ABSTRACT
OBJECTIVE: To evaluate the prevalence of sleep disorders in patients awaiting kidney transplants compared to a control group. PATIENTS AND METHODS: We carried out an observational study of 23 patients on a kidney transplant waiting list in comparison with 20 healthy volunteers matched for age, sex, and body mass index (BMI). Overnight polysomnography was performed and a diagnosis of sleep apnea-hypopnea syndrome (SAHS) established when the apnea-hypopnea index (AHI) was 10 or higher. RESULTS: Eighty-two percent of the patients awaiting kidney transplants (16 men and 7 women with a mean [SD] age of 51 [15] years and a mean BMI of 25 [3.8] kg/m2) had some type of sleep disorder. The most frequent disorders were SAHS (48%) and insomnia and periodic limb movement disorder (30%). Patients showed poorer sleep efficiency compared to the control group (75.4% vs 87.8%; P=.01) and a lower percentage of slow-wave and rapid eye movement sleep (24.5% vs 40%; P=.001). Those with sleep-disordered breathing had a higher AHI (17.7 vs 3.6; P=.001) and oxygen desaturation index (31.5 compared to 8.2; P=.001). CONCLUSIONS: Sleep disorders are common in patients awaiting kidney transplants. Such patients show reduced quantity and quality of sleep compared to controls and a significantly elevated number of respiratory events that may affect morbidity and mortality.
Subject(s)
Sleep Wake Disorders/epidemiology , Waiting Lists , Female , Humans , Kidney Transplantation , Male , Middle Aged , PrevalenceABSTRACT
OBJETIVO: Valorar la prevalencia de los trastornos del sueño en pacientes en lista de espera de trasplante renal, comparados con un grupo control. PACIENTES Y MÉTODOS: Se ha realizado un estudio observacional en 23 pacientes en lista de espera para trasplante renal, cuyos resultados se compararon con los de 20 personas sanas que accedieron voluntariamente a participar en él. Se emparejaron por edad, sexo e índice de masa corporal. Se efectuó una polisomnografía de noche completa y el diagnóstico de síndrome de apneas-hipopneas durante el sueño se estableció cuando el índice de apneas-hipopneas era como mínimo de 10. RESULTADOS: Los pacientes en lista de espera para trasplante renal (16 varones y 7 mujeres; edad media ± desviación estándar: 51 ± 15 años; índice de masa corporal: 25 ± 3,8 kg/m2) presentaron en un 82% de los casos algún trastorno del sueño. Los más frecuentes fueron el síndrome de apneas-hipopneas durante el sueño (48%) e insomnio y síndrome de movimiento periódico de piernas (30%). Los pacientes presentaron, respecto al grupo control, una menor eficiencia del sueño (el 75,4 frente al 87,8%; p = 0,01) y un menor porcentaje de sueño de ondas lentas y REM (un 24,5 frente a un 40%; p = 0,001), mientras que los trastornos respiratorios del sueño mostraron un mayor índice de apneashipopneas (17,7 frente a 3,6; p = 0,001) e índice de desaturación (31,5 frente a 8,2; p = 0,001). CONCLUSIONES: Los trastornos del sueño son frecuentes en pacientes en lista de espera para trasplante renal, quienes, respecto al grupo control, tienen una menor cantidad y calidad del sueño, con un número significativamente elevado de eventos respiratorios, que pueden influir en la morbimortalidad (AU)
OBJECTIVE: To evaluate the prevalence of sleep disorders in patients awaiting kidney transplants compared to a control group. PATIENTS AND METHODS: We carried out an observational study of 23 patients on a kidney transplant waiting list in comparison with 20 healthy volunteers matched for age, sex, and body mass index (BMI). Overnight polysomnography was performed and a diagnosis of sleep apnea-hypopnea syndrome (SAHS) established when the apnea-hypopnea index (AHI) was 10 or higher. RESULTS: Eighty-two percent of the patients awaiting kidney transplants (16 men and 7 women with a mean [SD] age of 51 [15] years and a mean BMI of 25 [3.8] kg/m2) had some type of sleep disorder. The most frequent disorders were SAHS (48%) and insomnia and periodic limb movement disorder (30%). Patients showed poorer sleep efficiency compared to the control group (75.4% vs 87.8%; P=.01) and a lower percentage of slow-wave and rapid eye movement sleep (24.5% vs 40%; P=.001). Those with sleep-disordered breathing had a higher AHI (17.7 vs 3.6; P=.001) and oxygen desaturation index (31.5 compared to 8.2; P=.001). CONCLUSIONS: Sleep disorders are common in patients awaiting kidney transplants. Such patients show reduced quantity and quality of sleep compared to controls and a significantly elevated number of respiratory events that may affect morbidity and mortality (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Kidney Transplantation/methods , Kidney Transplantation/psychology , Sleep Wake Disorders/epidemiology , Sleep Wake Disorders/physiopathology , Sleep Wake Disorders/psychology , Waiting Lists , Body Mass Index , Polysomnography/methods , Renal Insufficiency/complications , Polysomnography/psychology , Signs and Symptoms , Sleep Apnea Syndromes/complications , Sleep Initiation and Maintenance Disorders/complicationsABSTRACT
BACKGROUND AND OBJECTIVE: Prevalence of sleep apnea-hypopnea syndrome (SAHS) in end-stage renal disease (ESRD) is high and the polygraphy has not been validated as diagnostic technique in this group of patients. The objective of this study was to evaluate if only the cardiorespiratory analysis is valid for the diagnosis of SAHS. PATIENTS AND METHOD: 48 patients with ESRD were studied consecutively with all-night polysomnography. We compared the desaturation index of SaO2 > or = 4% (DI4), sleep time spent with SaO2 < 90% (T90) and the apnea-hypopnea index (AHI) per hour of sleep with the results of the cardiorespiratory analysis. RESULTS: We included 35 men and 13 women, age: 54 (16) years and IMC: 27.1. Eighteen patients were diagnosed of SAHS (37.5%). The cardiorespiratory analysis obtained a sensibility of 77.7%, specifity of 100%, positive predictive value was 100% and negative predictive was 88%. The polysomnography showed an AHI: 16 (17.2), while the cardiorespiratory analysis was 11 (13.2). There were a good correlation (r = 0.970) and concordance scores (CCI = 0.967; p < 0.001). The cardiorespiratory analysis, respect the polysomnography, also obtained a good correlation and concordance for ID4 (10 [11.8] vs 15 [15.5]) and for T90 (1 [2.9] vs 2 [4.7]; p < 0.001). In the COR curve, the best cut-off point of the cardiorespiratory analysis was an AIH = 7.2. CONCLUSIONS: In patients with ESRD, the cardiorespiratory analysis, is valid for the diagnosis and correctly detect the SaO2 at night, both being key parameters for the diagnostic and treatment of SAHS. The polygraphy could be an alternative diagnostic test in the SAHS, although it has to be definitively validated.
Subject(s)
Electrocardiography , Kidney Failure, Chronic/complications , Oximetry , Polysomnography , Sleep Apnea Syndromes/diagnosis , Adolescent , Adult , Aged , Chi-Square Distribution , Female , Humans , Male , Middle Aged , Oxygen/blood , Predictive Value of Tests , ROC Curve , Respiratory Mechanics , Sensitivity and Specificity , Sleep, REMABSTRACT
Fundamento y objetivo: En la insuficiencia renal crónica (IRC) la prevalencia del síndrome de apneas-hipopneas del sueño (SAHS) es alta. A pesar de su amplio uso, la poligrafía aún no ha sido validada como técnica diagnóstica. El objetivo de este estudio fue determinar si analizar únicamente las variables cardiorrespiratorias es válido para el diagnóstico del SAHS. Pacientes y método: Se estudió consecutivamente a 48 pacientes con IRC mediante polisomnografía comparando el número de descensos de la saturación arterial de oxígeno (SaO2) >= 4% (ID4), el porcentaje del tiempo de sueño con SaO2 < 90% (T90) y el número de apneas e hipopneas por hora de sueño (IAH) con los resultados del análisis cardiorrespiratorio. Resultados: Se incluyó a 35 varones y 13 mujeres, con unas medias de edad de 54 años y de índice de masa corporal (IMC) de 27,1. Se diagnosticó a 18 (37,5%) pacientes de SAHS. El análisis cardiorrespiratorio obtuvo una sensibilidad del 77,7%, una especificidad del 100%, un valor predictivo positivo del 100% y un valor predictivo negativo del 88%. La polisomnografía mostró un IAH medio (DE) de 16 (17,2) y el análisis cardiorrespiratorio, 11 (13,2), con buenas correlación (r = 0,970) y concordancia (coeficiente de correlación intraclase [CCI] = 0,967; p < 0,001). El análisis cardiorrespiratorio respecto a la polisomnografía también obtuvo buenas correlación y concordancia en el ID4 (media, 10 [11,8] frente a 15 [15,5]) y en el T90 (media, 1 [2,9] frente a 2 [4,7]; p < 0,001). En la curva COR, el mejor punto de corte del análisis cardiorrespiratorio fue un IAH de 7,2. Conclusiones: En pacientes con IRC, el análisis cardiorrespiratorio es válido para el diagnóstico y valora correctamente la SaO2 nocturna, parámetros claves en el manejo diagnóstico y terapéutico del SAHS. La poligrafía puede ser una alternativa diagnóstica en el SAHS, aunque hay que validarla definitivamente
Background and objective: Prevalence of sleep apnea-hypopnea syndrome (SAHS) in end-stage renal disease (ESRD) is high and the polygraphy has not been validated as diagnostic technique in this group of patients. The objective of this study was to evaluate if only the cardiorespiratory analysis is valid for the diagnosis of SAHS. Patients and method: 48 patients with ESRD were studied consecutively with all-night polysomnography. We compared the desaturation index of SaO2 >= 4% (DI4), sleep time spent with SaO2 < 90% (T90) and the apnea-hypopnea index (AHI) per hour of sleep wilh the results of the cardiorespiratory analysis. Results: We included 35 men and 13 women, age: 54 (16) years and IMC: 27.1. Eighteen patients were diagnosed of SAHS (37.5%). The cardiorespiratory analysis obtained a sensibility of 77.7%, specifity of 100%, positive predictive value was 100% and negative predictive was 88%. The polysomnography showed an AHI: 16 (17.2), while the cardiorespiratory analysis was 11 (13.2). There were a good correlation (r = 0.970) and concordance scores (CCI = 0.967; p < 0.001). The cardiorespiratory analysis, respect the polysomnography, also obtained a good correlation and concordance for ID4 (10 [11.8] vs 15 [15.5]) and for T90 (1 [2.9] vs 2 [4.7]; p < 0.001). In the COR curve, the best cut-off point of the cardiorespiratory analysis was an AIH = 7.2. Conclusions: In patients with ESRD, the cardiorespiratory analysis, is valid for the diagnosis and correctly detect the SaO2 at night, both being key parameters for the diagnostic and treatment of SAHS. The polygraphy could be an alternative diagnostic test in the SAHS, although it has to be definitively validated
Subject(s)
Humans , Renal Insufficiency, Chronic/complications , Sleep Apnea Syndromes/complications , Polysomnography , Sensitivity and Specificity , Predictive Value of Tests , Respiratory Function Tests , Heart Function TestsABSTRACT
OBJECTIVE: To assess the diagnostic validity, degree of patient satisfaction, and economic cost of home sleep monitoring compared to conventional polysomnography. PATIENTS AND METHODS: Consecutive patients with symptoms indicative of sleep apnea-hypopnea syndrome (SAHS) were included. We analyzed the diagnostic yield of home sleep monitoring using the apnea-hypopnea index (AHI), number of desaturations of at least 3%, and the percentage time with arterial oxygen saturation below 90%. The degree of patient satisfaction, measured on a visual analogue scale, and the cost of home monitoring were compared with conventional polysomnography. RESULTS: The study included 52 patients (42 men and 10 women) with a mean (SD) age of 51.8 (9) years and a body mass index of 32 (5) kg/m2. Polysomnography and home monitoring revealed an AHI of 33.6 (20) and 31 (19), respectively (r=0.971; intraclass correlation coefficient = 0.963; P< .001). The number of desaturations of at least 3% and the percentage time with arterial oxygen saturation below 90% showed significant correlation and concordance (P< .05). For an AHI cutoff of 10 recorded with polysomnography, home monitoring had a sensitivity of 89% and a specificity of 80%, with an area under the receiver operator characteristic curve of 0.804. For severe SAHS (AHI> or =30), the sensitivity and specificity of home monitoring was 100% (that is, the area under the receiver operating characteristic curve was 1). For home monitoring, the cost per diagnostic test was 101.34 euro less than that of polysomnography, and the patient satisfaction was significantly greater (P< .0001). CONCLUSIONS: Home sleep monitoring is a valid and cost-effective diagnostic test; patients with symptoms of SAHS are more satisfied with this technique than conventional polysomnography.
Subject(s)
Home Care Services/economics , Patient Satisfaction , Polysomnography/economics , Sleep Apnea, Obstructive/diagnosis , Sleep Apnea, Obstructive/economics , Cost-Benefit Analysis , Female , Humans , Male , Middle Aged , SpainABSTRACT
Objetivo: Comparar la validez diagnóstica, el grado de satisfacción del paciente y el coste económico de la poligrafía domiciliaria respecto a la polisomnografía convencional. Pacientes y métodos: Se seleccionó consecutivamente a pacientes con síntomas indicativos de síndrome de apneas-hipopneas durante el sueño (SAHS). Analizamos la rentabilidad de la poligrafía domiciliaria mediante el índice apneas-hipopneas (IAH), el índice de desaturación igual o mayor del 3% y el porcentaje de tiempo con una saturación arterial de oxígeno menor del 90%. Se compararon el grado de satisfacción del paciente, evaluada con una escala visual, y el coste de la poligrafía respecto a la polisomnografía. Resultados: Se incluyó en el estudio a 52 pacientes (42 varones y 10 mujeres) con una edad media ± desviación estándar de 51,8 ± 9 años e índice de masa corporal de 32 ± 5 kg/m2. La polisomnografía y la poligrafía obtuvieron un IAH de 33,6 ± 20 y de 31 ± 19, respectivamente (r = 0,971; coeficiente de correlación intraclase = 0,963; p < 0,001). Los valores del índice de desaturación igual o mayor del 3% y el porcentaje de tiempo con una saturación arterial de oxígeno menor del 90% mostraron una correlación y concordancia significativas (p < 0,05). Para un IAH obtenido en la polisomnografía de 10, la poligrafía mostró una sensibilidad del 89% y una especificidad del 80%, con un área bajo la curva de eficacia diagnóstica de 0,804; en el SAHS grave (IAH ≥ 30) la sensibilidad y especificidad de la poligrafía fue del 100% (área bajo la curva de eficacia diagnóstica = 1). En la poligrafía, el coste por prueba diagnóstica fue 101,34 menor que en la polisomnografía, y el grado de satisfacción del paciente, significativamente mayor (p < 0,0001). Conclusiones: La poligrafía domiciliaria es una técnica diagnóstica válida y coste-eficiente, que aporta mayor grado de satisfacción que la polisomnografía convencional al paciente con síntomas de SAHS
Objective: To assess the diagnostic validity, degree of patient satisfaction, and economic cost of home sleep monitoring compared to conventional polysomnography. Patients and methods: Consecutive patients with symptoms indicative of sleep apnea-hypopnea syndrome (SAHS) were included. We analyzed the diagnostic yield of home sleep monitoring using the apneahypopnea index (AHI), number of desaturations of at least 3%, and the percentage time with arterial oxygen saturation below 90%. The degree of patient satisfaction, measured on a visual analogue scale, and the cost of home monitoring were compared with conventional polysomnography. Results: The study included 52 patients (42 men and 10 women) with a mean (SD) age of 51.8 (9) years and a body mass index of 32 (5) kg/m2. Polysomnography and home monitoring revealed an AHI of 33.6 (20) and 31 (19), respectively (r=0.971; intraclass correlation coefficient = 0.963; P<.001). The number of desaturations of at least 3% and the percentage time with arterial oxygen saturation below 90% showed significant correlation and concordance (P<.05). For an AHI cutoff of 10 recorded with polysomnography, home monitoring had a sensitivity of 89% and a specificity of 80%, with an area under the receiver operator characteristic curve of 0.804. For severe SAHS (AHI≥30), the sensitivity and specificity of home monitoring was 100% (that is, the area under the receiver operating characteristic curve was 1). For home monitoring, the cost per diagnostic test was E101.34 less than that of polysomnography, and the patient satisfaction was significantly greater (P<.0001). Conclusions: Home sleep monitoring is a valid and cost-effective diagnostic test; patients with symptoms of SAHS are more satisfied with this technique than conventional polysomnography
