Clinical Presentation of Obstructive Sleep Apnea in Patients with - PDF document

See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/230672125 Clinical Presentation of Obstructive Sleep Apnea in Patients with Chronic Kidney Disease Article in Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine · August 2012 DOI: 10.5664/jcsm.2028 · Source: PubMed CITATIONS READS 35 81 8 authors , including: Andrea Loewen Brenda R Hemmelgarn The University of Calgary The University of Calgary 22 PUBLICATIONS 611 CITATIONS 586 PUBLICATIONS 24,406 CITATIONS SEE PROFILE SEE PROFILE Darlene Y Sola Tanvir Turin The University of Calgary The University of Calgary 25 PUBLICATIONS 398 CITATIONS 258 PUBLICATIONS 4,551 CITATIONS SEE PROFILE SEE PROFILE Some of the authors of this publication are also working on these related projects: Primary Care Access View project Health Literacy, Health Promotion: Social Media, Online Platform, Internet Resources View project All content following this page was uploaded by Darlene Y Sola on 17 February 2014. The user has requested enhancement of the downloaded file.

http://dx.doi.org/10.5664/jcsm.2028 Clinical Presentation of Obstructive Sleep Apnea in Patients with Chronic Kidney Disease David D. M. Nicholl, B.H.Sc. 1 ; Sofj a B. Ahmed, M.D., M.M.Sc. 1,2 ; Andrea H. S. Loewen, M.D. 1,3 ; Brenda R. Hemmelgarn, M.D., Ph.D. 1,2 ; Darlene Y. Sola, B.Sc.N. 1 ; Jaime M. Beecroft, M.Sc. 3 ; Tanvir C. Turin, M.B.B.S., Ph.D. 1 ; Patrick J. Hanly, M.D. 1,3 1 Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; 2 Alberta Kidney Disease Network, Alberta, Canada; 3 Sleep Centre, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada background: Obstructive sleep apnea (OSA) is an important referred to the sleep centre. and common comorbidity in patients with chronic kidney dis- Results: The prevalence of OSA symptoms and PSQI scores S C I E N T I F I C I N V E S T I g AT I O N S ease (CKD). However, few studies have addressed how OSA did not differ between CKD patients with OSA and CKD pa- presents in this patient population and whether it is clinically tients without apnea. Although the prevalence of daytime apparent. sleepiness was higher in CKD patients with OSA compared Objective: The objectives of this study were to determine if to CKD patients without apnea (39% vs. 19%, p = 0.033), both the prevalence and severity of sleep related symptoms distin- daytime sleepiness and other symptoms of sleep apnea were guished CKD patients with OSA from those without apnea, and considerably less frequent than in OSA patients without a his- whether the clinical presentation of OSA in CKD patients dif- tory of kidney disease. fered from the general OSA population. Conclusions: The presence of OSA in patients with CKD is Methods: One hundred nineteen patients were recruited from unlikely to be clinically apparent. Consequently, objective car- outpatient nephrology clinics. All patients completed a sleep diopulmonary monitoring during sleep is required to reliably history questionnaire, the Epworth Sleepiness Scale (day- identify this comorbidity. time sleepiness, ESS > 10), the Pittsburgh Sleep Quality In- Keywords: Obstructive sleep apnea, chronic kidney disease, dex (poor sleep quality, PSQI > 5), and underwent overnight snoring, symptoms, daytime sleepiness cardiopulmonary monitoring for determination of sleep apnea Citation: Nicholl DDM; Ahmed SB; Loewen AHS; Hemmel- (respiratory disturbance index ≥ 15). CKD patients with OSA garn BR; Sola DY; Beecroft JM; Turin TC; Hanly PJ. Clini- (n = 46) were compared to (1) CKD patients without OSA cal presentation of obstructive sleep apnea in patients with (n = 73) and (2) OSA patients without CKD (n = 230) who were chronic kidney disease. J Clin Sleep Med 2012;8(4):381-387. T here is growing evidence that obstructive sleep apnea bRIEF SUMMARY (OSA) is common in patients with chronic kidney disease Current Knowledge/Study Rationale: Although obstructive sleep ap- who do not require chronic dialysis (CKD). 1-7 The reported nea (OSA) is common in patients with chronic kidney disease (CKD), it prevalence of OSA in this population has ranged from 27% to may not be clinically apparent. Consequently, we compared the preva- 54%, 2,3,5-7 which is considerably higher than the general popula- lence and severity of sleep related symptoms in CKD patients with and tion. 8 The coexistence of OSA in patients with CKD is likely to without OSA and contrasted that with the clinical presentation of OSA in patients without CKD. have clinical relevance. In addition to causing impairment of Study Impact: OSA is not likely to be clinically apparent in patients with sleep quality and daytime function, 9 OSA increases the risk of CKD. Objective cardiopulmonary monitoring is required to reliably iden- systemic hypertension 10 and vascular disease, 11,12 both of which tify OSA in this patient population. are common complications of CKD. 13 Furthermore, OSA may accelerate the deterioration of kidney function in patients with CKD either directly, through the effect of hypoxia on the kid- the CKD population. Few studies have investigated the clinical ney, 14-16 or indirectly, by increasing systemic blood pressure, presentation of OSA in non–dialysis-dependent CKD. 2,5 These infm ammatory cytokines, and sympathetic nervous system ac- studies have reported a lower prevalence of daytime sleepi- tivity. 17-20 Since OSA can be effectively treated in many patients ness 2,5 and snoring 2 in the CKD population, but have not dis- with continuous positive airway pressure therapy (CPAP), 21 it tinguished CKD patients with OSA from those without apnea. is important that the disorder be recognized and formally diag- Thus, it is unclear whether OSA is clinically apparent in this nosed in this patient population. patient population. In conventional sleep medicine practice, the investigation The objectives of this study were to determine (1) if the of OSA is usually prompted by a constellation of sleep related prevalence and severity of sleep related symptoms distin- symptoms such as snoring, witnessed apneas during sleep, and guished CKD patients with OSA from those without apnea, daytime sleepiness. 22 It is not clear whether this clinical presen- and (2) if the clinical presentation of OSA in CKD patients tation can reliably distinguish patients with and without OSA in differed from that in the general sleep apnea population. We 381 Journal of Clinical Sleep Medicine, Vol. 8, No. 4, 2012