Effect of Kidney Transplantation on Sleep Disordered Breathing in End Stage Renal Disease Patients: A Polysomnographic study

Publication date: Available online 15 February 2018
Source:Sleep Medicine
Author(s): Sanjiv Mahajan, Kartik Gupta, Sanjeev Sinha, Atul Malhotra, Sandeep Mahajan
BackgroundSleep Disordered Breathing (SDB) is seen at an increased rate in patients suffering from End Stage Renal Disease (ESRD). This SDB is multifactorial with associated comorbidities like hypertension, diabetes mellitus and obesity interplaying with metabolic derangements in the form of uremia, acidosis, and hypervolemia. The renal transplant has been observed to correct most of these metabolic derangements and control progression of co-morbidities. While SDB is highly prevalent among patients in thepre-transplant stage, it remains to be seen whether the beneficial aspects of transplant are extended to improvement in SDB in ESRD patients.Methods18 patients undergoing thrice weekly hemodialysis (HD) for ESRD at the Transplant Clinic of All India Institute of Medical Sciences (AIIMS), New Delhi underwent detailed clinical, laboratory and polysomnographic evaluation. The average number of episodes of apnea and hypopnea per hour of sleep i.e.,Apnea-Hypopnea Index (AHI) was used to define the severity of sleep apnea. All patients underwent polysomnography (PSG) within 24 hours of the last HD and after 3 months of live donor transplant.ResultsOut of 18 patients, there were 14 males and 4 females. The median age was 28 years (Range 19 to 50 years). They had already spent a median period of 6 months (Range 3 to 31 months) on HD prior to inclusion. The prevalence of SDB (AHI ≥ 5/h) was 44.4% (8/18) before transplant which decreased to 5.6% (1/18) after transplant (p = 0.016). Desaturation Index had a median value of 5.8 events/hour (Range 0.1 to 35.4) in pre-transplant stage which decreased to 0 events/hour (Range 0 to 6.6) post-transplant (p=0.035).ConclusionThere was a significant improvement in the prevalence and severity of SDB after transplant. Whether improvement in SDB is sustained on long-termfollow-up remains to be seen.



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