Department of Medicine, University of Calgary, Alberta, Canada.
J Clin Sleep Med. 2009 Apr 15;5(2):115-21.
Obstructive sleep apnea (OSA) is common in patients with end-stage renal disease (ESRD) and is largely underrecognized. Our objective was to determine whether the presentation of OSA in patients with ESRD differs from the stereotypical presentation in the general population (loud snoring, witnessed apnea, and daytime sleepiness in overweight, middle-aged men).
Seventy-six chronic dialysis patients with OSA were compared to 380 OSA patients with normal renal function who were matched for apnea severity (apnea-hypopnea index). All patients underwent overnight polysomnography and completed the Epworth Sleepiness Scale and a questionnaire to assess symptoms of OSA.
Age and gender distribution were similar between groups, however, body mass index was lower in the ESRD group (28 +/- 5 vs. 33 +/- 14 kg/m2). Patients with ESRD were less likely to report snoring (80% vs. 98%), witnessed apnea during sleep (32% vs. 58%), unrefreshing sleep (55% vs. 73%), and morning headaches (15% vs. 27%). Overnight polysomnography revealed less intense snoring and more sleep disturbance in patients with ESRD. The prevalence and severity of self-reported daytime sleepiness was similar between groups.
The presenting symptoms of patients with ESRD and documented OSA differed from a control group of OSA patients matched for AHI. This suggests that the presentation of ESRD patients with OSA may differ from the general population, and this should be appreciated to avoid underdiagnosis of this important comorbidity.
阻塞性睡眠呼吸暂停（OSA）在终末期肾病（ESRD）患者中很常见，但很大程度上未被识别。我们的目的是确定 ESRD 患者中 OSA 的表现是否与一般人群中典型的表现（超重、中年男性的响亮鼾声、目击呼吸暂停和日间嗜睡）不同。
将 76 例患有 OSA 的慢性透析患者与 380 例肾功能正常的 OSA 患者进行比较，这些患者的呼吸暂停严重程度（呼吸暂停低通气指数）相匹配。所有患者均接受了夜间多导睡眠图检查，并完成了嗜睡量表和评估 OSA 症状的问卷。
两组的年龄和性别分布相似，但 ESRD 组的体重指数较低（28 +/- 5 与 33 +/- 14 kg/m2）。ESRD 患者报告打鼾的可能性较小（80%与 98%），睡眠中目击呼吸暂停的可能性较小（32%与 58%），睡眠质量差（55%与 73%），晨起头痛的可能性较小（15%与 27%）。夜间多导睡眠图显示 ESRD 患者的鼾声较轻，睡眠干扰较多。两组自报日间嗜睡的患病率和严重程度相似。
有 OSA 记录的 ESRD 患者的表现与 AHI 匹配的 OSA 对照组患者不同。这表明 ESRD 合并 OSA 患者的表现可能与一般人群不同，应该认识到这一点，以避免对此重要合并症的漏诊。
