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

¹ Dept of Medicine, University of Toronto
² Depts of Anaesthesia & Physiology, University of Toronto
³ Dept of Medicine, Humber River Regional Hospital, Toronto, Ontario
⁴ Dept of Medicine, University of Calgary, Alberta, Canada

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

	Abstract

Although sleep apnoea is very common in patients with end-stage renal disease, the physiologic mechanisms for this association have not been determined. We hypothesized that altered respiratory chemo-responsiveness may play an important role.

Fifty-eight patients receiving treatment with chronic dialysis were recruited for overnight polysomnography. A modified Read rebreathing technique used to assess basal ventilation, ventilatory sensitivity and threshold was completed before and after overnight polysomnography. Patients were divided into apneic (n=38, apnoea-hypopnoea index 35±22 events·hr^-1) and non-apneic (n=20, apnoea-hypopnoea index 3±3 events·hr^-1) groups with the presence of sleep apnoea defined as an apnoea-hypopnoea index >10 events·hr^-1. While basal ventilation and ventilatory recruitment threshold were similar between groups, ventilatory sensitivity during isoxic hypoxia (P_O2 50 mmHg) and hyperoxia (P_O2 150 mmHg) was significantly greater in apneic patients. Overnight changes in chemoreflex responsiveness were similar between groups.

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 destabilizes respiratory control, we suggest this contributes to the pathogenesis of sleep apnoea in this patient population.

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