Volume overload as a mechanism for obstructive sleep apnea in CKD?
Volume overload as a mechanism for obstructive sleep apnea in CKD?
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容量超负荷是 CKD 阻塞性睡眠呼吸暂停的机制吗？
DOI：
10.1093/ndt/gfs024
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Unruh,MarkL
中科院分区：
文献类型：
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作者：
Jhamb,Manisha;Unruh,MarkL
血液透析(HD)患者中睡眠呼吸暂停的患病率为50%[1，2]，而一般人群中只有2-4%[3]。在终末期肾病(ESRD)人群中，睡眠呼吸暂停不仅会导致高血压(HTN)和心血管发病率和死亡率的增加，而且还会显著降低他们的生活质量。然而，在我们对这一脆弱人群中睡眠呼吸暂停增加的潜在机制的理解方面，存在着巨大的知识空白。传统的危险因素，如年龄和体重指数(BMI)，不能完全解释这些患者睡眠呼吸暂停风险显著增加的原因[4]。由于HTN和液体超载在HD患者中几乎普遍存在，液体滞留可能会增加发生阻塞性睡眠呼吸暂停(OSA)的风险。如果液体超载确实导致了HD患者的睡眠呼吸暂停和睡眠效率低下，那么ESRD患者的睡眠呼吸暂停的治疗可以针对改善容量控制，而不是使用许多患者无法容忍或遵守的持续气道正压(CPAP)或口腔器械。
The prevalence rate of sleep apnea in the hemodialysis (HD) patient population is> 50%[1, 2] as compared to only 2–4% in the general population [3]. Not only does sleep apnea contribute to hypertension (HTN) and increased cardiovascular morbidity and mortality in the end-stage renal disease (ESRD) population, but it also significantly impairs their quality of life. However, large gaps in knowledge exist in our understanding of the potential mechanisms for increased sleep apnea in this vulnerable population. Traditional risk factors such as age and body mass index (BMI) do not fully account for the significant increased risk of sleep apnea in these patients [4]. As HTN and fluid overload occur almost universally in HD patients, it is possible that fluid retention may increase the risk of developing obstructive sleep apnea (OSA). If, indeed, fluid overload contributes to sleep apnea and poor sleep efficiency in HD patients, then the treatment of sleep apnea among those with ESRD could be targeted to improving volume control rather than using continuous positive airway pressure (CPAP) or an oral device, which many patients are unable to tolerate or comply with.