title: Obstructive sleep apnea in patients on conventional and short daily hemodialysis.
abstract: Obstructive sleep apnea (OSA) is common among patients on maintenance hemodialysis. However, the factors associated with the origin of OSA as well as the cardiovascular consequences in this population are not completely understood. We evaluated, by standard overnight polysomnography, 24-hour ambulatory blood pressure (BP) monitoring and echocardiography in 30 patients (14 males, age 34 +/- 11 years, BMI 23.2 +/- 5.2) - 15 on short daily hemodialysis (SDH) and 15 matched patients on conventional hemodialysis (CHD). The hemodialysis dose (standard Kt/V) was higher in patients on SDH than on CHD (p = 0.001). OSA (apnea-hypopnea index >5 events/h) was present in 13 patients (43%). Patients with OSA were predominantly males (77 vs. 44%), presented a higher BMI (25.5 +/- 6.2 vs. 21.5 +/- 3.6), a larger neck circumference (38 +/- 1 vs. 34 +/- 1 cm) and a lower Kt/V (2.6 +/- 0.3 vs. 2.2 +/- 0.1) than patients with no OSA (p < 0.05). Neck circumference and lower Kt/V were independently associated with OSA on multivariate analysis. No patient with Kt/V >2.5 (n = 10) presented OSA. On the other hand, hypertensive patients with OSA needed more BP control pills (p = 0.03). Despite similar BP control, patients with OSA presented a higher interventricular septum thickness (11.5 +/- 0.5 vs. 9.9 +/- 0.3 mm; p = 0.011). In conclusion, among patients on maintenance hemodialysis, the traditional risk factors for OSA are present and interact with hemodialysis efficiency. Among these patients, OSA is associated with difficult BP control and heart remodeling suggesting that OSA may contribute to poor cardiovascular outcome.
authors.affiliation: Division of Nephrology, Hospital das Clínicas, Universtiy of São Paulo School of Medicine, São Paulo, Brazil. rosilenemotta@hotmail.com
authors.forename: Rosilene Motta
authors.initials: RM
authors.lastname: Elias
authors.forename: Manuel Carlos Martins
authors.initials: MC
authors.lastname: Castro
authors.forename: Eduardo Lyra
authors.initials: EL
authors.lastname: de Queiroz
authors.forename: Hugo
authors.initials: H
authors.lastname: Abensur
authors.forename: João Egidio
authors.initials: JE
authors.lastname: Romão
authors.forename: Geraldo
authors.initials: G
authors.lastname: Lorenzi-Filho
mesh_terms: D000328:Adult; D000367:Age Factors; D018660:Blood Pressure Monitoring, Ambulatory; D015992:Body Mass Index; D004452:Echocardiography; D005260:Female; D015312:Hemodialysis Solutions / Q000008:administration & dosage*; D006801:Humans; D006973:Hypertension / Q000150:complications*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000033:anatomy & histology; D017286:Polysomnography; D011446:Prospective Studies; D006435:Renal Dialysis / Q000592:standards*; D012307:Risk Factors; D012737:Sex Factors; D020181:Sleep Apnea, Obstructive / Q000209:etiology*; D020257:Ventricular Remodeling; D055815:Young Adult
chemical_list: D015312:Hemodialysis Solutions