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Enhanced chemo-responsiveness in patients with sleep apnoea and end-stage renal disease

Depts of ¹ Medicine, and ² Anaesthesia & Physiology, University of Toronto, and ³ Dept of Medicine, Humber River Regional Hospital, Toronto, ON, and ⁴ Dept of Medicine, University of Calgary, Calgary, AB, Canada.

CORRESPONDENCE: P. J. Hanly, 1421 Health Sciences Center, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1 Canada. Fax: 1 4032836151. E-mail: phanly{at}ucalgary.ca

Keywords: Chemoreflex, dialysis, kidney failure, respiratory control

Received: June 27, 2005
Accepted February 14, 2006

Although sleep apnoea is very common in patients with end-stage renal disease, the physiological mechanisms for this association have not yet been determined. The current authors hypothesised that altered respiratory chemo-responsiveness may play an important role.

In total, 58 patients receiving treatment with chronic dialysis were recruited for overnight polysomnography. A modified Read rebreathing technique, which is used to assess basal ventilation, ventilatory sensitivity and threshold, was completed before and after overnight polysomnography. Patients were divided into apnoeic (n = 38; apnoea/hypopnoea index (AHI) 35±22 events·h^-1) and nonapnoeic (n = 20; AHI 3±3 events·h^-1) groups, with the presence of sleep apnoea defined as an AHI >10 events·h^-1. While basal ventilation and the ventilatory recruitment threshold were similar between groups, ventilatory sensitivity during isoxic hypoxia (partial pressure of oxygen (P_O2) 6.65 kPa) and hyperoxia (P_O2 19.95 kPa) was significantly greater in apnoeic patients. Overnight changes in chemoreflex responsiveness were similar between groups.

In conclusion, these data indicate that the responsiveness of both the central and peripheral chemoreflexes is augmented in patients with sleep apnoea and end-stage renal disease. Since increased ventilatory sensitivity to hypercapnia destabilises respiratory control, the current authors suggest this contributes to the pathogenesis of sleep apnoea in this patient population.

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