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NDT Advance Access published online on October 5, 2006
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfl582
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received June 17, 2006
Accepted August 24, 2006

Original Papers

Sleep apnoea in end-stage renal disease: a short review of mechanisms and potential benefit from its treatment

Indranil Chakravorty 1 *, Manu Shastry 2, and Ken Farrington 3

1 Department of Respiratory Medicine, East & North Herts NHS Trust, Lister Hospital, Stevenage, Herts, UK
2 Medicine, East & North Herts NHS Trust, Lister Hospital, Stevenage, Herts, UK
3 Department of Renal Medicine, East & North Herts NHS Trust, Lister Hospital, Stevenage, Herts, UK

* To whom correspondence should be addressed.
Indranil Chakravorty, E-mail: Indranil.chakravorty{at}nhs.net



  Abstract

Background Patients with end-stage renal disease (ESRD) are known to have a high morbidity and mortality. Sleep apnoea (SA) (both central and obstructive) has been shown to be highly prevalent in these patients. Co-existent SA may be an additional independent risk factor substantially increasing the mortality risk.

Methods Potential mechanisms include poorly controlled hypertension, increased after-load, increased sympathomimetic activity, reduced vagal tone and the impact of nocturnal hypoxia on cardiovascular arrhythmia.

There are complex homoeostatic relationships in patients with SA causing daytime fluid retention, nocturnal enuresis and nocturia. This may impact adversely on myocardial workload and the effectiveness of renal replacement therapy. Treatment of SA with CPAP may improve survival by modifying cardiovascular risk factors in ESRD patients and perhaps even reduce the progression of disease.

Conclusions This review examines the mechanisms and interactions of SA with ESRD and the potential impact of the reversal of co-existent SA on the health of patients with this condition. The benefits may extend beyond survival and improvement in quality of life to potential savings accruing from a delayed renal replacement therapy in pre-ESRD patients. These potential benefits may only be realized if there is an increased awareness of SA among renal physicians and a lower threshold for investigation and treatment.

Keywords: atrial natriuretic peptide; brain natriuretic peptide; chronic heart failure; continuous positive airway pressure; end-stage renal disease; sleep apnoea.
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