Disordered sleep and noncompliance in a patient with end-stage renal disease

Sleep disorders are relatively common in patients with end-stage renal disease, but the diagnosis may be difficult to establish because of the similarity of uremic symptoms to those of the sleep apnea syndrome. After excluding anatomic and metabolic disorders associated with excessive sleepiness and disordered breathing in sleep and after ensuring that the patient is receiving adequate dialysis, the sleep disorder should be diagnosed using polysomnography. Continuous positive pressure airway breathing is an effective treatment for hemodialysis patients with obstructive sleep apnea syndrome, but the use of this machinery requires patient compliance, as does the delivery of an adequate amount of dialysis. The difficulties adjusting to end-stage renal disease requiring dialysis can be multiplied by the coexistence of a sleep disorder that requires some ventilatory assistance at night; the case presented in this article characterizes precisely that circumstance.