title: Sleep-disordered breathing predicts cardiovascular events and mortality in hemodialysis patients.
abstract: BACKGROUND
  Sleep-disordered breathing (SDB), characterized by repetitive apnea and hypopnea during sleep, is a risk factor for cardiovascular disease. However, the links between SDB and cardiovascular events in hemodialysis (HD) patients have not been clearly evaluated.
  
  
  METHODS
  We followed the clinical outcome of 94 HD patients, who underwent overnight pulse oximetry on dialysis day. The SDB group was defined as 3% oxygen desaturation index (ODI) over five events per hour, and the others were the normal group. The primary outcome was cardiovascular events and death. We used Kaplan-Meier curve and Cox proportional hazard model for survival analyses.
  
  
  RESULTS
  Forty-four patients (46.8%) were classified into the SDB group. Body mass index, diabetes mellitus, 3% ODI and Epworth sleepiness scale were significantly higher, and duration of dialysis, Kt/V, normalized protein catabolism rate and hemoglobin were lower in the SDB group than in the normal group. During a median 55 months of follow-up, Kaplan-Meier analysis revealed that the SDB group had a significantly higher rate of cardiovascular events and all-cause mortality than the normal group. Age, cardiothoracic ratio, serum albumin and 3% ODI were predictors of cardiovascular events and all-cause mortality at univariate Cox regression analysis. In the adjusted analysis, SDB is an independent predictor of increased cardiovascular events (hazard ratio 3.10; 95% confidence interval (CI), 1.35-7.12; P = 0.008) and all-cause mortality (hazard ratio 2.81; 95% CI, 1.07-7.41; P = 0.037).
  
  
  CONCLUSIONS
  SDB is an independent risk factor for cardiovascular events and mortality in HD patients. Effective and earlier treatment for these patients is needed to improve clinical outcome.
authors.affiliation: RD – Néphrologie and Groupe Rein et HTA, EA3127, Institut Universitaire de Recherche Clinique IURC-UM1, 104 rue de la Galéra, Ecole Nationale Supérieure de Chimie, 34090 Montpellier, France. mmurata@jichi.ac.jp
authors.forename: Takahiro
authors.initials: T
authors.lastname: Masuda
authors.forename: Mitsunobu
authors.initials: M
authors.lastname: Murata
authors.forename: Sumiko
authors.initials: S
authors.lastname: Honma
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Iwazu
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Sasaki
authors.forename: Manabu
authors.initials: M
authors.lastname: Ogura
authors.forename: Akira
authors.initials: A
authors.lastname: Onishi
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ando
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Muto
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Shimada
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Kario
authors.forename: Eiji
authors.initials: E
authors.lastname: Kusano
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Asano
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology* / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000401:mortality; D015996:Survival Rate
chemical_list: D010100:Oxygen