ◽

pp. 51-56 ◽

Cited By ~ 52

Author(s):

Nand K. Wadhwa ◽

M. Seliger ◽

Harly E. Greenberg ◽

Edward Bergofsky ◽

Wallace B. Mendelson

Keyword(s):

Peritoneal Dialysis ◽

Sleep Apnea ◽

Renal Disease ◽

Sleep Disturbance ◽

Peritoneal Cavity ◽

End Stage Renal Disease ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients ◽

Chronic Sleep

Study Objective To assess the possible effects of peritoneal dialysis (PD) on sleep-related respiration, which might result from dialysate bulk load in the abdomen and/or alterations in metabolic control of respiration during sleep. Design Subjective and objective measures of sleep were prospectively compared on randomly assigned nights with PD fluid (2.0 L) and without PD fluid in the peritoneal cavity in 11 end-stage renal disease (ESRD) patients on PD. Setting Tertiary-referral university hospital. Patients and Methods Fifteen consecutive patients on peritoneal dialysis who complained of chronic sleep disturbance and requested sedative were selected. Four patients declined polysomnographic studies. Consequently, 11 ESRD patients (8 males and 3 females) with a mean age of 63±4 (SEM) years were studied. Results Eight of the 11 patients reported multiple types of sleep difficulties. Polysomnographic recordings revealed significant primarily obstructive sleep apnea in 6 of 11 patients on at least 1 of 2 nights. Arterial blood pH, paO2, and paC02 did not differ between nights with and without PD fluid in the peritoneal cavity in the group as a whole. In the 6 patients with sleep apnea, Pa02 was significantly lower (p<0.05) during the night with (Pa02=78±7 mmHg) than during the night without PD fluid (Pa02=92±4 mmHg). In the apneic patients, the amount of dialysate drained in the morning was negatively correlated with the minimum arterial oxygen saturation during the night (r=-0.94; p<0.005). Conclusions This study indicates a significant relationship between PD patients with chronic sleep disturbance and sleep apnea syndrome. These data suggest that apneic patients may be susceptible to complications of dialysate bulk effect on oxygen desaturation.

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