The following is a summary of “Obstructive sleep apnea in the hemodialysis population: are clinicians putting existing scientific evidence into practice?,” published in the June 2024 issue of Nephrology by Burkhalter et al.

People on hemodialysis (HD) often have obstructive sleep apnea (OSA) related to fluid overload. Managing fluid levels towards a lower dry weight can lessen OSA severity, offering new treatment possibilities. 

Researchers conducted a retrospective study to assess whether nephrologists are aware of OSA in patients on HD and whether the method is implicated in managing fluid levels. 

They conducted a multicenter study from July 2022 to July 2023, screening all patients on HD from 4 units for OSA and including patients with confirmed OSA. Anthropometric data and fluid status were gathered from electronic records. Predialysis fluid overload was assessed using multifrequency bioelectrical impedance (BCM^®). Nephrologists identified patients with OSA without consulting medical records. Fluid management was compared between correctly (OSA positive) and incorrectly (OSA negative) patients. 

The results showed 193 patients on HD, 23% (n=45) had confirmed OSA. The mean age was 76±7.5 years, with 82.2% being men. Only 60% were correctly identified as “OSA positive” by nephrologists. The BMI was the only correlated factor that identified OSA correctly. Predialysis fluid overload tended to be higher in the “OSA positive” group (2.2±1.4 kg vs. 1.5±1.3 kg; P=0.08), but post-dialysis dry weight achievement didn’t differ between groups (residual overweight 0.2±1.0 kg and 0.1±0.7 kg, P=0.672).

Investigators concluded that scientific evidence needed to be more consistently applied to manage OSA in patients on HD. However, nephrologists aim to achieve a uniform dry weight regardless of OSA. Educating nephrologists about OSA’s clinical nuances could enhance diagnosis and care.

Source: frontiersin.org/journals/nephrology/articles/10.3389/fneph.2024.1394990/full