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Vol. 44. Issue 7.
Pages 371-375 (January 2008)
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Vol. 44. Issue 7.
Pages 371-375 (January 2008)
Original Articles
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Sleep Disorders in Patients on a Kidney Transplant Waiting List
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4357
Bernabé Jurado Gámeza,
Corresponding author
bjg01co@hotmail.com

Correspondence: Dr B. Jurado Gámez, Servicio de Neumología (UTRS), Hospital Reina Sofía, Avda. Menéndez Pidal, s/n, 14004 Cordoba, Spain
, Alejandro Martín-Malob, Mari Carmen Fernández Marína, Alberto Rodríguez-Benotb, Natalia Pascuala, Luis Muñoz Cabreraa, Pedro Aljamab
a Servicio de Neumología, Hospital Universitario Reina Sofía, Córdoba, Spain
b Servicio de Nefrología, Hospital Universitario Reina Sofía, Córdoba, Spain
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Objective

To evaluate the prevalence of sleep disorders in patients awaiting kidney transplants compared to a control group.

Patients and methods

We carried out an observational study of 23 patients on a kidney transplant waiting list in comparison with 20 healthy volunteers matched for age, sex, and body mass index (BMI). Overnight polysomnography was performed and a diagnosis of sleep apnea-hypopnea syndrome (SAHS) established when the apnea-hypopnea index (AHI) was 10 or higher.

Results

Eighty-two percent of the patients awaiting kidney transplants (16 men and 7 women with a mean [SD] age of 51 [15] years and a mean BMI of 25 [3.8] kg/m2) had some type of sleep disorder. The most frequent disorders were SAHS (48%) and insomnia and periodic limb movement disorder (30%). Patients showed poorer sleep efficiency compared to the control group (75.4% vs 87.8%; P=.01) and a lower percentage of slow-wave and rapid eye movement sleep (24.5% vs 40%; P=.001). Those with sleep-disordered breathing had a higher AHI (17.7 vs 3.6; P=.00l) and oxygen desaturation index (31.5 compared to 8.2; P=.00l).

Conclusions

Sleep disorders are common in patients awaiting kidney transplants. Such patients show reduced quantity and quality of sleep compared to controls and a significantly elevated number of respiratory events that may affect morbidity and mortality.

Key words:
Apnea-hypopnea index
Oxygen desaturation index
Chronic renal failure
Kidney transplantation
Sleep disorders
Sleep-disordered breathing
Objetivo

Valorar la prevalencia de los trastornos del sueno en pacientes en lista de espera de trasplante renal, comparados con un grupo control.

Pacientes y métodos

Se ha realizado un estudio observacional en 23 pacientes en lista de espera para trasplante renal, cuyos resultados se compararon con los de 20 personas sanas que accedieron voluntariamente a participar en él. Se empare-jaron por edad, sexo e indice de masa corporal. Se efectuó una polisomnografía de noche completa y el diagnóstico de síndro-me de apneas-hipopneas durante el sueño se estableció cuando el índice de apneas-hipopneas era como mínimo de 10.

Resultados

Los pacientes en lista de espera para trasplante renal (16 varones y 7 mujeres; edad media ± desviación estáandar: 51 ± 15 años; índice de masa corporal: 25 ± 3,8 kg/m2) presentaron en un 82% de los casos algún trastorno del sueño. Los más frecuentes fueron el síndrome de apneas-hipopneas durante el sueñssso (48%) e insomnio y síndrome de movimiento periódico de piernas (30%). Los pacientes presentaron, respecto al grupo control, una menor eficiencia del sueño (el 75,4 frente al 87,8%; p = 0,01) y un menor porcentaje de sueño de ondas lentas y REM (un 24,5 frente a un 40%; p = 0,001), mientras que los trastornos respiratorios del sueño mostraron un mayor índice de apneas-hipopneas (17,7 frente a 3,6; p = 0,001) e indice de desaturación (31,5 frente a 8,2; p = 0,001).

Conclusiones

Los trastornos del sueño son frecuentes en pacientes en lista de espera para trasplante renal, quienes, respecto al grupo control, tienen una menor cantidad y calidad del sueño, con un número significativamente elevado de eventos respiratorios, que pueden influir en la morbimortalidad.

Palabras clave:
Índice de apneas-hipopneas del sueño
Índice de desaturación
Insuficiencia renal crónica
Trasplante renal
Trastornos del sueño
Trastornos respiratorios del sueño
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References
[1]
JM Marín, SJ Carrizo, F Vicente, A Agustí.
Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study.
Lancet, 365 (2005), pp. 1046-1053
[2]
HK Yaggi, J Concato, WN Kernan, JH Lichtman, LM Brass, V Mohsenin.
Obstructive sleep apnea as a risk factor for stroke and death.
N Engl J Med, 353 (2005), pp. 2034-2041
[3]
M Ceballos, K López-Revuelta, R Saracho, F García López, P Castro, JA Gutiérrez, et al.
Informe de diálisis y trasplante correspondiente al año 2002 de la Sociedad Española de Nefrología y Registro Autonómicos.
Nefrología, 25 (2005), pp. 121-129
[4]
United States Renal Data System-USRDS. 2003. Mortality and causes of death. Available from: http://www.usrds.org/2002/pdf/h.pdf
[5]
C Zoccali, F Mallamaci, G Tripepi.
Nocturnal hypoxemia predicts incident cardiovascular complications in dialysis patients.
J Am Soc Nephrol, 13 (2002), pp. 729-733
[6]
HH Jung, H Han, JH Lee.
Sleep apnea, coronary artery disease, and antioxidant status in hemodialysis patients.
Am J Kidney Dis, 45 (2005), pp. 875-882
[7]
NK Wadhwa, S Akhtar.
Sleep disorders in dialysis patients.
Semin Dial, 11 (1998), pp. 287-297
[8]
MA Kraus.
Sleep apnea in renal failure.
Adv Perit Dial, 13 (1997), pp. 88-92
[9]
U Kuhlmann, HF Becker, M Birkhahn, JH Peter, P von Wichert, S Schütterle, et al.
Sleep-apnea in patients with end-stage renal disease and objective results.
Clin Nephrol, 53 (2000), pp. 460-466
[10]
B Langevin, D Fouque, P Leger, D Robert.
Sleep apnea syndrome and end-stage renal disease: cure after renal transplantation.
Chest, 103 (1993), pp. 1330-1335
[11]
D Auckley, W Schmidt-Nowara, LK Brown.
Reversal of sleep apnea hypopnea syndrome in end-stage renal disease after kidney transplantation.
Am J Kidney Dis, 34 (1999), pp. 739-744
[12]
B Jurado-Gámez, A Martín-Malo, MA Álvarez-Lara, Cabrera Muñoz, A Cosano Povedano, P Aljama.
Sleep disorders are underdiagnosed in patients on maintenance hemodialysis.
Nephron, 105 (2007), pp. 35-42
[13]
J Perl, ML Unruh, CT Chan.
Sleep disorders in end-stage renal disease: markers of inadequate dialysis?.
Kidney Int, 70 (2006), pp. 1687-1693
[14]
CJ Oliveira Rodrigues, O Marson, S Tufic, O Kohlmann Jr, SM Guimaraes, P Togeiro, et al.
Relationship among end-stage renal disease, hypertension, and sleep apnea in nondiabetic dialysis patients.
Am J Hypertens, 18 (2005), pp. 152-157
[15]
Grupo Español de Sueño (GES).
Consenso nacional sobre el síndrome de apneas-hipopneas del sueño.
Arch Bronconeumol, 41 (2005), pp. 1-110
[16]
R Moreno Zabala, J Sayas Catalán, MJ Díaz de Atauri, E González Montes, V Pérez González, JM Morales.
Prevalencia de síndrome de apneas-hipopneas durante el sueño en una población con insuficiencia renal crónica terminal pendiente de trasplante renal.
Arch Bronconeumol, 42 (2006), pp. 60
[17]
E Chiner, JM Arriero, J Signes-Costa, J Marco, I Fuentes.
Validación de la versión española del test de somnolencia Epworth en pacientes con síndrome de apnea de sueño.
Arch Bronconeumol, 35 (1999), pp. 422-427
[18]
JW Johns.
A new method for measuring daytime sleepiness. The Epworth Sleepiness Scale.
Sleep, 14 (1991), pp. 540-545
[19]
MW Johns.
Sensitivity and specificity of Multiple Sleep Latency Test (MSLT), the Maintenance of Wakefulness Test and the Epworth Sleepiness Scale: failure of the MSLT as a gold standard.
J Sleep Res, 9 (2000), pp. 5-11
[20]
A Rechtschaffen, A Kales.
A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects, Government Printing Office, (1968),
[21]
American Sleep Disorders Association.
The Atlas Task Force. EEG arousals: scoring rules and examples.
Sleep, 15 (1992), pp. 174-184
[22]
RP Allen, D Picchietti, WA Hening, C Trenkwalder, AS Walters, J Montplaisir.
Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology: a report from the restless syndrome diagnostic and epidemiology workshop at the National Institutes of Health.
Sleep Med, 4 (2003), pp. 101-119
[23]
DSC Hui, TYH Wong, FWS Ko, TST Li, DKL Choy, KK Wong, et al.
Prevalence of sleep disturbances in Chinese patients with end-stage renal failure on continuous ambulatory peritoneal dialysis.
Am J Kidney Dis, 36 (2000), pp. 783-788
[24]
I Mucsi, MZ Molnar, C Ambrus, L Szeifert, A Kovacs, J Pap, et al.
Restless legs syndrome, insomnia and quality of life in patients on maintenance dialysis.
Nephrol Dial Trasplant, 20 (2005), pp. 571-575
[25]
G Merlino, A Piani, P Dolso, M Adorati, I Cancelli, M Valente, et al.
Sleep disorders in patients with end-stage renal disease undergoing dialysis therapy.
Nephrol Dial Trasplant, 21 (2006), pp. 184-190
[26]
M Sabbatini, B Minale, A Crispo, A Pisani, A Ragosta, R Esposito, et al.
Insomnia in maintenance hemodialysis patients.
Nephrol Dial Trasplant, 17 (2002), pp. 852-856
[27]
ML Unruh, AS Levey, C D'Ambrosio, NE Fink, NR Powe, KB Meyer.
Choices for Healthy Outcomes in caring for End-Stage Renal Disease (CHOICE) study: restless legs symptoms among incident dialysis patients: association with lower quality of life and shorter survival.
Am J Kidney Dis, 43 (2004), pp. 900-909
[28]
G Gigli, M Adorati, P Dolso, A Piani, M Valente, S Brotini, et al.
Restless legs syndrome in end-stage renal disease.
Sleep Med, 5 (2003), pp. 309-315
[29]
JW Winkelman, GM Chertow, JM Lazarus.
Restless legs syndrome in end-stage renal disease.
Am J Kidney Dis, 28 (1996), pp. 372-378
[30]
AI Pack.
Advances in sleep-disordered breathing.
Am J Respir Crit Care Med, 73 (2006), pp. 7-15
[31]
M Yamauchi, H Nakano, J Maekawa, Y Okamoto, Y Ohnishi, T Suzuki, et al.
Oxidative stress in obstructive sleep apnea.
Chest, 127 (2005), pp. 1674-1679
[32]
M Hayashi, K Fujimoto, K Urushibata, A Takamizawa, O Kinoshita, K Kubo.
Hypoxia-sensitive molecules may modulate the development of atherosclerosis in sleep apnoea syndrome.
[33]
Y Peker, J Carlson, J Hedner.
Increased incidence of coronary artery disease in sleep apnoea: a long-term follow-up.
Eur Respir J, 28 (2006), pp. 596-602
[34]
C Zoccali, FA Benedetto, Tripepi, F Cambareri, V Panuccio, V Candela, et al.
Nocturnal hypoxemia, night-day arterial pressure changes and left ventricular geometry in dialysis patients.
Kidney Int, 53 (1998), pp. 1078-1084
[35]
C Zoccali, FA Benedetto, F Mallamaci, G Tripepi, V Candela, C Labate, et al.
Left ventricular hypertrophy and nocturnal hypoxemia in hemodialysis patients.
J Hypertens, 19 (2001), pp. 287-293
[36]
PJ Hanly, A Pierratos.
Improvement of sleep apnea in patients with chronic renal failure who undergo nocturnal hemodialysis.
N Engl J Med, 344 (2001), pp. 102-107
[37]
CT Chan, P Hanly, J Gabor, P Picton, A Pierratos, JS Floras.
Impact of nocturnal hemodialysis on the variability of heart rate and duration of hypoxemia during sleep.
Kidney Int, 65 (2004), pp. 661-665
[38]
J Beecroft, J Duffin, A Pierratos, CT Chan, P McFarlane, PJ Hanly.
Enhanced chemo-responsiveness in patients with sleep apnoea and end-stage renal disease.
Eur Respir J, 28 (2006), pp. 151-158
[39]
J Durán, S Esnaola, R Rubio, A Iztueta.
Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr.
Am J Respir Crit Care Med, 163 (2001), pp. 685-689
[40]
JM Marín, JM Gascón, S Carrizo, J Gispert.
Prevalence of sleep apnoea in the Spanish adult population.
Intern J Epidemiol, 26 (1997), pp. 381-386
[41]
RC Basner.
Continuous positive airway pressure for obstructive sleep apnea.
N Engl J Med, 356 (2007), pp. 1751-1758
[42]
CA Kushida, MR Littner, M Hirshkowitz, TI Morgenthaler, CA Alessi, D Bailey, et al.
Practice parameters for the use of continuous and bilevel positive airways pressure devices to treat adult patients with sleep-related breathing disorders.
Sleep, 29 (2006), pp. 375-380
[43]
MP Pressman, RL Benz, CR Schleifer, DD Peterson.
Sleep disordered breathing in ESRD: acute beneficial effects of treatment with nasal continuous positive airway pressure.
Kidney Int, 43 (1993), pp. 1134-1139
[44]
DI Loube, PC Gay, KP Strohl, AI Pack, DP White, NA Collop.
Indications for positive airway pressure treatment of adult obstructive sleep apnea patients: a consensus statement.
Chest, 115 (1999), pp. 863-866
Copyright © 2008. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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