IMPROVEMENT IN SLEEP RELATED BREATHING DISORDERS WITH KIDNEY TRANSPLANTATION

Introduction:

Sleep is crucial for overall health, with quality defined by satisfaction with sleep initiation, maintenance, quantity, and refreshment upon awakening. Sleep disorders, including insomnia, sleep-disordered breathing (SDB), and restless legs syndrome (RLS), are prevalent in End-Stage Renal Disease (ESRD) patients and can exacerbate symptoms such as daytime sleepiness, poor cognitive function, and increased cardiovascular risk. This study investigates the impact of renal transplantation on sleep-related breathing disorders in ESRD patients.

Methods:

 Sixty ESRD patients undergoing thrice weekly hemodialysis and awaiting living donor kidney transplants were assessed. Excluded were those with COPD, congestive heart failure, obesity, or pre-existing sleep disorders. Pretransplantation, the patients were evaluated for  sleep disorders using the Pittsburgh Sleep Quality Index (PSQI), Berlin Questionnaire (BQ), Epworth Sleepiness Scale (ESS), and the International Restless Legs Syndrome Study Group (IRLS) rating scale. Those with sleep disorders  on the questionnaires were subjected to polysomnography (PSG) to assess sleep architecture and breathing disorders. A repeat PSG examination and evaluation with the same questionnaires was done six months after the transplant. The paired t-test was used to compare two related variables (pre and posttransplantation). The relative risk and absolute risk reduction were calculated to assess the strength of intervention (renal transplantation) and its clinical outcome. A p-value of <0.05 was considered statistically significant.

Results:

Pretransplantation, 30 patients (50%) were diagnosed with sleep-related breathing disorders. Post-transplantation, significant improvements were observed: the number of patients with obstructive sleep apnea (OSA) decreased from 15 to 10 (p = 0.043), and total apnea-hypopnea Index (AHI) reduced from 12.86±11.97 to 7.52±7.44 events per hour (p = 0.019). The absolute risk reduction for OSA was  8.24 %.The prevalence of AHI ≥ 5 events per hour dropped from 33.33% to 6.66% (p = 0.001). PSQI scores improved from 7.03±1.42 to 5.89±2.99 (p = 0.034), indicating better sleep quality. IRLS scores also decreased from 6.13±3.19 to 4.69±2.39 (p = 0.018), reflecting reduced RLS symptoms. The oxygen desaturation index showed significant reduction (p = 0.047). Other sleep parameters, including total sleep time and stages of sleep, did not show significant changes post-transplantation. There was a significant increase in both hemoglobin (9.05±1.15 vs 12.52±1.06, p<0.001) and BMI (22.64±2.45 vs 24.75±2.56, p<0.001) posttransplantation. The mean serum creatinine posttransplantation was  1.38±0.56 mg/dl.

This study confirms a high prevalence of sleep disorders among ESRD patients and demonstrates that renal transplantation significantly improves sleep-related breathing disorders. The reduction in AHI and improvement in sleep quality measures highlight the positive impact of transplantation. Improved hemoglobin and increased BMI after transplantation could be potential factors for inconsistent results across studies. 

Conclusions:

 Renal transplantation significantly improves sleep quality and reduces the incidence and severity of sleep-related breathing disorders in ESRD patients, underscoring its therapeutic value beyond renal function restoration.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.