Abstract
Background and Aims
Sleep apnoea (SA), either obstructive and central (OSA and CSA, respectively) associated with and excessive daytime sleepiness (EDS) are common sleep disorders among patients with end-stage renal disease (ESRD). Fluid overload characterizes end-stage kidney disease and plays an important role in the pathogenesis of OSA, CSA and EDS. In our study we assessed the prevalence of sleep apnoea and excessive daytime sleepiness in patients from a nephrology and dialysis unit from south-eastern Romania.
Method
86 patients with ESRD pre-dialysis (eGFR < 15 ml/min/1,73 m) or on maintenance haemodialysis were monitored for an interval of 2 years. We used questionnaires to assess the prevalence of SA and EDS. All subjects underwent overnight polysomnography (PSG). Extracellular fluid volume of the total body, neck, thorax and right leg were measured using bioelectrical impedance. We also examined the association between sleep apnoea, EDS, the underlying causes of ESRD, co-morbidities, medication used, and other demographic data.
Results
The mean patients age was 57.5 years ± 14.9 years; 65.1% were male, and 34.9% were female. The prevalence of SA as defined by the Berlin questionnaire (BQ) was 49.5% in males and 34.8% in females, which was not a statistically significant difference (P = 0.029). Sleep apnoea was significantly associated with age, obesity, diabetes, hypertension, fluid overload and 2nd or 3rd haemodialysis shift (P-values, 0.001, < 0.0001, < 0.002, < 0.008, <0.0001, and < 0.005. Sleep apnoea was also significantly associated with other sleep disorders such as restless leg syndrome, insomnia, habitual snoring, and EDS (P-values, < 0.001, < 0.001, < 0.001, and < 0.001, respectively). The prevalence of EDS was 35,5%, and EDS was significantly associated with age (over 60 years old), diabetes mellitus, hypertension and obesity. 18 patients (20.9%) had refractory hypertension, that improved after CPAP administration, and 10 of these patients (over 50% with refractory HT), that refused the application of appropriate therapy of sleep disorders, suffered a major cardiovascular event during our study.
Conclusion
Sleep apnoea, excessive daytime sleepiness and other sleep disorders are relatively common in pre-dialysis and haemodialysis patients and are significantly associated with refractory hypertension and severe cardio-vascular events. That is why a greater attention should be given to the diagnosis and management of sleep disorders, as one of the important steps in nursing and our patients’ rehabilitation.
The Epworth Sleepiness Scale in Service Members with Sleep Disorders
