Cardiovascular risk and mortality in end-stage renal disease patients undergoing dialysis: sleep study, pulmonary function, respiratory mechanics, upper airway collapsibility, autonomic nervous activity, depression, anxiety, stress and quality of life: a prospective, double blind, randomized controlled clinical trial.

BACKGROUND: Chronic kidney disease (CKD) is one of the most serious public health problems. The increasing prevalence of CKD in developed and developing countries has led to a global epidemic. The hypothesis proposed is that patients undergoing dialysis would experience a marked negative influence on physiological variables of sleep and autonomic nervous system activity, compromising quality of life. METHODS/DESIGN: A prospective, consecutive, double blind, randomized controlled clinical trial is proposed to address the effect of dialysis on sleep, pulmonary function, respiratory mechanics, upper airway collapsibility, autonomic nervous activity, depression, anxiety, stress and quality of life in patients with CKD. The measurement protocol will include body weight (kg); height (cm); body mass index calculated as weight/height(2); circumferences (cm) of the neck, waist, and hip; heart and respiratory rates; blood pressures; Mallampati index; tonsil index; heart rate variability; maximum ventilatory pressures; negative expiratory pressure test, and polysomnography (sleep study), as well as the administration of specific questionnaires addressing sleep apnea, excessive daytime sleepiness, depression, anxiety, stress, and quality of life. DISCUSSION: CKD is a major public health problem worldwide, and its incidence has increased in part by the increased life expectancy and increasing number of cases of diabetes mellitus and hypertension. Sleep disorders are common in patients with renal insufficiency. Our hypothesis is that the weather weight gain due to volume overload observed during interdialytic period will influence the degree of collapsibility of the upper airway due to narrowing and predispose to upper airway occlusion during sleep, and to investigate the negative influences of haemodialysis in the physiological variables of sleep, and autonomic nervous system, and respiratory mechanics and thereby compromise the quality of life of patients. TRIAL REGISTRATION: The protocol for this study is registered with the Brazilian Registry of Clinical Trials (ReBEC RBR-7yhr4w and World Health Organization under Universal Trial Number UTN: U1111-1127-9390 [http://www.ensaiosclinicos.gov.br/rg/RBR-7yhr4w/]).

Excessive daytime sleepiness in patients with chronic kidney disease undergone hemodialysis / Sonolência excessiva diurna em pacientes com doença renal crônica submetidos a hemodiálise

Introduction Approximately 80% of patients with chronic kidney disease complain about sleep disorders, which is a much higher percentage than in the general population. Excessive daytime sleepiness is the third most frequent complaint in these patients, and it is significantly associated with a higher risk of sleep apnea. The aim of this study was to assess the presence of daytime sleepiness in patients with end stage renal disease (ESRD) who were undergoing diurnal hemodialysis. Materials and methods The Epworth Sleepiness Scale (ESS) was applied to patients with ESRD who underwent diurnal hemodialysis in the Centro de Nefrologia da Zona Norte in Sao Paulo, Brazil. Results A total of 168 patients were included in the study. According to the ESS, 31% presented with a mild propensity to sleep, 22% with a moderate propensity, and 17% with a severe propensity. Conclusion Our study concluded that 70% of the sample of patients with ESRD who were undergoing hemodialysis presented with a propensity to sleep in inappropriate circumstances on the ESS. When excessive daytime sleepiness is associated with sleep apnea and other comorbidities, it is essential to carefully assess patients’ complaints.

Introdução Aproximadamente 80% dos pacientes com doença renal crônica (DRC) referem alguma queixa sobre distúrbios do sono, sendo muito maior do que na população em geral. A sonolência excessiva diurna é a terceira queixa mais frequente e está significativamente associada com um maior rico de apneia do sono. O objetivo deste estudo foi avaliar a presença de sonolência excessiva diurna em pacientes com doença renal em estágio final (DREF) submetidos a hemodiálise diurna. Materiais e métodos A escala de sonolência de Epworth (ESE) foi aplicada em pacientes em DREF, que realizam hemodiálise diurna no Centro de Nefrologia da Zona Norte, na cidade de São Paulo. Resultados Cento e sessenta e oito pacientes foram incluídos no estudo. Trinta e um por cento da amostra apresentou uma leve propensão a dormir, de acordo com ESE, enquanto que vinte e dois por cento apresentaram uma moderada propensão e dezessete por cento apresentaram uma grave propensão. Conclusão Nosso estudo concluiu que 70% da amostra em DREF submetidos a hemodiálise apresentaram uma propensão de dormir em circunstâncias inapropriadas, de acordo com a escala de sonolência de Epworth. Uma vez que a sonolência excessiva diurna está associada com a apneia do sono e outras comorbidades é essencial estar atento às queixas desses pacientes.