High Prevalence of Obstructive Sleep Apnoea among Patients with ESKD on Haemodialysis in India

Background: Patients with end- stage kidney disease (ESKD) may be affected with sleep disorders like insomnia, obstructive sleep apnoea (OSA), hypoventilation, central sleep apnoea, central disorders of hypersomnolence, circadian rhythm sleep–wake disorders, parasomnias and restless legs syndrome. OSA needs special mention as CKD is a comorbidity of OSA and contributes to the course of OSA. The objective of this study was to delineate the prevalence of OSA in ESKD patients on hemodialysis (HD) in India and to document the comorbidities in these patients, which might have an association with OSA. Methods: The study was a descriptive study with cross- sectional design conducted on 75 patients more than 18 years of age, with CKD stage 5 on MHD attending the Haemodialysis center of a tertiary care hospital in Kolkata, India. Stratified sampling was used and a pre-designed and pre-tested semi-structured schedule was used to collect data. The statistical software SPSS 20 was used for the analysis Results: The mean age of the 75 patients studied, was 62 years, of whom 57% were male. The prevalence of OSA was 65.3%, of whom 42.7% had moderate and 22.6 % had mild disease. The median Apnoea Hypopnoea Index (AHI) was 15. A statistically significant association was observed between AHI score and Body Mass Index (BMI), alcoholism, hypertension, chronic liver disease, frequency of dialysis per week, magnesium levels and ejection fraction. Binary logistic regression of factors showed a statistically significant association with BMI (p=0.000, 95% CI=1.304-2.067) and reduced ejection fraction (p=0.017, 95% CI=0.019-0.682). Conclusion: A high prevalence of OSA was noted in ESKD patients on maintenance hemodialysis in India. The patients tended to be obese. A high level of awareness and regular screening is mandated in this patient population to diagnose these cases early so that the quality of life, morbidity and mortality can be improved with CPAP therapy.