Sleep related respiratory disorders in end-stage renal disease patients on peritoneal dialysis.
OBJECTIVE
To assess the possible effects of peritoneal dialysis (PD) on sleep-related respiration, which might result from dialysate bulk load in the abdomen and/or alterations in metabolic control of respiration during sleep.


METHODS
Subjective and objective measures of sleep were prospectively compared on randomly assigned nights with PD fluid (2.0 L) and without PD fluid in the peritoneal cavity in 11 end-stage renal disease (ESRD) patients on PD.


METHODS
Tertiary-referral university hospital.


METHODS
Fifteen consecutive patients on peritoneal dialysis who complained of chronic sleep disturbance and requested sedative were selected. Four patients declined polysomnographic studies. Consequently, 11 ESRD patients (8 males and 3 females) with a mean age of 63 +/- 4 (SEM) years were studied.


RESULTS
Eight of the 11 patients reported multiple types of sleep difficulties. Polysomnographic recordings revealed significant primarily obstructive sleep apnea in 6 of 11 patients on at least 1 of 2 nights. Arterial blood pH, paO2, and paCO2 did not differ between nights with and without PD fluid in the peritoneal cavity in the group as a whole. In the 6 patients with sleep apnea, PaO2 was significantly lower (p less than 0.05) during the night with (PaO2 = 78 +/- 7 mmHg) than during the night without PD fluid (PaO2 = 92 +/- 4 mmHg). In the apneic patients, the amount of dialysate drained in the morning was negatively correlated with the minimum arterial oxygen saturation during the night (r = -0.94; p less than 0.005).


CONCLUSIONS
This study indicates a significant relationship between PD patients with chronic sleep disturbance and sleep apnea syndrome. These data suggest that apneic patients may be susceptible to complications of dialysate bulk effect on oxygen desaturation.
Wadhwa
N K
NK
Department of Medicine, State University of New York, Stony Brook.
Seliger
M
M
Greenberg
H E
HE
Bergofsky
E
E
Mendelson
W B
WB
D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010530:Peritoneal Dialysis; D010531:Peritoneal Dialysis, Continuous Ambulatory; D015995:Prevalence; D011446:Prospective Studies; D012890:Sleep / Q000502:physiology; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D013686:Telemetry