Chronic kidney disease (CKD) has a profound destructive effect on a patient’s quality of life, and results in significant increases in health care costs. CKD is also a leading cause of morbidity and mortality, especially cardiovascular events.

Patients with CKD have an increased prevalence of sleep apnea.  The presence of sleep apnea in the CKD population has been associated with an increased risk of cardiovascular events, such as stroke and heart attacks.

This increase in risk occurs whether the patient is on hemodialysis (removing toxins from the blood directly with a machine) or peritoneal dialysis (putting fluid in and out of the abdomen, often as a home treatment).  There is a bidirectional relationship between sleep apnea and CKD.  This means that sleep apnea can worsen CKD and CKD can worsen sleep apnea.

It is felt that sleep apnea causes worsening of CKD because of the intermittent reduction in oxygen level and effects on blood pressure which occurs during sleep periods in patients whose sleep apnea is unrecognized and untreated. CKD worsens sleep apnea because of its effect on nerves and muscle cells and rapid fluid shifts between dialysis treatments.

This brings me to the most important part of this article.  Namely, that despite the high incidence of sleep apnea in CKD patients the sleep issues often go unrecognized. Because sleep apnea can worsen CKD and CKD can worsen sleep apnea, it is important to diagnose the presence of sleep apnea in CKD patients early.