• Rosilene M Elias, T Douglas Bradley, Takatoshi Kasai, Shveta S Motwani, and Christopher T Chan.
• Department of Medicine, Toronto General Hospital, University Health Network, Sleep Research Laboratory of the Toronto Rehabilitation Institute, Centre of Sleep and Circadian Biology, University of Toronto, Toronto, Canada.
• Nephrol. Dial. Transplant. 2012 Apr 1;27(4):1569-73.

BackgroundIn both healthy male subjects and men with heart failure, the severity of obstructive sleep apnea (OSA) is related to the amount of fluid displaced from their legs into the neck overnight. Whether overnight rostral fluid shift contributes to the pathogenesis of OSA in patients with end-stage renal disease (ESRD) is unknown. We hypothesized that the change in neck circumference (NC) and severity of OSA are related to the extent of overnight change in leg fluid volume (LFV) in patients with ESRD.MethodsWe studied 26 patients with ESRD (14 men) on conventional hemodialysis. All subjects underwent polysomnography. LFV was measured by bioelectric impedance at bedtime and repeated in the next morning on awakening.ResultsOur cohort's overall apnea-hypopnea index was 22.8±26.8 episodes/h of sleep. Their overnight change in LFV was -243±278 mL. The change in LFV correlated with apnea-hypopnea time (AHT) (P=0.001) and NC (P=0.0016). Other independent factors associated with AHT included age (P=0.005), baseline neck (P=0.0002), sitting time (P=0.008) and male gender. Stepwise multiple regression analysis revealed that age, change in LFV and male gender remained independent related to AHT.ConclusionsNocturnal rostral fluid shift is associated with the severity of OSA in ESRD. Prospective evaluation of the effect of reducing fluid overload and severity of OSA in ESRD patients warrants further examination.

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