Eric S Kerns1, Esther D Kim2,3, Lucy A Meoni4,5,6, Stephen M Sozio4,5, Bernard G Jaar2,4,5,7, Michelle M Estrella8,9, Rulan S Parekh2,3,4,10, Ghada Bourjeily11. 1. Department of Medicine, Division of Nephrology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA. 2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. 3. Hospital for Sick Children, Toronto, Ontario, Canada. 4. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. 5. Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. 6. Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. 7. Nephrology Center of Maryland, Baltimore, Maryland, USA. 8. University of California San Francisco, Kidney Health Research Collaborative, San Francisco, California, USA. 9. San Francisco VA Health Care System, San Francisco, California, USA. 10. Department of Pediatrics and Medicine, School of Medicine, University of Toronto, Toronto, Ontario, Canada. 11. Department of Medicine, Divisions of Pulmonary, Critical Care and Sleep Medicine, and Obstetric Medicine, The Miriam Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Abstract
BACKGROUND: Mortality in end-stage renal disease (ESRD) occurs predominantly from cardiovascular disease (CVD) and sudden cardiac death (SCD). Obstructive sleep apnea (OSA) is characterized by periodic airflow limitation associated with sleep arousal and oxygen desaturation and is prevalent in patients with ESRD. Whether OSA increases the risk for SCD, cardiovascular and all-cause mortality among hemodialysis patients remains unknown. METHODS: In a prospective cohort of 558 incident hemodialysis patients, we examined the association of OSA with all-cause mortality, cardiovascular mortality, and SCD using Cox proportional hazards models controlling for traditional CVD risk factors. RESULTS: Sixty-six incident hemodialysis patients (12%) had OSA. Mean age (56 years) and percentage of males (56%) were identical in OSA and no-OSA groups. Fewer African Americans had OSA than non-African Americans (9 vs. 18%, respectively). Participants with OSA had higher body-mass index, Charlson comorbidity score, and left ventricular mass index and greater prevalence of diabetes and coronary artery disease. During 1,080 person-years of follow-up, 104 deaths occurred, 29% of which were cardiovascular. OSA was associated with a higher risk of all-cause mortality (HR 1.90 [95% CI 1.04-3.46]) and cardiovascular mortality (HR 3.62 [95% CI 1.36-9.66]) after adjusting for demographics and body-mass index. OSA was associated with a higher risk of SCD after adjusting for demographics (HR 3.28 [95% CI 1.12-9.57]) and multiple cardiovascular risk factors. CONCLUSIONS: Incident hemodialysis patients with OSA are at increased risk of all-cause and cardiovascular mortality and SCD. Future studies should assess the impact of screening for OSA and OSA-targeted interventions on mortality in ESRD.
BACKGROUND:Mortality in end-stage renal disease (ESRD) occurs predominantly from cardiovascular disease (CVD) and sudden cardiac death (SCD). Obstructive sleep apnea (OSA) is characterized by periodic airflow limitation associated with sleep arousal and oxygen desaturation and is prevalent in patients with ESRD. Whether OSA increases the risk for SCD, cardiovascular and all-cause mortality among hemodialysis patients remains unknown. METHODS: In a prospective cohort of 558 incident hemodialysis patients, we examined the association of OSA with all-cause mortality, cardiovascular mortality, and SCD using Cox proportional hazards models controlling for traditional CVD risk factors. RESULTS: Sixty-six incident hemodialysis patients (12%) had OSA. Mean age (56 years) and percentage of males (56%) were identical in OSA and no-OSA groups. Fewer African Americans had OSA than non-African Americans (9 vs. 18%, respectively). Participants with OSA had higher body-mass index, Charlson comorbidity score, and left ventricular mass index and greater prevalence of diabetes and coronary artery disease. During 1,080 person-years of follow-up, 104 deaths occurred, 29% of which were cardiovascular. OSA was associated with a higher risk of all-cause mortality (HR 1.90 [95% CI 1.04-3.46]) and cardiovascular mortality (HR 3.62 [95% CI 1.36-9.66]) after adjusting for demographics and body-mass index. OSA was associated with a higher risk of SCD after adjusting for demographics (HR 3.28 [95% CI 1.12-9.57]) and multiple cardiovascular risk factors. CONCLUSIONS: Incident hemodialysis patients with OSA are at increased risk of all-cause and cardiovascular mortality and SCD. Future studies should assess the impact of screening for OSA and OSA-targeted interventions on mortality in ESRD.
Authors: Cristiano Fava; Stefania Dorigoni; Francesco Dalle Vedove; Elisa Danese; Martina Montagnana; Gian Cesare Guidi; Krzysztof Narkiewicz; Pietro Minuz Journal: Chest Date: 2014-04 Impact factor: 9.410
Authors: Daniel I McIsaac; Andrea Gershon; Duminda Wijeysundera; Gregory L Bryson; Neal Badner; Carl van Walraven Journal: Anesthesiology Date: 2015-08 Impact factor: 7.892
Authors: Mao-Chang Su; Kuo-Liang Chiu; Pimon Ruttanaumpawan; Satomi Shiota; Dai Yumino; Stefania Redolfi; James S Haight; Brian Yau; Jennifer Lam; T Douglas Bradley Journal: Clin Sci (Lond) Date: 2009-05 Impact factor: 6.124
Authors: C Vaughan Tuohy; Maria E Montez-Rath; Mintu Turakhia; Tara I Chang; John W Winkelman; Wolfgang C Winkelmayer Journal: BMC Nephrol Date: 2016-02-09 Impact factor: 2.388
Authors: Marco Matteo Ciccone; Pietro Scicchitano; Annapaola Zito; Francesca Cortese; Barbara Boninfante; Vito Antonio Falcone; Vitaliano Nicola Quaranta; Valentina Anna Ventura; Antonietta Zucano; Francesca Di Serio; Mario Francesco Damiani; Onofrio Resta Journal: Molecules Date: 2014-01-29 Impact factor: 4.411
Authors: Tae-Hwi Schwantes-An; Matteo Vatta; Marco Abreu; Leah Wetherill; Howard J Edenberg; Tatiana M Foroud; Glenn M Chertow; Sharon M Moe Journal: Cardiorenal Med Date: 2021-08-10 Impact factor: 4.360
Authors: Jessica Fitzpatrick; Eric S Kerns; Esther D Kim; Stephen M Sozio; Bernard G Jaar; Michelle M Estrella; Larisa G Tereshchenko; Jose M Monroy-Trujillo; Rulan S Parekh; Ghada Bourjeily Journal: J Clin Sleep Med Date: 2021-08-01 Impact factor: 4.324
Authors: Bernard Canaud; Jeroen P Kooman; Nicholas M Selby; Maarten Taal; Andreas Maierhofer; Pascal Kopperschmidt; Susan Francis; Allan Collins; Peter Kotanko Journal: World J Nephrol Date: 2022-03-25