Pharyngeal narrowing in end-stage renal disease: Implications for obstructive sleep apnoea

¹ Dept of Medicine, University of Calgary, Alberta, Canada
² Dept of Medicine, University of Toronto, Ontario, Canada
³ Dept of Medicine, Humber River Regional Hospital, Toronto, Ontario, Canada

^* To whom correspondence should be addressed. E-mail: phanly{at}ucalgary.ca.

	Abstract

Sleep apnoea is common in patients with end-stage renal disease (ESRD). We hypothesized this is related to a narrower upper airway. We compared upper airway dimensions in patients with and without ESRD and sleep apnoea to determine whether upper airway changes associated with ESRD could contribute to the development of sleep apnoea. An acoustic reflection technique was used to estimate pharyngeal cross-sectional area. Sleep apnoea was assessed by overnight polysomnography. Forty-four patients with ESRD receiving conventional hemodialysis and 41 subjects with normal renal function were studied. ESRD and control groups were further categorized by the presence or absence of sleep apnoea (apnoea-hypopnoea index 10 events·hr^-1). Pharyngeal area was smaller in patients with ESRD compared to those with normal renal function (functional residual capacity: 3.04±0.84 cm² vs. 3.46±0.80 cm²; residual volume: 1.99±0.51 cm² vs. 2.14±0.58 cm²). The pharynx is narrower in patients with ESRD than those with normal renal function. Since a narrower upper airway predisposes to upper airway occlusion during sleep, we suggest that this contributes to the pathogenesis of sleep apnoea in dialysis-dependant patients.

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