Obstructive sleep apnea in adult dialysis patients: A review

Abstract

Obstructive sleep apnea (OSA) is an extremely common but underdiagnosed problem in adults receiving dialysis therapy. Patients with end-stage kidney disease (ESKD) on hemodialysis or peritoneal dialysis have a higher prevalence of OSA compared to the general population (Nicholl et al., 2013; Kimmel et al., 1989; Markou et al., 2006). This condition carries significant clinical implications, contributing to impaired sleep quality, daytime fatigue, and elevated cardiovascular risk if left untreated (Marin et al., 2005; Burkhalter et al., 2024). In fact, untreated OSA is associated with markedly higher rates of hypertension and adverse cardiac events in susceptible patients (Nicholl et al., 2013; Burkhalter et al., 2024). Despite these dangers, OSA often goes unrecognized in dialysis patients, partly because its presentation can be atypical or masked by uremic symptoms.

This review provides a comprehensive overview of OSA in adult dialysis patients. We discuss how OSA prevalence in dialysis populations is extremely high (often affecting half or more of patients) and examine why conventional screening tools may fail to identify many cases. We also describe the unique pathophysiological contributors in ESKD, such as fluid overload and its redistribution, that predispose patients to OSA. Finally, we review management strategies, including standard therapies like continuous positive airway pressure (CPAP) and dialysis-specific interventions such as intensive volume control and nocturnal dialysis. Improving awareness and treatment of OSA in this vulnerable population is crucial to enhance patient outcomes and quality of life.