Nocturnal hypoxemia and periodic limb movement predict mortality in patients on maintenance hemodialysis.
OBJECTIVE
Sleep disorders, including sleep-disordered breathing and periodic limb movements during sleep, are associated with an increased risk for cardiovascular diseases, which are the leading causes of death in patients with ESRD. This study investigated the association between sleep disorders and mortality in patients with ESRD.


METHODS
Thirty patients on maintenance hemodialysis, who were clinically stable for >2 months, underwent overnight polysomnography to evaluate sleep parameters.


RESULTS
All patients were followed for a median of 48 months (range: 14 to 62 months), and 14 of them died during the follow-up period. Among the sleep parameters, the percent of sleep time with arterial oxygen saturation <90% (T <90%), mean arterial oxygen saturation, and periodic limb movement index score were associated with significant increases in the risk of death. However, associations of the apnea-hypopnea index or oxygen desaturation index with mortality were NS. The hazard ratios (95% confidence intervals) for death per one SD increment in the log-transformed T <90% and periodic limb movement index score were 2.10 (1.06 to 4.15) and 2.48 (1.11 to 5.52), respectively, after adjusting for age.


CONCLUSIONS
We found that nocturnal hypoxemia and periodic limb movement during sleep, rather than apnea itself, were associated with an increased risk for death in patients with ESRD. However, conclusions from this study should be drawn with caution, because they are limited by the small sample size.
Department of Internal Medicine, Kangwon National University Hospital, Chunchon, Kangwon 200-947, Korea. haehyuk@kangwon.ac.kr
Hae Hyuk
HH
Jung
Jung Hie
JH
Lee
Hyun Jeong
HJ
Baek
Seong Jae
SJ
Kim
Jeong Jin
JJ
Lee
D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001798:Blood Proteins / Q000378:metabolism; D002423:Cause of Death; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000097:blood / Q000401:mortality* / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000097:blood / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D020189:Nocturnal Myoclonus Syndrome / Q000097:blood / Q000401:mortality* / Q000503:physiopathology; D010100:Oxygen / Q000097:blood; D017286:Polysomnography; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000401:mortality*; D056910:Republic of Korea / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D012890:Sleep; D012891:Sleep Apnea Syndromes / Q000097:blood / Q000401:mortality* / Q000503:physiopathology; D013997:Time Factors; D020107:Troponin T / Q000097:blood; D055815:Young Adult; D060749:alpha-2-HS-Glycoprotein
C556354:AHSG protein, human; D015415:Biomarkers; D001798:Blood Proteins; D020107:Troponin T; D060749:alpha-2-HS-Glycoprotein; D020097:Natriuretic Peptide, Brain; D010100:Oxygen