Case Report
Reversal of sleep apnea hypopnea syndrome in end-stage renal disease after kidney transplantation

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Abstract

Sleep apnea hypopnea syndrome (SAHS) is extremely common in patients with end-stage renal disease (ESRD). Although the underlying mechanisms linking these 2 conditions remain to be better defined, it is likely that multiple factors are involved. We report an individual with ESRD with severe SAHS that resolved after kidney transplantation. The improvement in SAHS paralleling the effective treatment of ESRD suggests the pathogenesis involves an unstable breathing pattern, possibly caused by an altered metabolic state, uremia, and changes in volume status. The possibility that elevations in cytokine levels could be involved also is discussed and deserves further attention.

Section snippets

Case report

A 44-year-old white man with ESRD undergoing HD for 3 years was referred to the University of New Mexico (Albuquerque, NM) Sleep Disorders Center in 1997 with reports of daytime hypersomnolence and interrupted sleep secondary to frequent episodes of choking and gasping.

Renal failure was first noted in 1994 when he presented with a swollen tongue, volume overload, urinary tract infection, and anemia. He had a history of intermittently treated hypertension for 7 years. On presentation, his blood

Discussion

This report documents the third case of an individual with ESRD-related SAHS followed up through the course of a kidney transplantation. As in the 2 prior cases,11 resolution of SAHS is seen after transplantation, in our case documented by resolution of symptoms and normalization of overnight pulse oximetry results.

The use of oximetry for the diagnosis of SAHS has been extensively studied. Using a change of 4% in oxyhemoglobin saturation to indicate a respiratory event, overnight oximetry has a

Acknowledgements

Acknowledgment: The authors thank Antonia Harford, MD, for her advice during manuscript preparation.

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  • Cited by (0)

    Received October 1, 1998; accepted in revised form April 16, 1999.

    Address reprint requests to Lee K. Brown, MD, Clinical Professor of Medicine, Medical Director, New Mexico Center for Sleep Medicine, Lovelace Health Systems, Inc., 4700 Jefferson Blvd NE, Suite 800, Albuquerque, NM 87109. E-mail: [email protected]

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