Hypervolemia and Sleep Apnea in Kidney Disease

• Published in: Seminars in nephrology Vol. 35; no. 4; pp. 373 - 382
• Main Authors: Lyons, Owen D., MB, BCh, Bradley, T. Douglas, MD, Chan, Christopher T., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2015
• Subjects: Acid-Base Imbalance; central sleep apnea; End-stage renal disease; fluid overload; fluid shift; Humans; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - physiopathology; Nephrology; obstructive sleep apnea; Posture; Risk Factors; Sleep Apnea Syndromes - etiology; Sleep Apnea Syndromes - physiopathology; Water-Electrolyte Imbalance - etiology; Water-Electrolyte Imbalance - physiopathology; obstructive sleep apnea; fluid shift; End-stage renal disease; fluid overload; central sleep apnea
• ISSN: 0270-9295; 1558-4488
• DOI: 10.1016/j.semnephrol.2015.06.008

Summary In end-stage renal disease (ESRD) and heart failure, conditions characterized by fluid overload, both obstructive sleep apnea (OSA) and central sleep apnea (CSA) are highly prevalent. This observation suggests that fluid overload may be a unifying mechanism in the pathogenesis of both OSA and CSA in these conditions. An overnight rostral fluid shift from the legs to the neck and lungs has been shown to contribute to the pathogenesis of OSA and CSA, respectively, in various different patient populations. This article reviews the evidence that supports a role for fluid overload and overnight fluid shift in the pathogenesis of sleep apnea in ESRD. The diagnosis, epidemiology, and clinical features of sleep apnea in patients with ESRD also are considered.