Sleep apnea, coronary artery disease, and antioxidant status in hemodialysis patients.
BACKGROUND
It recently was suggested that sleep apnea syndrome (SAS) is associated with the cardiovascular complications and outcomes seen in patients with end-stage renal disease (ESRD). This study investigates the association of SAS with coronary artery disease and antioxidant status in patients with ESRD.


METHODS
Twenty-six hemodialysis patients underwent overnight polysomnography to evaluate sleep parameters. We performed multirow spiral computed tomography to derive coronary artery calcification (CAC) scores as an indicator of the severity of coronary artery disease and measured predialysis serum total antioxidant status (TAS) as a marker of antioxidant defenses.


RESULTS
Nine of 26 patients had normal to mild SAS with an apnea-hypopnea index (AHI) less than 15, 9 patients had moderate SAS with an AHI of 15 to 30, and the remaining 8 patients had severe SAS with an AHI greater than 30. AHI and oxygen desaturation index (ODI) were strongly interrelated (r = 0.754; P < 0.001). CAC severity was associated with SAS severity: median CAC scores increased (P = 0.009) with increasing AHI category. However, values for TAS were not significantly different among the 3 AHI categories. CAC score also correlated positively (r = 0.564; P = 0.003) with ODI, and TAS correlated negatively (r = -0.539; P = 0.005) with ODI.


CONCLUSIONS
These results suggest that frequent oxygen desaturation triggered by SAS is associated with severe coronary artery disease and decreased antioxidant status in patients with ESRD. However, conclusions from this study should be drawn with caution because of its methodological limitations (cross-sectional design, heterogeneity of study population, and small number of patients).
Jung
Hae Hyuk
HH
Department of Internal Medicine, Kangwon National University Hospital, College of Medicine, Kangwon National University, Chuncheon, Kangwon-do, Republic of Korea. jhielee@mail.kangwon.ac.kr
Han
Heon
H
Lee
Jung Hie
JH
D000975:Antioxidants / Q000032:analysis*; D002114:Calcinosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D000860:Hypoxia / Q000209:etiology / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications* / Q000628:therapy; D007723:Korea; D008297:Male; D008875:Middle Aged; D010084:Oxidation-Reduction; D018384:Oxidative Stress; D010100:Oxygen / Q000097:blood*; D017286:Polysomnography; D006435:Renal Dialysis; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000503:physiopathology; D012907:Smoking / Q000453:epidemiology; D036542:Tomography, Spiral Computed
D000975:Antioxidants; D010100:Oxygen