Langevin B, Fouque D, Léger P, Robert D
Intensive Care Unit, Hôpital Croix-Rousse, Lyon, France.
Chest. 1993 May;103(5):1330-5. doi: 10.1378/chest.103.5.1330.
We report two patients undergoing maintenance hemodialysis who presented with sleep apnea syndrome (SAS). The first patient is a 36-year-old man with a terminal Berger's glomerulopathy and associated obstructive sleep apnea syndrome (OSAS) (apnea-hypopnea index [AHI] = 80). He was receiving home hemodialysis and was treated by nasal continuous positive airway pressure (CPAP). After successful renal transplantation, his symptoms completely disappeared, and control polysomnography greatly improved (AHI = 9). The second patient had hypokalemic nephropathy with severe, uncontrolled hypertension and hypertensive myocardiopathy. He was receiving home dialysis and showed a central sleep apnea syndrome with an AHI of 51. He also was successfully treated by nasal CPAP. After renal transplantation, his sleep improved, insomnia disappeared, and polysomnography showed great improvement (AHI = 5). We discuss the role of periodic breathing related to end-stage renal disease associated metabolic abnormalities, as a pathogenetic factor of these SASs. Respiratory correction of chronic metabolic acidosis, "uremic toxins," "middle molecules," and hemodialysis are all evoked as etiologic factors and their own roles are discussed.
我们报告了两名接受维持性血液透析且出现睡眠呼吸暂停综合征（SAS）的患者。首例患者是一名36岁男性，患有终末期伯杰氏肾小球病及相关阻塞性睡眠呼吸暂停综合征（OSAS）（呼吸暂停低通气指数[AHI]=80）。他接受家庭血液透析，并采用经鼻持续气道正压通气（CPAP）治疗。肾移植成功后，其症状完全消失，对照多导睡眠监测结果显著改善（AHI=9）。第二例患者患有低钾性肾病，伴有严重的、难以控制的高血压和高血压性心肌病。他接受家庭透析，表现为中枢性睡眠呼吸暂停综合征，AHI为51。他也通过经鼻CPAP成功治疗。肾移植后，其睡眠改善，失眠消失，多导睡眠监测结果显示显著改善（AHI=5）。我们讨论了与终末期肾病相关代谢异常有关的周期性呼吸作为这些SAS发病因素的作用。慢性代谢性酸中毒、“尿毒症毒素”、“中分子物质”的呼吸纠正以及血液透析均被提及为病因因素，并对它们各自的作用进行了讨论。
