Benz RL, Pressman EH, Hovick EH, Peterson DD
Predictors of mortality in ESRD patients with sleep
disorders
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1439 1996
Benz et al. report the results of sleep studies in 27 patients with
ESRD, dividing the patients into two groups: those who died (group D)
and those who survived (group S). Group D had a markedly higher mean
hourly rate of periodic leg movements of sleep (PLMS), that is,
"repetitive dorsiflexions of the legs... occurring with regular
periodicity," (127.8/hr vs. 19.3/hr, p=0.01). Comorbid conditions, age,
race, gender, URR, albumin, incidence of sleep apnea, and O2 saturation
did not differ between the groups, although group S patients had higher
mean hematocrit (33.4 vs. 29.9, p=.07). PLMS predicted death (by Fisher
Exact test), but URR and serum albumin did not. The authors conclude
that sleep studies are more sensitive predictors of mortality than
"presently used" predictors, presumably URR and albumin.
Comment: This is an interesting study, in that it indicates a high
incidence of sleep disorders in dialysis patients, and especially, it
seems, in sick dialysis patients. As far as one can tell, the study design
is very, very far from being able to justify the conclusions--the selection
of patients does not seem to be randomized, the overall number of patients
is quite small, and the statistical analysis is rather primitive.
Nonetheless, the findings do suggest that the occurrence of this kind of
sleep disorder may be a sensitive index of uremia or inadequate
dialysis. One would like very much to see what the effect of increasing
the intensity of dialysis would have been on the rate of PLMS in group
D.
(Robert H. Barth, M.D., VA Medical Center, Brooklyn, NY)
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Am Soc Nephrol
CRF by organ system :
Neurological
H: Pathophysiology :
Sleep, sleep apnea