Sleep disturbances and sleep apnea in patients on chronic peritoneal dialysis

Sleep disturbances in chronic peritoneal dialysis (PD) patients are increasingly widely recognized. These include changes in sleep architecture, sleep apnea syndrome, restless legs syndrome, periodic limb movement disorder and excessive daytime sleepiness. Some of these entities will be addressed in this review. The study tools for detecting sleep-related disorders in PD patients range from self-reported questionnaires (subjective) to standard overnight polysomnographic measurements (objective). Both these tools identify a high prevalence (over 50%) of sleep-related disorders among dialysis patients. Among these, sleep apnea syndrome is one of the most widely reported sleep-related disorders in PD. Sleep apnea in PD may be attributed to chronic fluid overload and uremia, leading to both obstructive and central forms of apneas. The exact underlying pathophysiology, however, is complex and likely involves a combination of multiple factors. There are preliminary data that nocturnal PD may be advantageous over conventional continuous ambulatory peritoneal dialysis in correcting sleep apnea associated with PD. Randomized studies are needed for confirmation.