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Obstructive sleep apnea (OSA) and chronic kidney disease (CKD) are common medical disorders with an estimated global prevalence of 936 [1] and 850 million [2], respectively. Furthermore, the prevalence of both conditions increases with age [3, 4]. Consequently, it is not uncommon for OSA and CKD to co-exist in individual patients, particularly in an older population. The clinical relevance of this coexistence is how OSA and CKD interact and whether they influence each other’s natural history. This is important as both conditions, if left untreated, can have a significant impact both on individual patients and the healthcare system.

There is an abundance of medical literature that supports a bidirectional relationship between OSA and CKD [5]. Initial research highlighted the association of end-stage kidney disease with a high prevalence of sleep apnea, predominantly OSA [6]. The responsible mechanisms have been attributed both to fluid overload, causing upper airway narrowing [7], and unstable ventilatory control [8], both of which were improved by dialysis with an associated improvement in the severity of sleep apnea [9–11]. Although an increased prevalence of OSA has also been reported in patients with severe CKD that is not dialysis-dependant [12, 13], mechanistic studies have not been performed in this population.

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