• Ea Wha Kang, Khaled Abdel-Kader, Jonathan Yabes, Khaleelah Glover, and Mark Unruh.
• Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, PA, USA.
• Am. J. Kidney Dis. 2012 Dec 1; 60 (6): 949-58.

BackgroundSleep-disordered breathing and cognitive impairment are common in patients with chronic kidney disease (CKD). Sleep-disordered breathing is known to be a risk factor for cognitive dysfunction in the general population, but this association has not been studied in patients with CKD.Study DesignCross-sectional study.Settings & ParticipantsA cohort of 169 patients with CKD stages 4-5.PredictorsSleep-disordered breathing; covariates included demographics, diabetes, cardiovascular disease, depression, and dialysis modality.OutcomesCognitive impairment, generally defined as a score 1.5 standard deviations or more from the age- and education level-adjusted normative cognitive test score.MeasurementsStandardized health interview, neurocognitive assessment, sleep-related questionnaires, and polysomnography.ResultsSleep-disordered breathing (apnea-hypopnea index >15) was diagnosed in 83 (49.1%) individuals. This group had a significantly higher prevalence of nocturnal hypoxemia (65.8% vs 26.8%; P < 0.001) and excessive daytime sleepiness (38.6% vs 20.7%; P = 0.01). In addition, this group had significantly lower scores in tests measuring verbal memory, working memory, attention, and psychomotor speed. Sleep-disordered breathing was associated with higher risk of immediate verbal memory impairment after adjustment for known confounders (adjusted OR, 2.67; 95% CI, 1.17-6.08). However, in a subgroup analysis of older adults (aged >60 years), there were no significant differences in cognitive testing between the groups with and without sleep-disordered breathing.LimitationsCross-sectional design, limited sample size.ConclusionsSleep-disordered breathing is associated with cognitive impairments, especially impaired verbal memory, in patients with advanced CKD. However, the impact appeared limited in older adults. Early evaluation and management of sleep-disordered breathing in patients with CKD may provide an opportunity to improve cognitive function.Copyright © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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