Manisha Jhamb1, Xinhui Ran2, Hossam Abdalla3, Maria-Eleni Roumelioti4, Surui Hou2, Herbert Davis4, Sanjay R Patel5, Jonathan Yabes2,6, Mark Unruh4,7. 1. Renal-Electrolyte Division, Department of Medicine, jhambm@upmc.edu. 2. Department of Biostatistics. 3. Renal-Electrolyte Division, Department of Medicine. 4. Division of Nephrology, Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico; and. 5. Division of Pulmonary, Allergy and Critical Care Medicine, and. 6. Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. 7. Section of Nephrology, New Mexico Veterans Affairs Hospital, Albuquerque, New Mexico.
Abstract
BACKGROUND AND OBJECTIVES: In the general population, sleep disorders are associated with mortality. However, such evidence in patients with CKD and ESKD is limited and shows conflicting results. Our aim was to examine the association of sleep apnea with mortality among patients with CKD and ESKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this prospective cohort study, 180 patients (88 with CKD stage 4 or 5, 92 with ESKD) underwent in-home polysomnography, and sleep apnea measures such as apnea hypopnea index (AHI) and nocturnal hypoxemia were obtained. Mortality data were obtained from the National Death Index. Cox proportional hazard models were used for survival analysis. RESULTS: Among the 180 patients (mean age 54 years, 37% women, 39% with diabetes, 49% CKD with mean eGFR 18±7 ml/min per 1.73 m2), 71% had sleep apnea (AHI>5) and 23% had severe sleep apnea (AHI>30). Median AHI was 13 (range, 4-29) and was not significantly different in patients with advanced CKD or ESKD. Over a median follow-up of 9 years, there were 84 (47%) deaths. AHI was not significantly associated with mortality after adjusting for age, sex, race, diabetes, body mass index, CKD/ESKD status, and kidney transplant status (AHI>30: hazard ratio [HR], 1.5; 95% confidence interval [95% CI], 0.6 to 4.0; AHI >15 to 30: HR, 2.3; 95% CI, 0.9 to 5.9; AHI >5 to 15: HR, 2.1; 95% CI, 0.8 to 5.4, compared with AHI≤5). Higher proportion of sleep time with oxygen saturation <90% and lower mean oxygen saturation were significantly associated with higher mortality in adjusted analysis (HR, 1.4; 95% CI, 1.1 to 1.7; P=0.007 for every 15% higher proportion, and HR, 1.6; 95% CI, 1.2 to 2.1; P=0.003 for every 2% lower saturation, respectively). Sleep duration, sleep efficiency, or periodic limb movement index were not associated with mortality. CONCLUSIONS: Hypoxemia-based measures of sleep apnea are significantly associated with increased risk of death among advanced CKD and ESKD.
BACKGROUND AND OBJECTIVES: In the general population, sleep disorders are associated with mortality. However, such evidence in patients with CKD and ESKD is limited and shows conflicting results. Our aim was to examine the association of sleep apnea with mortality among patients with CKD and ESKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this prospective cohort study, 180 patients (88 with CKD stage 4 or 5, 92 with ESKD) underwent in-home polysomnography, and sleep apnea measures such as apnea hypopnea index (AHI) and nocturnal hypoxemia were obtained. Mortality data were obtained from the National Death Index. Cox proportional hazard models were used for survival analysis. RESULTS: Among the 180 patients (mean age 54 years, 37% women, 39% with diabetes, 49% CKD with mean eGFR 18±7 ml/min per 1.73 m2), 71% had sleep apnea (AHI>5) and 23% had severe sleep apnea (AHI>30). Median AHI was 13 (range, 4-29) and was not significantly different in patients with advanced CKD or ESKD. Over a median follow-up of 9 years, there were 84 (47%) deaths. AHI was not significantly associated with mortality after adjusting for age, sex, race, diabetes, body mass index, CKD/ESKD status, and kidney transplant status (AHI>30: hazard ratio [HR], 1.5; 95% confidence interval [95% CI], 0.6 to 4.0; AHI >15 to 30: HR, 2.3; 95% CI, 0.9 to 5.9; AHI >5 to 15: HR, 2.1; 95% CI, 0.8 to 5.4, compared with AHI≤5). Higher proportion of sleep time with oxygen saturation <90% and lower mean oxygen saturation were significantly associated with higher mortality in adjusted analysis (HR, 1.4; 95% CI, 1.1 to 1.7; P=0.007 for every 15% higher proportion, and HR, 1.6; 95% CI, 1.2 to 2.1; P=0.003 for every 2% lower saturation, respectively). Sleep duration, sleep efficiency, or periodic limb movement index were not associated with mortality. CONCLUSIONS:Hypoxemia-based measures of sleep apnea are significantly associated with increased risk of death among advanced CKD and ESKD.
Authors: C Zoccali; F A Benedetto; G Tripepi; F Cambareri; V Panuccio; V Candela; F Mallamaci; G Enia; C Labate; F Tassone Journal: Kidney Int Date: 1998-04 Impact factor: 10.612
Authors: Mark L Unruh; Mark H Sanders; Susan Redline; Beth M Piraino; Jason G Umans; Terese C Hammond; Imran Sharief; Naresh M Punjabi; Anne B Newman Journal: J Am Soc Nephrol Date: 2006-11-02 Impact factor: 10.121
Authors: Ali Azarbarzin; Scott A Sands; Katie L Stone; Luigi Taranto-Montemurro; Ludovico Messineo; Philip I Terrill; Sonia Ancoli-Israel; Kristine Ensrud; Shaun Purcell; David P White; Susan Redline; Andrew Wellman Journal: Eur Heart J Date: 2019-04-07 Impact factor: 29.983
Authors: Cihan Heybeli; Pinar Soysal; Mehmet Asi Oktan; Lee Smith; Ali Çelik; Rumeyza Kazancioglu Journal: Aging Clin Exp Res Date: 2021-08-27 Impact factor: 3.636
Authors: Andrew E Beaudin; Jill K Raneri; Sofia B Ahmed; A J Marcus Hirsch Allen; Andrhea Nocon; Teresa Gomes; Simon Gakwaya; Fréderic Series; John Kimoff; Robert P Skomro; Najib T Ayas; Patrick J Hanly Journal: Sleep Date: 2022-02-14 Impact factor: 5.849