As in heart failure, obstructive and central sleep apnoea (OSA and CSA, respectively) are common in end-stage renal disease. Fluid overload characterises end-stage renal disease and heart failure, and in heart failure plays a role in the pathogenesis of OSA and CSA. We postulated that in end-stage renal disease patients, those with sleep apnoea would have greater fluid volume overload than those without.
End-stage renal disease patients on thrice-weekly haemodialysis underwent overnight polysomnography on a nondialysis day to determine their apnoea–hypopnoea index (AHI). Extracellular fluid volume of the total body, neck, thorax and right leg were measured using bioelectrical impedance.
28 patients had an AHI ≥15 (sleep apnoea group; OSA:CSA 21:7) and 12 had an AHI <15 (no sleep apnoea group). Total body extracellular fluid volume was 2.6 L greater in the sleep apnoea group than in the no sleep apnoea group (p=0.006). Neck, thorax, and leg fluid volumes were also greater in the sleep apnoea than the no sleep apnoea group (p<0.05), despite no difference in body mass index (p=0.165).
These findings support a role for fluid overload in the pathogenesis of both OSA and CSA in end-stage renal disease.
Fluid overload plays a key role in the pathogenesis of OSA and CSA in end-stage renal disease http://ow.ly/zSZo308a8TP
Support statement: Operating grant MOP-82731 from the Canadian Institutes of Health Research. O.D. Lyons was supported by a joint Canadian Thoracic Society/European Respiratory Society Peter Macklem Research Fellowship and the Joseph M. West Family Memorial Fund Postgraduate Research Award, T. Inami by an unrestricted fellowship from Philips Respironics (Japan), C.T. Chan by the R. Fraser Elliot Chair in Home Dialysis, A. Yadollahi by fellowships from the Toronto Rehabilitation Institute, Mitacs Elevate programme and a CIHR Training Grant in Sleep and Biological Rhythms, and T.D. Bradley by the Clifford Nordal Chair in Sleep Apnoea and Rehabilitation Research, and the Godfrey S. Pettit Chair in Respiratory Medicine. Funding information for this article has been deposited with the Open Funder Registry.
Conflict of interest: None declared.
- Received September 8, 2016.
- Accepted January 5, 2017.
- Copyright ©ERS 2017