Sleep-disordered breathing predicts cardiovascular events and mortality in hemodialysis patients

Takahiro Masuda, Mitsunobu Murata, Sumiko Honma, Yoshitaka Iwazu, Nobuhiro Sasaki, Manabu Ogura, Akira Onishi, Yasuhiro Ando, Shigeaki Muto, Kazuyuki Shimada, Kazuomi Kario, Eiji Kusano, Yasushi Asano

Research output: Contribution to journalArticlepeer-review

61 Scopus citations

Abstract

Background. Sleep-disordered breathing (SDB), characterized by repetitive apnea and hypopnea during sleep, is a risk factor for cardiovascular disease. However, the links between SDB and cardiovascular events in hemodialysis (HD) patients have not been clearly evaluated.Methods. We followed the clinical outcome of 94 HD patients, who underwent overnight pulse oximetry on dialysis day. The SDB group was defined as 3% oxygen desaturation index (ODI) over five events per hour, and the others were the normal group. The primary outcome was cardiovascular events and death. We used Kaplan-Meier curve and Cox proportional hazard model for survival analyses.Results. Forty-four patients (46.8%) were classified into the SDB group. Body mass index, diabetes mellitus, 3% ODI and Epworth sleepiness scale were significantly higher, and duration of dialysis, Kt/V, normalized protein catabolism rate and hemoglobin were lower in the SDB group than in the normal group. During a median 55 months of follow-up, Kaplan-Meier analysis revealed that the SDB group had a significantly higher rate of cardiovascular events and all-cause mortality than the normal group. Age, cardiothoracic ratio, serum albumin and 3% ODI were predictors of cardiovascular events and all-cause mortality at univariate Cox regression analysis. In the adjusted analysis, SDB is an independent predictor of increased cardiovascular events (hazard ratio 3.10; 95% confidence interval (CI), 1.35-7.12; P = 0.008) and all-cause mortality (hazard ratio 2.81; 95% CI, 1.07-7.41; P = 0.037).Conclusions. SDB is an independent risk factor for cardiovascular events and mortality in HD patients. Effective and earlier treatment for these patients is needed to improve clinical outcome.

Original languageEnglish
Pages (from-to)2289-2295
Number of pages7
JournalNephrology Dialysis Transplantation
Volume26
Issue number7
DOIs
StatePublished - Jul 2011
Externally publishedYes

Keywords

  • cardiovascular events
  • hemodialysis
  • mortality
  • oxygen desaturation index
  • sleep-disordered breathing

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