TY - JOUR
T1 - Sleep apnea in end-stage renal disease patients
T2 - risk factors and mortality
AU - Prabu, Pranav
AU - Acree, Lillian
AU - Waller, Jennifer L.
AU - Linder, Daniel F
AU - Bollag, Wendy B.
AU - Mohammed, Azeem Abdul
AU - Padala, Sandeep Anand
AU - Healy, William
AU - Kheda, Mufaddal
AU - Baer, Stephanie L.
AU - Dillard, Thomas A
AU - Taskar, Varsha
N1 - Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the AU Department of Medicine Translational Research Program, a grant from Dialysis Clinic, Inc., and the Medical College of Georgia Medical Scholars Program. The contents of this article do not represent the views of the Department of Veterans Affairs or the United States Government. The data reported here have been supplied by the USRDS, This manuscript has been supported by funding from Dialysis Clinic, Inc. under grant C-3953.
Publisher Copyright:
© 2023 American Federation for Medical Research.
PY - 2023/6
Y1 - 2023/6
N2 - Sleep apnea (SA) is highly prevalent in the end-stage renal disease (ESRD) population. However, the impact of SA on mortality in ESRD is unclear. This study investigates the relationship between SA and mortality in ESRD. The United States Renal Data System was queried in a retrospective cohort study to identify ESRD patients aged 18–100 years who initiated hemodialysis between 2005 and 2013. Diagnoses of SA and comorbidities were determined from International Classification of Disease-9 codes and demographic variables from Centers for Medicare and Medicaid Services Form-2728. Cox proportional hazards models were used to examine the association of SA with mortality controlling for multiple variables. Of 858,131 subjects meeting inclusion criteria, 587 were found to have central SA (CSA) and 22,724 obstructive SA (OSA). The SA cohort was younger and more likely to be male and Caucasian compared to the non-SA cohort, with more diagnoses of tobacco and alcohol use, hypertension, heart failure, and diabetes. Both CSA (adjusted hazard ratio (aHR) = 1.42, 95% confidence interval (CI): 1.29–1.56) and OSA (aHR = 1.35, 95% CI: 1.32–1.37) were associated with increased mortality. Other variables associated with increased mortality included age, dialysis initiation with a catheter or graft, alcohol use, hypertension, and cardiovascular disease. Factors associated with decreased mortality included female sex, black race, Hispanic ethnicity, diagnosis of heart failure or diabetes, and an ESRD etiology of glomerulonephritis or polycystic kidney disease. Since a diagnosis of either OSA or CSA increases mortality risk, early identification of SA and therapy in this ESRD population may improve survival.
AB - Sleep apnea (SA) is highly prevalent in the end-stage renal disease (ESRD) population. However, the impact of SA on mortality in ESRD is unclear. This study investigates the relationship between SA and mortality in ESRD. The United States Renal Data System was queried in a retrospective cohort study to identify ESRD patients aged 18–100 years who initiated hemodialysis between 2005 and 2013. Diagnoses of SA and comorbidities were determined from International Classification of Disease-9 codes and demographic variables from Centers for Medicare and Medicaid Services Form-2728. Cox proportional hazards models were used to examine the association of SA with mortality controlling for multiple variables. Of 858,131 subjects meeting inclusion criteria, 587 were found to have central SA (CSA) and 22,724 obstructive SA (OSA). The SA cohort was younger and more likely to be male and Caucasian compared to the non-SA cohort, with more diagnoses of tobacco and alcohol use, hypertension, heart failure, and diabetes. Both CSA (adjusted hazard ratio (aHR) = 1.42, 95% confidence interval (CI): 1.29–1.56) and OSA (aHR = 1.35, 95% CI: 1.32–1.37) were associated with increased mortality. Other variables associated with increased mortality included age, dialysis initiation with a catheter or graft, alcohol use, hypertension, and cardiovascular disease. Factors associated with decreased mortality included female sex, black race, Hispanic ethnicity, diagnosis of heart failure or diabetes, and an ESRD etiology of glomerulonephritis or polycystic kidney disease. Since a diagnosis of either OSA or CSA increases mortality risk, early identification of SA and therapy in this ESRD population may improve survival.
KW - central sleep apnea
KW - end-stage renal disease
KW - mortality
KW - obstructive sleep apnea
KW - Sleep apnea
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U2 - 10.1177/10815589231162541
DO - 10.1177/10815589231162541
M3 - Article
C2 - 36945195
AN - SCOPUS:85159125125
SN - 1081-5589
VL - 71
SP - 465
EP - 470
JO - Journal of Investigative Medicine
JF - Journal of Investigative Medicine
IS - 5
ER -