Department of Nephrology, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India.
Department of Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India.
Sleep Med. 2018 May;45:140-145. doi: 10.1016/j.sleep.2017.11.1151. Epub 2018 Feb 15.
Sleep-disordered breathing (SDB) is common in patients with end-stage renal disease (ESRD). SDB is associated with comorbidities such as hypertension, diabetes mellitus, and obesity, interplaying with metabolic derangements in the form of uremia, acidosis, and hypervolemia. Renal transplant has been observed to correct most of these metabolic derangements and to control progression of comorbidities. While SDB is highly prevalent among patients in the pretransplant stage, it remains to be seen whether the beneficial aspects of transplant are extended to improvement in SDB in patients with ESRD.
Eighteen patients undergoing thrice-weekly hemodialysis (HD) for ESRD at the transplant clinic of All India Institute of Medical Sciences (AIIMS), New Delhi, underwent detailed clinical, laboratory, and polysomnographic evaluation. The average number of apneas and hypopneas per hour of sleep, ie, Apnea-Hypopnea Index (AHI), was used to define the severity of sleep apnea. All patients underwent polysomnography (PSG) within 24 h of the last HD and after three months of living-donor transplant.
Of 18 patients, there were 14 males and four females. The median age was 28 years (range 19-50 years). They had already spent a median period of six months (range 3-31 months) on HD before inclusion. The prevalence of SDB (AHI ≥ 5/h) was 44.4% (8/18) before transplant, which decreased to 5.6% (1/18) after transplant (p = 0.016). The oxygen desaturation index had a median value of 5.8 events/h (range 0.1-35.4) in the pretransplant stage, which decreased to 0 events/h (range 0-6.6) in the post-transplant stage (p = 0.035).
There was a significant improvement in the prevalence and severity of SDB after transplant. Whether improvement in SDB is sustained on a long-term follow-up remains to be seen.
睡眠呼吸障碍（SDB）在终末期肾病（ESRD）患者中很常见。SDB 与高血压、糖尿病和肥胖等合并症有关，与尿毒症、酸中毒和高血容量等代谢紊乱相互作用。肾移植已被观察到可纠正这些代谢紊乱的大部分，并控制合并症的进展。虽然 SDB 在移植前阶段的患者中非常普遍，但仍需观察移植的有益方面是否扩展到改善 ESRD 患者的 SDB。
在新德里全印度医学科学研究所（AIIMS）的移植诊所，18 名接受每周三次血液透析（HD）治疗 ESRD 的患者接受了详细的临床、实验室和多导睡眠图评估。每小时睡眠的呼吸暂停和低通气次数，即呼吸暂停低通气指数（AHI），用于定义睡眠呼吸暂停的严重程度。所有患者在最后一次 HD 后 24 小时内和活体供者移植后三个月进行多导睡眠图（PSG）。
18 名患者中，有 14 名男性和 4 名女性。中位年龄为 28 岁（范围 19-50 岁）。他们在纳入前已经接受了中位 6 个月（范围 3-31 个月）的 HD。移植前 SDB（AHI≥5/h）的患病率为 44.4%（18/18），移植后降至 5.6%（1/18）（p=0.016）。移植前的氧减饱和度指数中位数为 5.8 次/h（范围 0.1-35.4），移植后降至 0 次/h（范围 0-6.6）（p=0.035）。
移植后 SDB 的患病率和严重程度有显著改善。SDB 的改善是否在长期随访中持续存在还有待观察。
