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Background: In Western societies, sleep apnea has emerged as a major medical problem with important social and financial implications. The issue may be even more relevant in nephrology because some of the factors involved in the pathogenesis of renal disease also cause or are associated with obstructive sleep apnea (OSA) in the general population. Emerging evidence suggests that nocturnal hypoxemia and OSA are novel cardiovascular risk factors for chronic kidney disease (CKD). Patients with these conditions have a high prevalence of sleep disorders. However, the diagnosis of sleep disorders is often complicated by the presence of comorbid illness and/or the uremic syndrome itself.
Case Report: A 42-year-old male patient – with a history of untreated hypertension for more than 20 years developed acute renal failure due to a generalized infection caused by complications after an appendectomy in 2004 – received a diagnosis of CKD in 2009. When he started undergoing renal replacement therapy in 2010, consisting of a daytime dialysis modality, he was found with hypertension, hypertensive nephrosclerosis, and diabetes mellitus. The patient underwent baseline nocturnal polysomnography, which showed an apnea/hypopnea index (AHI) of 100.5/h associated with significant oxyhemoglobin desaturation and periodic limb movements.
Conclusions: This case report describes an ESRD patient who was Undergoing hemodialysis and presented a very high expressive AHI associated with daytime sleepiness, considerable levels of depression, sleep impairment, and decreased quality of life. We suggest that further longitudinal research is needed to determine long-term outcomes involving the pathophysiology, clinical consequences, and effects of non-invasive ventilation treatment in patients with end-stage renal disease (ESRD).

Keywords: Polysomnography, Sleep Disorders, chronic kidney disease, hemodialysis, Quality of Life