title: Prevalence and Diagnostic Approach to Sleep Apnea in Hemodialysis Patients: A Population Study.
abstract: BACKGROUND
  Previous observations found a high prevalence of obstructive sleep apnea (OSA) in the hemodialysis population, but the best diagnostic approach remains undefined. We assessed OSA prevalence and performance of available screening tools to propose a specific diagnostic algorithm.
  
  
  METHODS
  104 patients from 6 Swiss hemodialysis centers underwent polygraphy and completed 3 OSA screening scores: STOP-BANG, Berlin's Questionnaire, and Adjusted Neck Circumference. The OSA predictors were identified on a derivation population and used to develop the diagnostic algorithm, which was validated on an independent population.
  
  
  RESULTS
  We found 56% OSA prevalence (AHI ≥ 15/h), which was largely underdiagnosed. Screening scores showed poor performance for OSA screening (ROC areas 0.538 [SE 0.093] to 0.655 [SE 0.083]). Age, neck circumference, and time on renal replacement therapy were the best predictors of OSA and were used to develop a screening algorithm, with higher discriminatory performance than classical screening tools (ROC area 0.831 [0.066]).
  
  
  CONCLUSIONS
  Our study confirms the high OSA prevalence and highlights the low diagnosis rate of this treatable cardiovascular risk factor in the hemodialysis population. Considering the poor performance of OSA screening tools, we propose and validate a specific algorithm to identify hemodialysis patients at risk for OSA for whom further sleep investigations should be considered.
authors.affiliation: Department of Nephrology and Hypertension, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland.
authors.forename: Valentina
authors.initials: V
authors.lastname: Forni Ogna
authors.affiliation: Centre for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland.
authors.forename: Adam
authors.initials: A
authors.lastname: Ogna
authors.affiliation: Department of Nephrology and Hypertension, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland.
authors.forename: Menno
authors.initials: M
authors.lastname: Pruijm
authors.affiliation: Department of Nephrology and Hypertension, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Bassi
authors.affiliation: Department of Nephrology and Hypertension, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland.
authors.forename: Emilie
authors.initials: E
authors.lastname: Zuercher
authors.affiliation: Hemodialysis Unit, Northern Vaud Hospital, 1400 Yverdon, Switzerland.
authors.forename: Georges
authors.initials: G
authors.lastname: Halabi
authors.affiliation: Hemodialysis Unit, Broye Intercantonal Hospital, 1530 Payerne, Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: Phan
authors.affiliation: Hemodialysis Unit, EHC Hospital, 1110 Morges, Switzerland.
authors.forename: Roberto
authors.initials: R
authors.lastname: Bullani
authors.affiliation: Department of Nephrology and Hypertension, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Teta
authors.affiliation: Hemodialysis Unit, Riviera Providence Hospital, 1800 Vevey, Switzerland.
authors.forename: Thierry
authors.initials: T
authors.lastname: Gauthier
authors.affiliation: Hemodialysis Unit, Cecil Clinic, 1011 Lausanne, Switzerland.
authors.forename: Anne
authors.initials: A
authors.lastname: Cherpillod
authors.affiliation: Hemodialysis Unit, Cecil Clinic, 1011 Lausanne, Switzerland.
authors.forename: Claudine
authors.initials: C
authors.lastname: Mathieu
authors.affiliation: Centre for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Mihalache
authors.affiliation: Centre for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland.
authors.forename: Francoise
authors.initials: F
authors.lastname: Cornette
authors.affiliation: Centre for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland.
authors.forename: José
authors.initials: J
authors.lastname: Haba-Rubio
authors.affiliation: Department of Nephrology and Hypertension, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland.
authors.forename: Michel
authors.initials: M
authors.lastname: Burnier
authors.affiliation: Centre for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland.
authors.forename: Raphaël
authors.initials: R
authors.lastname: Heinzer
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D012372:ROC Curve; D006435:Renal Dialysis; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000453:epidemiology*; D013557:Switzerland / Q000453:epidemiology