The influences of maintenance hemodialysis on sleep architecture and sleep apnea in the patients with chronic renal failure

Park, Yong Geun; Lee, Sang Haak; Choi, Young Mee; Ahn, Seok Joo; Kwon, Soon Seog; Kim, Young Kyoon; Kim, Kwan Hyoung; Song, Jeong Sup; Park, Sung Hak; Moon, Hwa Sik

Abstract

BACKGROUND: Sleep-related breathing disorders are commonly found in patients with chronic renal failure and particularly, sleep apnea may have an influence on the long-term mortality rates in these pa tients. Maintenance hemodialysis is the mainstay of medical measures for correcting the metabolic derangements of chronic renal failure but it is uncertain whether it may alleviate sleep disorders including sleep apnea.
METHODS
Forty seven patients on maintenance hemodialysis were surveyed with the sleep questionnaire about their clinical symptoms related to sleep disorders. Among them, 15 patients underwent the polysomnography and their blood levels of urea nitrogen, creatinine, electrolytes and the arterial blood gases in the nights before and following hemodialysis were measured.
RESULTS
Forty (85.1%) of the 47 patients complained of the symptoms associated with sleep-wake cycle disturbances, 55.3% experienced snoring and 27.7% reported witnessed apneas. The duration of REM sleep increased significantly in the nights after hemodialysis compared to the nights without hemodialysis (p<0.05) and the percentage of total sleep time comprising NREM sleep decreased significantly in the nights following hemodialysis compared to the nights before hemodialysis (p<0.05). The percentage of total sleep time consisting of the stage 1 and 2 NREM sleep showed the trend for a decrease in the nights after hemodialysis (p=0.051), while the percentage of total sleep time comprising the stage 3 and 4 NREM sleep did not change between nights. Tne obstructive sleep apnea was more predominant type than the central one in both nights and there were no differences in the apnea index and the apnea-hypopnea index between the nights. The decrease in the blood level of urae nitrogen, creatinine, potassium and phoshorus was observed after hemodialysis (p<0.05), but the differences of paramenters measured during polysomnography between the nights did not correlate with the changes of biochemical factors obtained on the two night. Arterial blood gas analysis showed that pH was significantly greater in the nights after hemodialysis than in the nights before hemodialysis (p<0.05), but there were no correlations between the parameters examined during polysomnography and the parameters of arterial blood gas anslysis (p<0.05).
CONCLUSION
These results suggest that chronic renal failure is an important systemic disorder which is strongly associated with sleep disorders. Maintenance hemodialysis, although it is a widely accepted measure to treat chronic renal failre, did not significantly modulate the sleep architecture and the severity of sleep apnea. Thus, taking the patients with chronic renal failure into account, it is advisable to try not only to find a substantial way for correcting metabolic derangements but also to consider the institution of more effective treatments for sleep disorders.