The Research Of Sleep Apnea And Hypopnea Syndrome In The Patients With Chronic Kidney Disease

Objective:The sleep disordered is common in the patients with Chonic kidney disease(CKD), it includes insomnia, daytime sleepiness, sleep apnea and hypopnea syndrome(SAHS), restless leg syndrome(RLS), periodic limb movement disorder(PLMD) and so on. SAHS is a systemic disease, its mainly characterizes are sleep snoring accompanied with apnea and(or) shallow breathing, recurrently hypoxemia and hypercapnia, and sleep disorder structure, and these lead to daytime sleepiness and multiple organ damage, and seriously influence the patient,s quality of life and survival. SAHS is common in patients with CKD, its prevalence is higher than healthy adults. The existence of SAHS causes the quality of life drop in the patients with CKD, at the same time increases the complications of the patients with CKD, especially the incidence rate of cardiovascular diseases(CVD) and mortality of patients. This illness of CKD with SAHS appears hiddenly which is neglected easily. This topic propose to investigate the morbidity of snoring and SAHS and our hospital patients with CKD cognition degree of sleep apnea syndrome, to discuss the influence of SAHS for the incidence of CVD in the patients with CKD, and try to observe the influence of conventional hemodilysis treatment in the patients of CKD with SAHS.Methods:To investigated sleep questionnaire in 319 patients who were dignosed CKD in our hospital from July 2013 to May 2014.The questionnaire includes personal information(age, education, smoking, alcohol ingestion, family history, height, weight), sleep-breating situation(snoring), Epworth sleeping scale, cardiovascular disease(hypertention, congestive heart failure, uremic cardiomyopathy, hydropericardium, vascular calcification, atherosclerosis), type of kidney disease and dialysis information. To select the patients with CKD who were selected to adopt the convenient sampling, to test polysomnography(PSG) for this part patients who were combined with moderate-severe snoring. And to test PSG for the patients who combined with SAHS and treated by CHD(CHD is a hemodialysis with three times a week,and 4hours/times at daytime) respectively at the dialysis night and the night before. To analysis the relationship between the severity of CKD and the morbidity of SAHS; and to analysis the type of SAHS in the patients with CKD; and the treatment of SAHS in the patients with CKD.Results:1. The general data319 subjects were investigated into this study(173 male, 146 women), the average age was(55.04 ± 15.50)year, the average BMI was(25.29 ± 3.85) kg/m2. Average history of kidney disease was(54.99 ± 71.24) months, Among all subjects, 135 with chronic nephritis, 74 with diabetic nephropathy, 36 with hypertensive renal, 32 with nephrotic syndrome, 9 with lupus nephritis, 6 with polycystic kidney diseaseas, 6 with CAN, 5 with HSPN, 4 with renal atrophy, 3 with chronic interstitial nephropathy, 2 with medicinal nephropathy, 2with multiple myeloma renal disease, 1with occult nephropathy, 1with renal tuberculosis, 1 with renal cyst, 1with dry syndrome renal disease, 1 with Ig A nephropathy. 40 with CKD1 stage, 24 with CKD2 stage; 30 with CKD3 stage; 31 with CKD4 stage; 194 with CKD5(ESRD)stage.2. The prevalence of snoringIn 319 patients with CKD, 166 with never nnoring(52.04%), 153 with snoring(47.96%). Among with snoring group, 55 with mild snoring(35.95%), 51 with moderate snoring(33.33%), 47 with severe snoring(30.72%). The prevalence of moderate-severe snoring was 30.72%(98/319).3. The situation of ESS in the patients with CKD123 patients with ESS<9, 196 patients with ≥9.4. The prevalence of SAHSAmong 98 cases of patients with moderately severe snoring, 92 with PSG, 63 patients with SAHS, the prevalence of SAHS was 68.48%. The prevalence of mild SAHS patients with CKD was 8.70%(8/92), moderate SAHS was 17.39%(16/92), severe SAHS was 42.39%(39/92). The prevalence of SAHS with CKD1 stage patients was 40%(4/10), among this stage, mild SAHS was 10%(1/10),moderate SAHS was 10%(1/10),severe SAHS was 20%(2/10); The prevalence of SAHS with CKD2 stage patients was 50%(3/6), all were moderate to sever SAHS patients,among them, moderate SAHS was 33.33%(2/6), severe SAHS was 16.67%(1/6), mild SAHS didn’t appear in this group; The prevalence of SAHS with CKD3 stage patients was 50%(2/4), all were sever SAHS patients which prevalence rate was 50%(2/4), mild-moderate SAHS didn’t appear in this stage; The prevalence of SAHS with CKD4 stage patients was 66.67%(4/6), all were moderate to sever SAHS patients,among them moderate SAHS was 16.67%(1/6), severe SAHS was 50%(3/6), mild SAHS didn’t appear in this stage;The prevalence of SAHS with CKD5 stage patients was 75.76%(50/66), in this stage, with mild SAHS was 10.61%(7/66), with moderate SAHS was 18.18%(12/66), with severe SAHS was 46.97%(31/66).5. The relationship between degree of CKD and degree of SAHS in the patients with CKD combined SAHSThe relationship between the degree of CKD and the severity was linear correlated,with the increase of the degree of CKD,the SAHS condition degree aggravate gradually(P<0.05). The number of AHI was negatively correlated with GFR, with the decrease of GFR,AHI showed a trend of rising(R=﹣0.208, P<0.05).6. The type of SAHS in the patients with CKDTwenty-six of 63 CKD patients had OSAHS(41.27%), Thirty-four of 63 patients had CSAHS(53.97%),three of 63 patients had MSAHS(4.76%).7. The correlation between SAHS and CVD in the patients with CKDThe incidence of CVD in CKD merger SAHS was 71.43%(45/63), and 31.03%(9/29) in control group(without SAHS in CKD patients). The risk of CVD in CKD combined SAHS was 5.56 fold higher than control group(OR=5.56, 95%CI 2.13-14.48, P<0.05).8. The situation of CHD with SAHSIn 83 CHD patients, 33 with PSG, the prevalence of CKD with SAHS was 78.79%(26/33), with OSAHS was 42.31%(11/26), with CSAHS was 57.69%(15/26).9. The changes of SAHS at before CHD and after CHD treatment in the patients with ESRDThe differences of AHI, obstructive apnea index, obstructive apnea time longest,central apnea index,central apnea time longest,LSa O2 and Sa O2 less than 90% of the total time has no significant between before and after CHD in patients(P>0.05);the longest oxygen reduction time of after CHD is lower than before CHD and the difference was significant(P<0.05).10. The cognition of CKD patients319 cases of patients with CKD participate in the survey, there has 45.45 %(145)cases who think that snoring is not a disease, 24.76%(79) cases think snoring is a disease but did not need treated, 0.63%(2)think snoring is a disease and needed treated, only 0.63%(2) have already treated.Conclusion:1. SAHS is common in the patients with CKD, the prevalence of SAHS in this group was 68.48%, and the severe SAHS was primary; the prevalence of SAHS with CKD5 patients is higher than CKD1-4 patients.The type of sleep apnea in CKD patients is CSA.2. With the increase of the degree of CKD,the severity of SAHS was more and more serious.3. The patients of CKD combined SAHS may increase the risk of complicated with CVD.4. Simple Conventional hemodialysis can slightly improve the hypopxia of the patients with ESRD combined SAHS,but it is not fully improve the condition of SAHS with ESRD patients, we are going to advocate Nocturnal hemodialysis(NHD) and Continuous positive airway pressure(CPAP) synchronous treatment to improve the patient’s condition.5. The cognition and outpatient rate of snoring and SAHS for the patients with CKD was low, they didn’t aware of the dangers of snoring and SAHS on their own, so we should strengthen the health promotion and education.