title: Sleep disordered breathing and cardiovascular risk in older patients initiating dialysis in the United States: a retrospective observational study using medicare data.
abstract: BACKGROUND
  Sleep disordered breathing (SDB) such as sleep apnea is associated with cardiovascular disease in the general population. However, little is known about the cardiovascular risks of SDB in patients with end-stage renal disease (ESRD).
  
  
  METHODS
  We identified Medicare fee-for-service beneficiaries aged ≥67 years initiating dialysis between 2004 and 2009. Outcomes of interest included all-cause mortality, incident myocardial infarction, ischemic stroke, and atrial fibrillation. We compared patients with and without diagnosed SDB using Cox proportional hazards regression.
  
  
  RESULTS
  Between 2004 and 2009, 184,217 older patients developed ESRD, of whom 15,121 (8.2 %) were previously diagnosed with SDB. Patients diagnosed with SDB were younger, more likely to be male and Caucasian, less Medicaid eligible, had more non-Nephrology clinic visits, higher body mass index, and more comorbidity. In analyses adjusting for demographics and BMI, diagnosed SDB was associated with higher risk of death and atrial fibrillation, but not associated with myocardial infarction or ischemic stroke risk. After further adjustment for all baseline characteristics, diagnosed SDB was associated with slightly lower risks of death (hazard ratio [HR]: 0.93, 95 % confidence interval [CI]: 0.91-0.96), myocardial infarction (HR: 0.92, CI: 0.87-0.98), and ischemic stroke (HR: 0.90, 95 % CI: 0.82-0.98), and not associated with atrial fibrillation (HR: 1.02, CI: 0.98-1.07).
  
  
  CONCLUSIONS
  In older patients initiating dialysis in the U.S., diagnosed SDB was weakly associated with lower risks of death and important cardiovascular outcomes, thus adding to the list of established risk factors that are paradoxically associated with cardiovascular outcomes in the ESRD population.
authors: Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.|Department of Medicine, New York University School of Medicine, New York, NY, USA.
authors: C Vaughan
authors: CV
authors: Tuohy
authors: Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
authors: Maria E
authors: ME
authors: Montez-Rath
authors: Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.|Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
authors: Mintu
authors: M
authors: Turakhia
authors: Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
authors: Tara I
authors: TI
authors: Chang
authors: Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors: John W
authors: JW
authors: Winkelman
authors: Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA. wcw1@stanford.edu.|Department of Health Research and Policy, Stanford University School of Medicine, Palo Alto, CA, USA. wcw1@stanford.edu.|Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, One Baylor Plaza, Suite ABBR R705, Houston, TX, 77030, USA. wcw1@stanford.edu.
authors: Wolfgang C
authors: WC
authors: Winkelmayer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology*; D002545:Brain Ischemia / Q000150:complications; D002423:Cause of Death; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D008297:Male; D006278:Medicare; D009203:Myocardial Infarction / Q000453:epidemiology*; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000453:epidemiology* / Q000401:mortality; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D014481:United States / Q000453:epidemiology