Obstructive Sleep Apnea and Objective Sleep Quality in Non-Dialysed Patients with Chronic Kidney Disease: An European Sleep Apnea Database (ESADA) Study - European Medical Journal
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Obstructive Sleep Apnea and Objective Sleep Quality in Non-Dialysed Patients with Chronic Kidney Disease: An European Sleep Apnea Database (ESADA) Study

Authors:
*Oreste Marrone,1 Fabio Cibella,1 Gabriel Roisman,2 Pawel Sliwinski,3 Ozen K. Basoglu,4 Sophia Schiza,5 Izolde Bouloukaki,5 Athanasia Pataka,6 Richard Staats,7 Johan Verbraecken,8 Ludger Grote,9 Jan Hedner,9 Maria R. Bonsignore10
Disclosure:

Dr Grote has received grants from the Philips Respironics Foundation, the Resmed Foundation, Bayer AG, and the European Respiratory Society (ERS)supporting the ESADA; speakers bureau fees from Resmed, Philips, Itamar, and Fisher&Paykel; and grants from Resmed and  Itamar outside the submitted work. In addition, Dr Grote has a patent and sleep apnea treatment licensed. Dr Verbraecken has received personal fees from ResMed, Philips, Sanofi, Agfa-Gevaert, Bioprojet, Jazz Pharmaceutics, and Springer; and grants from ResMed, Bioprojet, Jazz Pharmaceutics, AirLiquide, Westfalen Medical, SomnoMed, Vivisol, Total Care, Medidis, Fisher & Paykel, Wave Medical, OSG, Mediq Tefa, NightBalance, Heinen & Löwenstein, AstraZen, Accuramed, Bekaert Deslee Academy, and UCB Pharma (outside the submitted work). Dr Hedner has received grants from ResMed, Philips Respironics, and the  European Respiratory Society (ERS), all related to maintenance of database on behalf of the ESADA group during the conduct of the study. All other authors have declared no conflicts of interest.

Citation
EMJ Respir. ;7[1]:64-65. Abstract No AR04.

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.

BACKGROUND

Short sleep duration and poor sleep quality have been reported in chronic kidney disease (CKD). Additionally, sleep disordered breathing (SDB), a well-known cause of disturbed sleep, is highly prevalent in CKD. The majority of studies on sleep quality in CKD were  focussed on dialysed patients, were based on subjective reports, and did not consider possible coexistence of SDB.1 Only a small number of studies assessed sleep quality on polysomnographic data in non-dialysed patients with CKD.2

AIM

The aim of this study was to evaluate objective sleep quality based on electroencephalographic (EEG) recordings during nocturnal polysomnography in non-dialysed patients with CKD, taking into account coexisting SDB and psychiatric diagnoses.

METHODS

The European Sleep Apnea Database (ESADA) cohort includes patients studied for suspected obstructive sleep apnea from numerous European sleep centres. From this cohort, 375 non-dialysed CKD patients who had undergone full polysomnography were matched one-by-one with 375 non-CKD patients. CKD was defined as an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73m2. Matching criteria were sleep centre, age, sex, and apnea-hypopnea index (AHI). Total sleep time and percentage duration of each sleep stage were compared between cases and controls. The analysis was repeated in 310 patients and controls with no psychiatric diagnosis and who did not use psycholeptic or psychoanaleptic drugs.

RESULTS

CKD patients (eGFR=48.3±11.4 mL/min/1.73m2) were marginally more obese, exhibited worse sleep hypoxaemia, and displayed more comorbidities than controls, including arterial hypertension, Type 2 diabetes mellitus, and congestive heart failure. However, these patients did not differ from controls in any evaluated objective sleep parameter. The sample was subdivided into three groups, each of which included patients and matched controls, according to AHI tertiles. The duration of each sleep stage differed depending on AHI tertile (all p<0.001); whereas, no difference was detected between CKD patients and controls within each AHI tertile. Exclusion of patients with a psychiatric diagnosis did not modify the results.

CONCLUSIONS

Objective sleep quality is not affected by CKD in patients with moderate reduction of eGFR, independent of SDB and psychiatric diagnosis. Varying AHI is associated with parallel changes in sleep stage distribution in patients with and without CKD. Previously reported poor sleep quality and duration in CKD may partly be because of the high prevalence of SDB in CKD.

References
Plantinga L et al. Association of sleep-related problems with CKD in the United States, 2005-2008. Am J Kidney Dis. 2011;58(4):554-64. Ogna A et al. Sleep characteristics in early stages of chronic kidney disease in the HypnoLaus cohort. Sleep. 2016;39(4):945-53.