Sleep apnea syndrome........

Submitted by Mr CS Soong

Kidney International (2010) 77, 1031–1038;

Sydney C W Tang 1,2, Bing Lam 1, Tzy Jyun Yao 3, Wah Shing
Leung 2, Chung Ming Chu 2, Yiu Wing Ho 2, Mary S M Ip 1 and
Kar Neng Lai 1

1 Department of Medicine, The University of Hong Kong, Queen
Mary Hospital, Hong Kong China
2 Department of Medicine and Geriatrics, United Christian
Hospital, Hong Kong, China
3 Clinical Trials Center, The University of Hong Kong, Queen
Mary Hospital, Hong Kong, China

Abstract

Sleep apnea syndrome is increasingly recognized in
peritoneal dialysis patients; however, its prognostic
implication in this population is unknown.

To study this, we prospectively followed the clinical outcome of 93 peritoneal
dialysis patients with baseline polysomnography. Of these,
51 were diagnosed with the syndrome defined by an
apnea–hypopnea index (AHI) of at least 15 per hour. During a
median follow-up of 41 months, there were 30 deaths, of
which 17 were due to cardiovascular causes.

Kaplan–Meier analysis for the entire follow-up period
indicated that patients with sleep apnea at baseline had
significantly higher all-cause and cardiovascular mortality
during follow-up than those without. Minimal nocturnal
saturation and desaturation indices were predictors of
mortality and cardiovascular events at univariate analysis.
Multivariable Cox regression analysis identified significant
sleep apnea syndrome at baseline as an independent predictor
of increased all-cause mortality independent of age, male
gender, and diabetic status. Further, an absolute increase
in the AHI was associated with an incremental risk of
cardiovascular events.

Thus, sleep apnea syndrome, detected at the start of
peritoneal dialysis, is a novel risk predictor for
subsequent mortality and cardiovascular events.