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Conference Paper: Nocturnal cycler-assisted peritoneal dialysis (NPD) improves sleep apnea by augmenting middle molecule clearance and reducing upper airway edema

TitleNocturnal cycler-assisted peritoneal dialysis (NPD) improves sleep apnea by augmenting middle molecule clearance and reducing upper airway edema
Authors
Issue Date2008
PublisherMultimed, Inc. The Journal's web site is located at http://pdiconnect.com
Citation
The 12th Congress of the International Society for Peritoneal Dialysis (ISPD 2008), Istanbul, Turkey, 21-24 June 2008. In Peritoneal Dialysis International, v. 28 suppl. 4, p. S7, abstract no. OP-17 How to Cite?
AbstractWe recently showed that nocturnal cycler-assisted peritoneal dialysis (NPD) may have a therapeutic edge over continuous ambulatory peritoneal dialysis (CAPD) in sleep apnea (SA) associated with renal failure. To further dissect the underlying biophysical mechanisms, we extended our investigational tools to include magnetic resonance imaging (MRI) of the upper airway and urea kinetics during sleep. In a fixed-sequence intervention study, 35 incident patients [pts (mean age: 54.5±13.4 years)] underwent one polysomnography (PSG) during mandatory NPD while awaiting CAPD training, and a second PSG after being established on stable CAPD. The prevalence of SA, defined as an apnea–hypopnea index (AHI) ≥ 15, was 17.1% during NPD and 40.0% during CAPD (p=0.008). Mean AHI increased from 7.7±2.32 during NPD to 18.9±3.77 during CAPD (p < 0.001). The central (CSA) and obstructive (OSA) forms of SA were both significantly less severe during NPD. Total body water (TBW) by bioelectrical impedance analysis was lower during NPD than during CAPD (32.6±6.77 L vs. 35.0±7.1 L, p=0.004), and NPD delivered greater reductions in TBW (–3.06±0.35 L vs. –1.07±0.31 L, p=0.015) and hydration fraction (–4.05%±0.51% vs. – 0.62%±0.44%, p=0.005) during sleep. Nightly peritoneal Kt/V (pKt/V) and creatinine clearance (pCCr) derived solely from overnight effluent were both higher during NPD than during CAPD (pKt/V: 0.29±0.06 vs. 0.063±0.027, p < 0.001; pCCr: 4.94±1.33 L vs. 1.77±0.74 L, p < 0.001). Among 10 pts who underwent MRI, pharyngeal volume and minimum pharyngeal cross-sectional area were higher (p < 0.05) and tongue volume was lower (p < 0.01) during NPD than during CAPD, signifying a more patent upper airway during NPD. Compared with CAPD, NPD may alleviate SA in pts with chronic renal failure by achieving better fluid and middle-molecule clearance during sleep, respectively resulting in less upper airway edema and hence less OSA, and less depressed respiratory drive and hence less CSA.
DescriptionConference Theme: Positioning PD towards the Future
Oral Presentations: no. OP-17
This journal suppl. entitled: Abstratcs of the 12th Congress of the ISPD
Persistent Identifierhttp://hdl.handle.net/10722/98746
ISSN
2015 Impact Factor: 1.298
2015 SCImago Journal Rankings: 0.683

 

DC FieldValueLanguage
dc.contributor.authorTang, SCWen_HK
dc.contributor.authorLam, Ben_HK
dc.contributor.authorLai, ASen_HK
dc.contributor.authorPang, CBYen_HK
dc.contributor.authorTse, KCen_HK
dc.contributor.authorTso, WKen_HK
dc.contributor.authorKhong, PLen_HK
dc.contributor.authorIp, MSMen_HK
dc.contributor.authorLai, KNen_HK
dc.date.accessioned2010-09-25T18:00:36Z-
dc.date.available2010-09-25T18:00:36Z-
dc.date.issued2008en_HK
dc.identifier.citationThe 12th Congress of the International Society for Peritoneal Dialysis (ISPD 2008), Istanbul, Turkey, 21-24 June 2008. In Peritoneal Dialysis International, v. 28 suppl. 4, p. S7, abstract no. OP-17en_HK
dc.identifier.issn0896-8608en_HK
dc.identifier.urihttp://hdl.handle.net/10722/98746-
dc.descriptionConference Theme: Positioning PD towards the Future-
dc.descriptionOral Presentations: no. OP-17-
dc.descriptionThis journal suppl. entitled: Abstratcs of the 12th Congress of the ISPD-
dc.description.abstractWe recently showed that nocturnal cycler-assisted peritoneal dialysis (NPD) may have a therapeutic edge over continuous ambulatory peritoneal dialysis (CAPD) in sleep apnea (SA) associated with renal failure. To further dissect the underlying biophysical mechanisms, we extended our investigational tools to include magnetic resonance imaging (MRI) of the upper airway and urea kinetics during sleep. In a fixed-sequence intervention study, 35 incident patients [pts (mean age: 54.5±13.4 years)] underwent one polysomnography (PSG) during mandatory NPD while awaiting CAPD training, and a second PSG after being established on stable CAPD. The prevalence of SA, defined as an apnea–hypopnea index (AHI) ≥ 15, was 17.1% during NPD and 40.0% during CAPD (p=0.008). Mean AHI increased from 7.7±2.32 during NPD to 18.9±3.77 during CAPD (p < 0.001). The central (CSA) and obstructive (OSA) forms of SA were both significantly less severe during NPD. Total body water (TBW) by bioelectrical impedance analysis was lower during NPD than during CAPD (32.6±6.77 L vs. 35.0±7.1 L, p=0.004), and NPD delivered greater reductions in TBW (–3.06±0.35 L vs. –1.07±0.31 L, p=0.015) and hydration fraction (–4.05%±0.51% vs. – 0.62%±0.44%, p=0.005) during sleep. Nightly peritoneal Kt/V (pKt/V) and creatinine clearance (pCCr) derived solely from overnight effluent were both higher during NPD than during CAPD (pKt/V: 0.29±0.06 vs. 0.063±0.027, p < 0.001; pCCr: 4.94±1.33 L vs. 1.77±0.74 L, p < 0.001). Among 10 pts who underwent MRI, pharyngeal volume and minimum pharyngeal cross-sectional area were higher (p < 0.05) and tongue volume was lower (p < 0.01) during NPD than during CAPD, signifying a more patent upper airway during NPD. Compared with CAPD, NPD may alleviate SA in pts with chronic renal failure by achieving better fluid and middle-molecule clearance during sleep, respectively resulting in less upper airway edema and hence less OSA, and less depressed respiratory drive and hence less CSA.-
dc.languageengen_HK
dc.publisherMultimed, Inc. The Journal's web site is located at http://pdiconnect.comen_HK
dc.relation.ispartofPeritoneal Dialysis Internationalen_HK
dc.titleNocturnal cycler-assisted peritoneal dialysis (NPD) improves sleep apnea by augmenting middle molecule clearance and reducing upper airway edemaen_HK
dc.typeConference_Paperen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0896-8608&volume=28&spage=S7&epage=&date=2008&atitle=Nocturnal+cycler-assisted+peritoneal+dialysis+(NPD)+improves+sleep+apnea+by+augmenting+middle+molecule+clearance+and+reducing+upper+airway+edemaen_HK
dc.identifier.emailTang, SCW: scwtang@hku.hken_HK
dc.identifier.emailLam, B: lambing@HKUCC.hku.hken_HK
dc.identifier.emailPang, CBY: bycpang@hkucc.hku.hken_HK
dc.identifier.emailKhong, PL: plkhong@hkucc.hku.hken_HK
dc.identifier.emailIp, MSM: msmip@hku.hken_HK
dc.identifier.emailLai, KN: knlai@hku.hken_HK
dc.identifier.authorityTang, SCW=rp00480en_HK
dc.identifier.authorityKhong, PL=rp00467en_HK
dc.identifier.authorityIp, MSM=rp00347en_HK
dc.identifier.authorityLai, KN=rp00324en_HK
dc.identifier.hkuros156729en_HK
dc.identifier.volume28en_HK
dc.identifier.issuesuppl. 4-
dc.identifier.spage7en_HK
dc.identifier.spageS7, abstract no. OP-17-
dc.identifier.epageS7, abstract no. OP-17-

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