https://orcid.org/0000-0002-6616-1996
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Francesca Mallamaci, Carmine Zoccali, The wane and wax of sleep apnea in kidney transplant patients, Nephrology Dialysis Transplantation, Volume 40, Issue 1, January 2025, Pages 7–9, https://doi.org/10.1093/ndt/gfae163
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Chronic kidney disease (CKD) is a growing public health concern, ranked as the fifth leading cause of death globally by 2040. Sleep apnea (SA) is a condition characterized by episodes of hypoxia, sleep fragmentation and excessive daytime sleepiness, and is a highly prevalent, yet still often overlooked, problem in CKD patients. SA is not of trivial importance in this population because it impacts cardiovascular disease and CKD progression [1]. Herein, we provide a brief reminder of the SA phenotype and SA pathophysiology in CKD and kidney failure (KF) patients, then discuss the evolution of SA after renal transplantation, which is the most effective treatment for SA in KF.
SA can be categorized into three types: obstructive (OSA), central (CSA) and mixed. OSA is characterized by airway obstruction, while CSA occurs without airway obstruction. OSA is more common than CSA in both pre-dialysis and dialysis patients [1].
Fluid overload, which affects approximately 40% of hypertensive patients with CKD [2] and over 50% of KF patients, is a major risk factor for SA from the early stages of CKD. Indeed, fluid redistribution during sleep contributes to upper airway obstruction [3]. As CKD progresses, other factors, such as the accumulation of uremic toxins, dysautonomia and increased chemosensitivity, may contribute to SA [1].
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