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2011

2011 Jun - Prevalence of sleep-disordered breathing in dialysis patients in a renal unit of a regional hospital in Hong Kong

Dr Anthony Pak-Yuen Yau Department of M&G, Caritas Medical Centre

Background
Sleep-disordered breathing (SDB) was being increasingly recognized as a major health issue in the general population. Several medical conditions, including end stage renal failure, were identified to be associated with sleep-disordered breathing and sleep apnoea syndrome. Previous Caucasian studies suggested that the prevalence of sleep-disordered breathing was much higher than that in the general population. There was a lack of data of the prevalence in the Chinese Population. This study investigated the prevalence of this disease in the end stage renal failure (ESRF) population in Hong Kong.

Methods
Consecutive patients who attended the renal clinic were screened and they were invited to participate if they fulfilled the inclusion criteria. Background demographics were recorded and overnight polysomnography examinations were conducted. Patients with an Apnoea-Hypopnoea Index (AHI) of five or more events per hour were diagnosed to have sleep-disordered breathing.

Results
Fifty-seven patients were screened and polysomnography examinations were performed on 33 of them. Twenty-one patients (63.6%) were diagnosed to have sleep-disordered breathing. The prevalence of sleep-disordered breathing among the haemodialysis patients and continuous peritoneal dialysis patients was 66.7% and 58.8% respectively. Among those who had sleep-disordered breathing, 40% of them had at least moderate severe diseases (AHI  15 per hour). Hypertension was present in 90.5% of the patients with sleep-disordered breathing. Among those who had sleep-disordered breathing, the mean Epworth Sleepiness Scale score was 8.1 and 42.9% of them were reported to have excessive daytime somnolence.

Conclusion
This study demonstrated a high prevalence of sleep-disordered breathing among ESRF patients. Hypertension was associated with SDB. Typical features of sleep apnoea syndrome may not occur in our ESRF patients. Using Epworth Sleepiness Scale as a screening tool may under-diagnose the disease.

Table
 
 
 
 
 
SDB
No SDB
total
p
Characteristics
n=21
n=12
n=33
 
HD:CAPD:IPD
10:10:1
5:7:0
33
-
Age
55.43+/-9.20
51.33+/-11.20
53.94+/-10.00
0.264
BMI
22.75+/-4.36
21.67+/-2.68
22.36+/-3.82
0.442
BMI>=23 (%)
9(42.9)
5(41.7)
14(42.4)
0.947
SBP (mmHg)
146.00+/-31.33
138.25+/-31.56
143.18+/-31.15
0.500
DBP (mmHg)
76.24+/-11.18
76.33+/-13.83
76.27+/-11.99
0.983
MAP (mmHg)
99.49+/-14.85
96.98+/-17.08
98.58+/-15.48
0.661
Male (%)
16(76.2)
8(66.7)
24(72.7)
0.690
Active smoker (%)
1(4.8)
2(16.7)
3(9.1)
0.538
Drinker (%)
0(0)
0(0)
0(0)
-
COPD (%)
0(0)
0(0)
0(0)
-
Asthma (%)
0(0)
1(8.3)
1(3.0)
0.364
CHF (%)
6(28.6)
2(16.7)
8(24.2)
0.678
IHD (%)
7(33.3)
3(25.0)
10(30.3)
0.710
CVA (%)
2(9.5)
0(0)
2(6.1)
0.523
DM (%)
12(57.1)
6(50.0)
18(54.5)
0.692
HT (%)
19(90.5)
6(50)
25(75.8)
0.015*
Witnessed apnoea (%)
0(0)
0(0)
0(0)
-
Snoring (%)
5(23.8)
3(25.0)
8(24.2)
1.000
Nocturnal choking (%)
1(4.8)
1(8.3)
2(6.1)
1.000
Non-refreshing sleep
7(33.3)
7(58.3)
14(42.4)
0.162
Daytime somnolence (%)
9(42.9)
11(91.7)
20(60.6)
0.009#
ESS
8.10+/-6.07
6.42+/-3.68
7.48+/-5.33
0.331
VAS fatigue score
3.85+/-2.04
3.87+/-2.60
3.86+/-2.23
0.984
BMI: body mass index;SBP: systolic blood pressure; DBP: diastolic blood pressure; MAP: mean arterial pressure
 
COPD: chronic obstructive pulmonary disease; CHF: congestive heart failure;IHD: ischemic heart disease; CVA: cerebrovascular accident; DM: diabetes
HT: hypertension;ESS: Epworth Sleepiness Scale; VAS: visual analogue scale
 
 
 
Parametric variables are presented as mean+/-SD.Data is otherwise presented as number (%)
 
 
*OR 9.50, 95% CI 1.50-60.11
#OR 0.068, 95% CI 0.007-0.629
 
 


BMI: body mass index;SBP: systolic
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