title: A systematic review of central sleep apnea in adult patients with chronic kidney disease.
abstract: BACKGROUND
  Obstructive sleep apnea has been widely studied in patients with chronic renal insufficiency; however only a limited number of studies have reviewed the association between central sleep apnea (CSA) and chronic kidney disease (CKD). The objectives of this systematic review were to assess the prevalence of CSA in and its association with CKD in adult patients and to determine if inclusion of the central hypopnea index affected the reported rates for the prevalence of CSA in CKD.
  
  
  METHODS
  Medline, Web of Science, Google Scholar, Scopus, and Cochrane Library were searched through October 2015 without any language limitations.
  
  
  RESULTS
  Of 188 articles searched, 8 articles met our study inclusion criteria. Of a cumulative total of 313 patients with CKD undergoing sleep study, a total of 30 patients were diagnosed with central sleep apnea. Three studies had patients with coexistent congestive heart failure, six studies included some patients on dialysis and at least 3 studies included central hypopneas while calculating central sleep apnea index.
  
  
  CONCLUSIONS
  The aggregate point prevalence of CSA in CKD is 9.6 %, although the estimated range is highly variable between 0 and 75 %. Limited evidence suggested that even after adjustment for cardiovascular comorbidities, CKD is independently associated with CSA. It is unknown if patients on dialysis are at increased risk compared to patients without end-stage renal disease. Standardization of polysomnographic criteria used to define CSA and sleep disordered breathing (SDB) as well as inclusion of central hypopneas in the overall CSA index will limit the heterogeneity and allow better estimation of the prevalence of CSA in patients with CKD.
authors.affiliation: Clay County Hospital, 911 Stacy Burk Drive, Flora, IL, 62839, USA. dr.nigamgaurav@gmail.com.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Nigam
authors.affiliation: NSCB Medical College, Nagpur Road, Jabalpur, 482003, India.
authors.forename: Charu
authors.initials: C
authors.lastname: Pathak
authors.affiliation: Twin Cities Community Hospital, 1100 Las Tablas Rd, Templeton, CA, 93465, USA.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Riaz
mesh_terms: D000328:Adult; D000368:Aged; D045422:Continuous Positive Airway Pressure; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D020182:Sleep Apnea, Central / Q000150:complications* / Q000453:epidemiology* / Q000628:therapy; D013223:Statistics as Topic
keywords: Apnea-hypopnea index; Central sleep apnea; Chronic kidney disease; Congestive heart failure; Hemodialysis; Prevalence; Sleep disordered breathing
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