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A systematic review of central sleep apnea in adult patients with chronic kidney disease

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Background

Obstructive sleep apnea has been widely studied in patients with chronic renal insufficiency; however only a limited number of studies have reviewed the association between central sleep apnea (CSA) and chronic kidney disease (CKD). The objectives of this systematic review were to assess the prevalence of CSA in and its association with CKD in adult patients and to determine if inclusion of the central hypopnea index affected the reported rates for the prevalence of CSA in CKD.

Methods

Medline, Web of Science, Google Scholar, Scopus, and Cochrane Library were searched through October 2015 without any language limitations.

Results

Of 188 articles searched, 8 articles met our study inclusion criteria. Of a cumulative total of 313 patients with CKD undergoing sleep study, a total of 30 patients were diagnosed with central sleep apnea. Three studies had patients with coexistent congestive heart failure, six studies included some patients on dialysis and at least 3 studies included central hypopneas while calculating central sleep apnea index.

Conclusion

The aggregate point prevalence of CSA in CKD is 9.6 %, although the estimated range is highly variable between 0 and 75 %. Limited evidence suggested that even after adjustment for cardiovascular comorbidities, CKD is independently associated with CSA. It is unknown if patients on dialysis are at increased risk compared to patients without end-stage renal disease. Standardization of polysomnographic criteria used to define CSA and sleep disordered breathing (SDB) as well as inclusion of central hypopneas in the overall CSA index will limit the heterogeneity and allow better estimation of the prevalence of CSA in patients with CKD.

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Author contributions

GN is the guarantor of the manuscript and takes full responsibility for the integrity of the presented data and the accuracy of the data analysis. GN is the principal investigator of the study. GN, CP, and MR contributed to the study concept and design, data acquisition and analysis, data interpretation, drafting of the manuscript, and approval of the final manuscript.

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Authors and Affiliations

  1. Clay County Hospital, 911 Stacy Burk Drive, Flora, IL, 62839, USA

    Gaurav Nigam

  2. NSCB Medical College, Nagpur Road, Jabalpur, 482003, India

    Charu Pathak

  3. Twin Cities Community Hospital, 1100 Las Tablas Rd, Templeton, CA, 93465, USA

    Muhammad Riaz

Authors
  1. Gaurav Nigam
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  2. Charu Pathak
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  3. Muhammad Riaz
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Corresponding author

Correspondence to Gaurav Nigam.

Ethics declarations

Not applicable as this is a systematic review.

Funding

No funding was received for this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Informed consent

Not applicable as this is a systematic review.

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Comments

The review is on an important clinical aspect in sleep medicine, which has not been well explored. The review demonstrates the limitations of the studies currently available on this subject.

The discussion is important since it concludes that, due to methodological limitations, final conclusions cannot be established yet.

Luciana Palombini

Sao Paulo, Brazil

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Nigam, G., Pathak, C. & Riaz, M. A systematic review of central sleep apnea in adult patients with chronic kidney disease. Sleep Breath 20, 957–964 (2016). https://doi.org/10.1007/s11325-016-1317-0

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  • DOI: https://doi.org/10.1007/s11325-016-1317-0

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