Sleep Apnea and Chronic Kidney Disease – A State of the Art Review.
Patients with chronic kidney disease have increased morbidity and mortality, mainly due to cardiovascular disease. Compared to the general population, patients with chronic kidney disease have an increased prevalence of both obstructive and central sleep apnea, and the presence of sleep apnea in this population has been associated with an increased risk of cardiovascular events and mortality. While obstructive sleep apnea can lead to an increase in the rate of kidney function decline, there is also evidence that the presence of end stage renal disease can lead to worsening of sleep apnea, indicating a bidirectional relationship between sleep apnea and chronic kidney disease. The objective of this review is to describe the epidemiology of sleep apnea in chronic kidney disease, understand the pathophysiological mechanisms by which obstructive sleep apnea can lead to progression of chronic kidney disease, and consider the role of treatment with continuous positive airways pressure in this regard. The review also explores the pathophysiological mechanism by which end stage renal disease can lead to sleep apnea and considers how intensification of renal replacement therapy or extra fluid removal by ultrafiltration may attenuate the degree of sleep apnea severity in this population.