Hypervolemia and Sleep Apnea in Kidney Disease.
In end-stage renal disease (ESRD) and heart failure, conditions characterized by fluid overload, both obstructive sleep apnea (OSA) and central sleep apnea (CSA) are highly prevalent. This observation suggests that fluid overload may be a unifying mechanism in the pathogenesis of both OSA and CSA in these conditions. An overnight rostral fluid shift from the legs to the neck and lungs has been shown to contribute to the pathogenesis of OSA and CSA, respectively, in various different patient populations. This article reviews the evidence that supports a role for fluid overload and overnight fluid shift in the pathogenesis of sleep apnea in ESRD. The diagnosis, epidemiology, and clinical features of sleep apnea in patients with ESRD also are considered.
Sleep Research Laboratory of the University Health Network Toronto Rehabilitation Institute, Toronto, Ontario, Canada; Centre for Sleep Medicine and Circadian Biology, University of Toronto, Toronto, Ontario, Canada. Electronic address: owen.lyons@uhn.ca.
Owen D
OD
Lyons
Sleep Research Laboratory of the University Health Network Toronto Rehabilitation Institute, Toronto, Ontario, Canada; Centre for Sleep Medicine and Circadian Biology, University of Toronto, Toronto, Ontario, Canada; Division of Respirology, University of Toronto, Toronto, Ontario, Canada.
T Douglas
TD
Bradley
Division of Nephrology, Department of Medicine, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada.
Christopher T
CT
Chan
D000137:Acid-Base Imbalance; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000503:physiopathology; D011187:Posture; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000209:etiology* / Q000503:physiopathology; D014883:Water-Electrolyte Imbalance / Q000209:etiology* / Q000503:physiopathology
End-stage renal disease; central sleep apnea; fluid overload; fluid shift; obstructive sleep apnea