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Hypervolemia and Sleep Apnea in Kidney Disease

  • Owen D. Lyons
    Correspondence
    Address reprint requests to Dr. Owen Lyons, Sleep Research Laboratory, Toronto Rehabilitation Institute, 550 University Avenue, Toronto, ON M5G 1X5, Canada
    Affiliations
    Sleep Research Laboratory of the University Health Network Toronto Rehabilitation Institute, Toronto, Ontario, Canada

    Centre for Sleep Medicine and Circadian Biology, University of Toronto, Toronto, Ontario, Canada
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  • T. Douglas Bradley
    Affiliations
    Sleep Research Laboratory of the University Health Network Toronto Rehabilitation Institute, Toronto, Ontario, Canada

    Centre for Sleep Medicine and Circadian Biology, University of Toronto, Toronto, Ontario, Canada

    Division of Respirology, University of Toronto, Toronto, Ontario, Canada
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  • Christopher T. Chan
    Affiliations
    Division of Nephrology, Department of Medicine, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
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      Summary

      In end-stage renal disease (ESRD) and heart failure, conditions characterized by fluid overload, both obstructive sleep apnea (OSA) and central sleep apnea (CSA) are highly prevalent. This observation suggests that fluid overload may be a unifying mechanism in the pathogenesis of both OSA and CSA in these conditions. An overnight rostral fluid shift from the legs to the neck and lungs has been shown to contribute to the pathogenesis of OSA and CSA, respectively, in various different patient populations. This article reviews the evidence that supports a role for fluid overload and overnight fluid shift in the pathogenesis of sleep apnea in ESRD. The diagnosis, epidemiology, and clinical features of sleep apnea in patients with ESRD also are considered.

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