Effect of Renal Transplantation on Obstructive Sleep Apnea in End Stage Renal Disease Patients (SASinTx)
Effect of Renal Transplantation on Obstructive Sleep Apnea in End Stage Renal Disease Patients (SASinTx)
The purpose of this study is to investigate the effect of renal transplantation on fluid
 overload and its consequence on the severity of obstructive sleep apnea, in patients with end
 stage chronic kidney disease. It aims further to investigate the relationship between
 overhydration, nocturnal rostral fluid shift and the severity of sleep apnea.
Obstructive sleep disordered breathing is more prevalent in end stage kidney disease patients
 than in the general population, and may participate to the increased cardiovascular mortality
 observed in this group of patients. Despite a significant increase in knowledge about the
 harmful effects of obstructive sleep apnea, the pathophysiological mechanisms are poorly
 understood. Recent observations suggest a causative relationship between overnight fluid
 displacement from the legs to the neck soft and the severity of obstructive sleep apnea. This
 mechanism was demonstrated in otherwise healthy subjects, in heart failure patients, and in
 patients with venous insufficiency. We thus suspect that this pathophysiologic mechanism
 could explain the increased prevalence of obstructive sleep apnea in patients with fluid
 overload, including chronic renal failure.

 The purpose of this study is to investigate the effect of renal transplantation on fluid
 overload and its consequence on the severity of obstructive sleep apnea, in patients with end
 stage chronic kidney disease. It aims further to investigate the relationship between
 overhydration, nocturnal rostral fluid shift and the severity of sleep apnea.

 The severity of obstructive sleep apnea is measured by two attended polysomnographies, a
 baseline PSG performed before and a follow-up PSG performed 6 month after renal
 transplantation. Overhydration and leg fluid are evaluated by bioimpedance, performed at the
 beginning and at the end of each polysomnography. Patients who are not already transplanted 6
 months after the baseline PSG will be re-assessed and will be analyzed as control group.
Inclusion Criteria:

 -  moderate to severe obstructive sleep apnea, with an apnea-hypopnea index (AHI) ≥ 15/h

 -  age ≥ 18 years

 -  patient with end stage renal disease on waiting list for a renal transplantation
 (cadaveric or live donor).

 Exclusion Criteria:

 -  unstable congestive heart failure

 -  active psychiatric disease

 -  amputation of the lower limbs, proximal to the ankle