Sleep disorders are underdiagnosed in patients on maintenance hemodialysis.
BACKGROUND
Sleep apnea-hypopnea syndrome (SAHS) is a cardiovascular risk factor. The aim of this study was to evaluate sleep disorders using polysomnography on a non-selected population of patients on maintenance hemodialysis.


METHODS
Overnight polysomnography was performed on 32 hemodialysis patients (24 men/8 women, 54 +/- 16 years), and on 19 healthy subjects of similar age, sex and body mass index who were used as controls.


RESULTS
In hemodialysis patients, the most frequent sleep disorder was SAHS in 44% (14/32), followed by insomnia in 41% (13/32). Compared to healthy controls, patients on hemodialysis showed less slow-wave sleep and rapid eye movement sleep (23 vs. 36%, p = 0.001), less sleep efficiency (71 vs. 87%, p = 0.0079) and a higher periodic limb movement index (39.7 vs. 9.1; p = 0.003). An increase in apnea-hypopnea index (18.9 vs. 4.3; p = 0.007) and dips in the SaO(2) (> or =4%) per hour of sleep (22.6 vs. 6.4; p = 0.021) were also significantly greater in hemodialysis patients than controls. 72% of the cases of SAHS were diagnosed solely by means of polysomnography.


CONCLUSIONS
The patients on hemodialysis showed poor sleep quality with a significant increase in the apnea-hypopnea index and in the number of dips in SaO(2). SAHS was underdiagnosed in a large percentage of the hemodialysis patients.
Jurado-Gamez
B
B
Respiratory Service, Reina Sofía University Hospital, Cordoba, Spain. bjg01co@hotmail.com
Martin-Malo
A
A
Alvarez-Lara
M A
MA
Muñoz
L
L
Cosano
A
A
Aljama
P
P
D015984:Causality; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D006435:Renal Dialysis / Q000009:adverse effects / Q000706:statistics & numerical data*; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000453:epidemiology; D012893:Sleep Wake Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D012913:Snoring / Q000175:diagnosis / Q000453:epidemiology