Sleep apnea syndrome prevalence in chronic kidney disease and end stage kidney disease patients: a systematic review and meta-analysis

Abstract Background Several studies have examined the frequency of sleep apnea (SA) in patients with chronic kidney disease (CKD), reporting different prevalence rates. Our systematic review and meta-analysis aimed to define the clinical penetrance of SA in CKD and end-stage kidney disease (ESKD) patients. Methods Ovid-MEDLINE and PubMed databases were explored up to 5th June, 2023 to identify studies providing SA prevalence in CKD and ESKD patients assessed by different diagnostic methods, either sleep questionnaires or respiration monitoring equipment (such as PSG, type III portable monitors or other diagnostic tools). Single-study data were pooled using the random-effects model. The Chi2 and Cochrane-I2 tests were used to assess the presence of heterogeneity, that was explored performing sensitivity and/or subgroup analyses. Results A cumulative analysis from 32 single study data revealed a prevalence of SA of 57% (95% CI 42–71%) in the CKD population, whereas a prevalence of 49% (95% CI 47–52%) was found pooling data from 91 studies in ESKD individuals. The prevalence of SA using instrumental sleep monitoring devices, including classical PSG and type III portable sleep monitors, was 62% (95% CI 52–72) and 56% (95% CI 42–69%) in CKD and ESKD populations, respectively. Sleep questionnaires revealed a prevalence of 33% (95% CI 16–49%) and 39% (95% CI 30–49%). Conclusions SA is commonly seen in both non-dialysis CKD and ESKD patients. Sleep-related questionnaires underestimated the presence of SA in this population. This emphasises the need for using objective diagnostic tools to identify such a syndrome in kidney disease.