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NDT Advance Access originally published online on September 22, 2007
Nephrology Dialysis Transplantation 2008 23(2):673-679; doi:10.1093/ndt/gfm598
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org


Nocturnal haemodialysis increases pharyngeal size in patients with sleep apnoea and end-stage renal disease

Jaime M. Beecroft1, Victor Hoffstein2, Andreas Pierratos3, Christopher T. Chan2, Philip McFarlane2 and Patrick J. Hanly1

1Department of Medicine, University of Calgary, Alberta, 2Department of Medicine, University of Toronto and 3Department of Medicine, Humber River Regional Hospital, Toronto, Ontario, Canada

Correspondence to: Patrick J. Hanly, MD, 1421 HSC, 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1. Email: phanly{at}ucalgary.ca



  Abstract

Background. Sleep apnoea is common in patients with end-stage renal disease (ESRD) and is improved by nocturnal haemodialysis (NHD). Recent findings from our laboratory indicate the development of ESRD is associated with pharyngeal narrowing. We hypothesized that NHD increases pharyngeal cross-sectional area and that this is associated with an improvement in sleep apnoea.

Methods. Twenty-four patients (aged 32–68 years), receiving conventional haemodialysis (CHD) (4 h/day, 3 days/week), were recruited for overnight polysomnography and estimation of pharyngeal cross-sectional area at functional residual capacity (FRC) and residual volume (RV). Patients were divided into apnoeic and non-apnoeic groups based on an apnoea–hypopnoea index (AHI) ≥15/h. Following conversion from CHD to NHD (8 h/night, 3–6 nights/week) all measurements were repeated and apnoeic patients were classified as ‘responders’ if AHI fell to <15 events/h.

Results. Conversion from CHD to NHD was associated with an increase in pharyngeal cross-sectional area (FRC: 3.29 ± 0.67 vs 3.39 ± 0.75 cm2; RV: 1.91 ± 0.51 vs 2.13 ± 0.48 cm2, P < 0.05), which was not significantly different between groups. Sleep apnoea improved in three patients.

Conclusions. Conversion from CHD to NHD is associated with an increase in pharyngeal cross-sectional area. This may play a role in some patients whose sleep apnoea improves on NHD.

Keywords: nocturnal haemodialysis; pharyngometry; sleep apnoea; upper airway

Received for publication: 17. 5.07
Accepted in revised form: 1. 8.07


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