BACKGROUND: Sleep-disordered breathing and cognitive impairment are common in patients with chronic kidney disease (CKD). Sleep-disordered breathing is known to be a risk factor for cognitive dysfunction in the general population, but this association has not been studied in patients with CKD. STUDY DESIGN: Cross-sectional study. SETTINGS & PARTICIPANTS: A cohort of 169 patients with CKD stages 4-5. PREDICTORS: Sleep-disordered breathing; covariates included demographics, diabetes, cardiovascular disease, depression, and dialysis modality. OUTCOMES: Cognitive impairment, generally defined as a score 1.5 standard deviations or more from the age- and education level-adjusted normative cognitive test score. MEASUREMENTS: Standardized health interview, neurocognitive assessment, sleep-related questionnaires, and polysomnography. RESULTS: Sleep-disordered breathing (apnea-hypopnea index >15) was diagnosed in 83 (49.1%) individuals. This group had a significantly higher prevalence of nocturnal hypoxemia (65.8% vs 26.8%; P < 0.001) and excessive daytime sleepiness (38.6% vs 20.7%; P = 0.01). In addition, this group had significantly lower scores in tests measuring verbal memory, working memory, attention, and psychomotor speed. Sleep-disordered breathing was associated with higher risk of immediate verbal memory impairment after adjustment for known confounders (adjusted OR, 2.67; 95% CI, 1.17-6.08). However, in a subgroup analysis of older adults (aged >60 years), there were no significant differences in cognitive testing between the groups with and without sleep-disordered breathing. LIMITATIONS: Cross-sectional design, limited sample size. CONCLUSIONS: Sleep-disordered breathing is associated with cognitive impairments, especially impaired verbal memory, in patients with advanced CKD. However, the impact appeared limited in older adults. Early evaluation and management of sleep-disordered breathing in patients with CKD may provide an opportunity to improve cognitive function.
BACKGROUND:Sleep-disordered breathing and cognitive impairment are common in patients with chronic kidney disease (CKD). Sleep-disordered breathing is known to be a risk factor for cognitive dysfunction in the general population, but this association has not been studied in patients with CKD. STUDY DESIGN: Cross-sectional study. SETTINGS & PARTICIPANTS: A cohort of 169 patients with CKD stages 4-5. PREDICTORS: Sleep-disordered breathing; covariates included demographics, diabetes, cardiovascular disease, depression, and dialysis modality. OUTCOMES: Cognitive impairment, generally defined as a score 1.5 standard deviations or more from the age- and education level-adjusted normative cognitive test score. MEASUREMENTS: Standardized health interview, neurocognitive assessment, sleep-related questionnaires, and polysomnography. RESULTS:Sleep-disordered breathing (apnea-hypopnea index >15) was diagnosed in 83 (49.1%) individuals. This group had a significantly higher prevalence of nocturnal hypoxemia (65.8% vs 26.8%; P < 0.001) and excessive daytime sleepiness (38.6% vs 20.7%; P = 0.01). In addition, this group had significantly lower scores in tests measuring verbal memory, working memory, attention, and psychomotor speed. Sleep-disordered breathing was associated with higher risk of immediate verbal memory impairment after adjustment for known confounders (adjusted OR, 2.67; 95% CI, 1.17-6.08). However, in a subgroup analysis of older adults (aged >60 years), there were no significant differences in cognitive testing between the groups with and without sleep-disordered breathing. LIMITATIONS: Cross-sectional design, limited sample size. CONCLUSIONS:Sleep-disordered breathing is associated with cognitive impairments, especially impaired verbal memory, in patients with advanced CKD. However, the impact appeared limited in older adults. Early evaluation and management of sleep-disordered breathing in patients with CKD may provide an opportunity to improve cognitive function.
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Authors: Daniel E Weiner; Tammy M Scott; Lena M Giang; Brian T Agganis; Eric P Sorensen; Hocine Tighiouart; Mark J Sarnak Journal: Am J Kidney Dis Date: 2011-07-20 Impact factor: 8.860
Authors: A M Murray; D E Tupper; D S Knopman; D T Gilbertson; S L Pederson; S Li; G E Smith; A K Hochhalter; A J Collins; R L Kane Journal: Neurology Date: 2006-07-25 Impact factor: 9.910
Authors: Jiaxuan Zhang; Terri E Weaver; Zheng Zhong; Robyn A Nisi; Kelly R Martin; Alana D Steffen; M Muge Karaman; Xiaohong Joe Zhou Journal: Sleep Med Date: 2018-09-29 Impact factor: 3.492