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Original Research: SLEEP DISORDERS |

Declining Kidney Function Increases the Prevalence of Sleep Apnea and Nocturnal HypoxiaSleep Apnea and Chronic Kidney Disease

David D. M. Nicholl, BHSc; Sofia B. Ahmed, MD; Andrea H. S. Loewen, MD; Brenda R. Hemmelgarn, MD, PhD; Darlene Y. Sola, RN; Jaime M. Beecroft, MSc; Tanvir C. Turin, MBBS, PhD; Patrick J. Hanly, MD
Author and Funding Information

From the Department of Medicine (Mr Nicholl; Drs Ahmed, Loewen, Hemmelgarn, Turin, and Hanly; and Ms Sola), Faculty of Medicine, and Sleep Centre (Drs Loewen and Hanly and Mr Beecroft), Foothills Medical Centre, University of Calgary, Calgary, AB, Canada.

Correspondence to: Patrick J. Hanly, MD, 1421 Health Sciences Centre, 3330 Hospital Dr NW, Calgary, AB, T2N 4Z5, Canada; e-mail: phanly@ucalgary.ca


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Funding/Support: This research was supported by the Alberta Heritage Foundation for Medical Research, O’Brien Centre, University of Calgary, and the Department of Medicine, University of Calgary.


© 2012 American College of Chest Physicians


Chest. 2012;141(6):1422-1430. doi:10.1378/chest.11-1809
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Background:  Sleep apnea is an important comorbidity in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). Although the increased prevalence of sleep apnea in patients with ESRD is well established, few studies have investigated the prevalence of sleep apnea in patients with nondialysis-dependent kidney disease, and no single study, to our knowledge, has examined the full spectrum of kidney function. We sought to determine the prevalence of sleep apnea and associated nocturnal hypoxia in patients with CKD and ESRD. We hypothesized that the prevalence of sleep apnea would increase progressively as kidney function declines.

Methods:  Two hundred fifty-four patients were recruited from outpatient nephrology clinics and hemodialysis units. All patients completed an overnight cardiopulmonary monitoring test to determine the prevalence of sleep apnea (respiratory disturbance index ≥ 15) and nocturnal hypoxia (oxygen saturation < 90% for ≥ 12% of monitoring). Patients were stratified into three groups based on estimated glomerular filtration rate (eGFR) as follows: eGFR ≥ 60 mL/min/1.73 m2 (n = 55), CKD (eGFR < 60 mL/min/1.73 m2 not on dialysis, n = 124), and ESRD (on hemodialysis, n = 75).

Results:  The prevalence of sleep apnea increased as eGFR declined (eGFR ≥ 60 mL/min/1.73 m2, 27%; CKD, 41%; ESRD, 57%; P = .002). The prevalence of nocturnal hypoxia was higher in patients with CKD and ESRD (eGFR ≥ 60 mL/min/1.73 m2, 16%; CKD, 47%; ESRD, 48%; P < .001).

Conclusions:  Sleep apnea is common in patients with CKD and increases as kidney function declines. Almost 50% of patients with CKD and ESRD experience nocturnal hypoxia, which may contribute to loss of kidney function and increased cardiovascular risk.

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