Sleep disorders and end-stage renal disease.

PURPOSE OF REVIEW: To provide an update on the prevalence and clinical importance of sleep disorders in patients with end-stage renal disease (ESRD) and to highlight recent findings on their pathogenesis and treatment.

RECENT FINDINGS: Although poor sleep quality is common in patients with ESRD, it is underrecognized. In addition to causing impaired quality of life, poor sleep is associated with increased cardiovascular mortality. There is evidence that sleep quality may be improved by cognitive-behavioral therapy that may help to reduce the frequent use of hypnotic medication. There are differences in the clinical presentation of sleep apnea in patients with ESRD compared with patients with normal renal function. The pathogenesis of sleep apnea in patients with ESRD appears to be related both to increased chemosensitivity, which destabilizes the control of breathing, and narrowing of the upper airway, which predisposes to closure of the airway during sleep. Although renal transplantation corrects periodic leg movements, it does not always correct sleep apnea.

SUMMARY: Sleep disorders are common in patients with ESRD. Although our understanding of their pathogenesis and clinical presentation has grown in recent years, further research is required to determine their impact on clinical outcomes in this patient population.