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Decreased Renal Function and the Prevalence of Obstructive Sleep ApneaRenal Function and Obstructive Sleep Apnea: More Data Are Needed FREE TO VIEW

Aibek E. Mirrakhimov, MD
Author and Funding Information

From the Kyrgyz State Medical Academy.

Correspondence to: Aibek E. Mirrakhimov, MD, 2900 N Lake Shore, Chicago, IL 60657; e-mail: amirrakhimov1@gmail.com


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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


Chest. 2012;142(4):1076. doi:10.1378/chest.12-1410
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To the Editor:

I have read the study by Nicholl et al1 published in CHEST (June 2012) with a particular interest. The researchers have analyzed the home sleep monitoring data of 254 individuals with some degree of renal dysfunction (75 on hemodialysis). They have concluded that a decreased kidney function is associated with greater prevalence of obstructive sleep apnea (OSA) and nocturnal hypoxia. It is well known that kidney disease (as well as heart failure and resistant arterial hypertension) is related to volume overload, and in the supine position this extra fluid can shift toward the neck, causing increased upper airway resistance and collapsibility.2 However, this is only one potential explanation, with alternatives being possible.

Some study aspects merit a brief discussion. First, the patients with chronic kidney disease and end-stage renal disease were older, had a greater BMI, and had a greater prevalence of congestive heart failure (CHF), cerebrovascular disease, and COPD. Age and increased BMI are known risk factors of OSA, and greater prevalence of OSA in patients with worse renal function can be attributed to these variables, at least to some extent. Cerebrovascular disease and CHF can be considered as risk factors for OSA, and CHF is likely to act via the same fluid overload pathway.3,4 Thus, the greater prevalence of OSA can be a pure reflection of a greater age and multiple comorbidities but not because of the impact of renal disease.

It is also relevant to note that the home sleep monitoring used cannot reliably distinguish between OSA and central sleep apnea, which have different pathophysiologic pathways.5 An association between decreased renal function and nocturnal hypoxia can be partially explained by a higher prevalence of COPD in patients with chronic kidney disease and end-stage renal disease. Based on the aforementioned factors, longitudinal studies are needed to give the answer as to whether declining renal function is an independent risk factor for OSA.

Nicholl DDM, Ahmed SB, Loewen AHS, et al. Declining kidney function increases the prevalence of sleep apnea and nocturnal hypoxia. Chest. 2012;141(6):1422-1430. [PubMed] [CrossRef]
 
Friedman O, Bradley TD, Chan CT, Parkes R, Logan AG. Relationship between overnight rostral fluid shift and obstructive sleep apnea in drug-resistant hypertension. Hypertension. 2010;56(6):1077-1082.
 
Yumino D, Redolfi S, Ruttanaumpawan P, et al. Nocturnal rostral fluid shift: a unifying concept for the pathogenesis of obstructive and central sleep apnea in men with heart failure. Circulation. 2010;121(14):1598-1605.
 
Dyken ME, Im KB. Obstructive sleep apnea and stroke. Chest. 2009;136(6):1668-1677.
 
Malhotra A, Owens RL. What is central sleep apnea?. Respir Care. 2010;55(9):1168-1178.
 

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References

Nicholl DDM, Ahmed SB, Loewen AHS, et al. Declining kidney function increases the prevalence of sleep apnea and nocturnal hypoxia. Chest. 2012;141(6):1422-1430. [PubMed] [CrossRef]
 
Friedman O, Bradley TD, Chan CT, Parkes R, Logan AG. Relationship between overnight rostral fluid shift and obstructive sleep apnea in drug-resistant hypertension. Hypertension. 2010;56(6):1077-1082.
 
Yumino D, Redolfi S, Ruttanaumpawan P, et al. Nocturnal rostral fluid shift: a unifying concept for the pathogenesis of obstructive and central sleep apnea in men with heart failure. Circulation. 2010;121(14):1598-1605.
 
Dyken ME, Im KB. Obstructive sleep apnea and stroke. Chest. 2009;136(6):1668-1677.
 
Malhotra A, Owens RL. What is central sleep apnea?. Respir Care. 2010;55(9):1168-1178.
 
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