Kidney Week

Abstract: FR-PO1175

Long-Term Changes in Sleep Disordered Breathing in Renal Transplant Patients

Session Information

• Transplantation: Clinical - Post-Transplant Complications
  November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1901 Transplantation: Basic

Authors

• Mallamaci, Francesca, IFC-CNR, Reggio Calabria, Italy

Francesca Mallamaci,

• Tripepi, Rocco, IFC-CNR, Reggio Calabria, Italy

Rocco Tripepi,

• D'Arrigo, Graziella, IFC-CNR, Reggio Calabria, Italy

Graziella D'Arrigo,

• Porto, Gaetana, IFC-CNR, Reggio Calabria, Italy

Gaetana Porto,

• Marino, Carmela, IFC-CNR, Reggio Calabria, Italy

Carmela Marino,

• Sanguedolce, Maria cristina, IFC-CNR, Reggio Calabria, Italy

Maria cristina Sanguedolce,

• Tripepi, Giovanni, IFC-CNR, Reggio Calabria, Italy

Giovanni Tripepi,

• Zoccali, Carmine, IFC-CNR, Reggio Calabria, Italy

Carmine Zoccali,

Background

Sleep Disordered Breathing (SDB) triggers sympathetic over-activity, hypertension and cardiovascular (CV) events in the dialysis population. SDB improves after renal transplantation but long term changes in SDB in renal transplant patients have not been studied.

Methods

We studied long term changes in SDB in a series of 221 renal transplant patients (age: 46.9±11 years; M: 70.1%). Over a median follow up of 52.1 months (Interquartile range: 36.8-67.3 months) we performed 404 polysomnographic recordings (on average 2 studies per patient). Data analysis was performed by Generalized Estimating Equations (GEE).

Results

At baseline, the median value of the apnea-hypopnea index (AHI) was 1.8 episodes/h [interquartile range (IQR): 0.6-5.0]. One-hundred and sixty-six patients (75%) had a normal AHI (<5). Thirty-seven patients (17%) had mild to moderate SDB (AHI 5 to 14.9) and a minority (18 patients , 8%) had severe SDB (AHI >15). At baseline, AHI was directly related with age (rho=0.24, P<0.001), BMI (rho=0.27, P<0.001), fibrinogen (rho=0.16, P=0.027) and glucose (rho=0.14, P=0.035). The median values of minimum (MinSaO₂) and average nocturnal O₂ saturation were 89% and 95.6%. On longitudinal observation, the median AHI rose from 1.8 (IQR: 0.6-5.0) to 2.9 (IQR: 1.0-6.6) and to 3.6 (IQR: 1.7-10.4) at the second and the third longitudinal visit, respectively (P for trend=0.009) and the proportion of patients with mild to moderate and severe SDB rose to 22.7% and 20.5%, respectively. Longitudinal changes in MinSaO2 paralleled those in the AHI. In adjusted analyses BMI (P<0.001) and C-reactive protein (P=0.001) emerged as the sole independent longitudinal correlates of AHI and MinSaO₂.

Conclusion

Sleep Disordered Breathing worsens over time in renal transplanted patients. The post-transplantation rise in BMI, a potentially modifiable risk factor, is an important factor underlying the risk for SDB worsening in this population.