Obstructive Sleep Apnea in hemodialysis patients

Abstract

ESRD patients on regular hemodialysis 3 sessions per week complain of some abnormalities related to sleep affecting there quality of life . Many studies were done to evaluate these problems and precipitating factors. Subjective sleep complaints include difficulty initiating and maintaining sleep, problems with restless, jerking legs, and/or day time sleepiness.Sleep disorders are very inconvenient for the patients and affect their activities of daily living. Most patients believe that relief of these symptoms would improve subjective quality of life. Hence by exploring the profile of sleep problems we can offer help to improve their quality of life. Sleep disordered breathing (SDB) is the most common cause of poor sleep in kidney disease patients with manifestations ranging from obstructive apneas,in which upper airway obstruction leads to cessation or reduction of airflow despite persistent ventilator efforts, to central apnea, in which airflow is absent because of cessation of ventilatory efforts or mixed(central and obstructive) apnea. Studies in the past have consistently shown a high prevalence of SDB in patients on hemodialysis (HD) because of compromised upper airway stability (extracellular fluid volume overload), ventilatory control instability (altered central and peripheral chemosensitivity), and reduced upper airway muscle tone (uremia). Risk factors associated with increased incidence of these disorders include duration of illness ,hypertension, BMI, quality of dialysis and history of psychiatric illness. This study compared 20 patients with ESRD on regular hemodialysis 3 sessions/wk for at least 6 months in hemodialysis units of Ain-shams university hospitals against 20 persons of general population working at our institute of psychiatry .Both groups were matched to age ,sex ,BMI, absence of previous psychiatric illness. PSQI questionnaire and polysomnography done for both groups in addition to history taking ,general examination and laboratory investigations. Our results showed that obstructive sleep apnea in addition to central and mixed apneas are common in ESRD patients approved by polysomnography. RLS and PLM are present with high percent affecting sleep quality and increasing daytime sleepiness. There is a strong correlation between duration of illness and sleep disorders including obstructive sleep apnea that was found in 65% of cases. Unlike many previous studies serum creatinine was found to be higher in patients with better sleep quality. DM and hypertension was found in number of patients with poor sleep quality but further studies will be needed to study correlation between them and sleep disorders.