PURPOSE: Cardiovascular disease is the leading cause of death for patients with end stage renal disease and after renal transplantation. Although cardiovascular disease has a well described association with obstructive sleep apnea (OSA), few studies have examined echocardiographic findings of renal transplant recipients with OSA. In this study, we aimed to describe the echocardiographic findings of renal transplant patients and make comparisons in subjects with and without OSA.
METHODS: We performed a retrospective study of 35 renal transplant recipients who underwent polysomnography post-transplantation for sleep disturbances between 1989 and 2009. Demographic data, height, weight, immunosuppressants, and echocardiographic data were gathered. Sleep analysis data including apnea hypopnea index (AHI) and oxygen desaturation index were collected. Comparisons were made between subjects with and without OSA.
RESULTS: The study group consisted of middle aged obese men and women. The mean age of subjects was 54+/-10.2 years with a mean BMI 37.6+/-6.9). 24 of 35 (79.6%) patients had OSA with an AHI greater than 5 events per hour. One patient with systolic heart failure had central sleep apnea. Ten subjects (28.5%) did not have OSA. 31 of 35 subjects had echocardiographic data available. The mean left ventricular (LV) ejection fraction was 46.12%+/-14.88. Collectively,12/34 (35%) of renal transplant patients had echocardiographic evidence of diastolic dysfunction, 2/34 subjects had LV hypertrophy, 1/34 had evidence of systolic dysfunction, 1/34 with severe mitral regurgitation, and 1/34 subjects had evidence of pulmonary hypertension (right ventricular systolic pressure RVSP of 78 mmHg). Findings of elevated RVSP were noted amongst 8 subjects with a mean of 46.12+/-14.88 mmHg. 13/20 (65%) of subjects with OSA had evidence of systolic or diastolic dysfunction or LV hypertrophy compared to 3/10 (30%) of the non-OSA group.
CONCLUSIONS: The incidence of systolic and diastolic heart failure is higher in renal transplant recipients with OSA.
CLINICAL IMPLICATIONS: Renal transplant recipients with OSA have a higher incidence of echocardiographic findings of cardiovascular disease. Further study with a larger cohort is necessary to determine the significance of this data.
DISCLOSURE: The following authors have nothing to disclose: Marcia Henderson, Miranda Boucher, Shirley Jones
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