title: Sleep apnea prevalence in chronic kidney disease - association with total body water and symptoms.
abstract: Sleep apnea is common and associated with poor outcome in severe chronic kidney disease, but validated screening tools are not available. Our objectives were to determine the prevalence of sleep apnea in this population, to assess the validity of screening for sleep apnea using an ApneaLink device and to investigate the relationship of sleep apnea to; symptoms, spirometry and body water.
  
  
  
  Patients with glomerular filtration rate ≤30 mL/min/1.73 m2, whether or not they were receiving haemodialysis, were eligible for enrolment. Participants completed symptom questionnaires, performed an ApneaLink recording and had total body water measured using bioimpedance. This was followed by a multi-channel polysomnography recording which is the gold-standard diagnostic test for sleep apnea.
  
  
  
  Fifty-seven participants were enrolled and had baseline data collected, of whom only 2 did not have sleep apnea. An apnea hypopnea index ≥30/h was found in 66% of haemodialysis and 54% of non-dialysis participants. A central apnea index ≥5/h was present in 11 patients, with only one dialysis patient having predominantly central sleep apnea. ApneaLink underestimated sleep apnea severity, particularly in the non-dialysis group. Neither total body water corrected for body size, spirometry, subjective sleepiness nor overall symptom scores were associated with sleep apnea severity.
  
  
  
  This study demonstrates a very high prevalence of severe sleep apnea in patients with chronic kidney disease. Sleep apnea severity was not associated with quality of life or sleepiness scores and was unrelated to total body water corrected for body size. Routine identification of sleep apnea with polysomnography rather than screening is more appropriate in this group due to the high prevalence.
authors.affiliation: Department of Respiratory and Sleep Medicine, The Canberra Hospital, Garran, ACT, Australia. Richard.singer@act.gov.au.|The Australian National University Medical School, Acton, ACT, Australia. Richard.singer@act.gov.au.
authors.forename: Hsin-Chia
authors.initials: HC
authors.lastname: Huang
authors.affiliation: Department of Renal Medicine, The Canberra Hospital, Garran, ACT, Australia.|The Australian National University Medical School, Acton, ACT, Australia.
authors.forename: Giles
authors.initials: G
authors.lastname: Walters
authors.affiliation: Department of Renal Medicine, The Canberra Hospital, Garran, ACT, Australia.|The Australian National University Medical School, Acton, ACT, Australia.
authors.forename: Girish
authors.initials: G
authors.lastname: Talaulikar
authors.affiliation: Department of Respiratory and Sleep Medicine, The Canberra Hospital, Garran, ACT, Australia.
authors.forename: Derek
authors.initials: D
authors.lastname: Figurski
authors.affiliation: Department of Respiratory and Sleep Medicine, The Canberra Hospital, Garran, ACT, Australia.
authors.forename: Annette
authors.initials: A
authors.lastname: Carroll
authors.affiliation: Department of Respiratory and Sleep Medicine, The Canberra Hospital, Garran, ACT, Australia.|The Australian National University Medical School, Acton, ACT, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Hurwitz
authors.affiliation: Department of Renal Medicine, The Canberra Hospital, Garran, ACT, Australia.|The Australian National University Medical School, Acton, ACT, Australia.
authors.forename: Krishna
authors.initials: K
authors.lastname: Karpe
authors.affiliation: Department of Renal Medicine, The Canberra Hospital, Garran, ACT, Australia.|The Australian National University Medical School, Acton, ACT, Australia.
authors.forename: Richard
authors.identifier: 0000-0001-8180-6732
authors.initials: R
authors.lastname: Singer
mesh_terms: D000368:Aged; D001315:Australia / Q000453:epidemiology; D001834:Body Water; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D015995:Prevalence; D011788:Quality of Life; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000378:metabolism / Q000503:physiopathology; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000453:epidemiology* / Q000503:physiopathology; D011795:Surveys and Questionnaires
keywords: Body water; Chronic kidney failure; Quality of life; Renal dialysis; Sleep