0876 Sleep Apnea and Change in Quality of Life Among Veterans with Kidney Disease: A Prospective Cohort Study

Abstract

Introduction: Sleep apnea (SA) is common in patients with chronic kidney disease (CKD) and negatively impacts quality of life (QOL) in the general population. However, to date, the impact of SA on QOL among Veterans with CKD is unknown. Methods: We conducted a prospective cohort study of 248 veterans aged 18-89 with estimated glomerular filtration rate (eGFR) of 15-44 ml/min/1.73m2 who were not on treatment for SA. At baseline, participants underwent 25-channel unattended PSG and completed the Kidney Disease Quality of Life-Short Form (KDQOL-SF) Survey. The survey was repeated annually for three years. SA was defined by the apnea-hypopnea index (AHI, events/hour) of ≥15. Nocturnal hypoxemia was defined as % total sleep time <90%SaO2 (%TST90) ≥10%. We used linear mixed modeling to examine the effect of SA, nocturnal hypoxemia and total sleep time (TST, tertiles) on annualized QOL change. We pre-specified domains for this analysis based upon published literature. Results: Mean age was 73.2 ± 9.6 y; 95.2% were male; 78.2% were Caucasian. Mean BMI was 30.3 ± 4.8 kg/m2, mean MDRD eGFR was 34.9 ± 8.7 ml/min/1.73m2. 54.8% were diabetic, 95.6% had hypertension and 28.6% had depression. Overall, QOL declined across all key domains (PCS, Δ=-2.1 ± 1.1; MCS, Δ=-2.0 ± 1.1; Role-emotional, Δ=-3.9 ± 2.6; Role-physical, Δ=-3.2 ± 2.3; Physical function, Δ=-2.4 ± 1.5; Burden of kidney disease, Δ=-2.7 ± 1.5). When participants with SA were compared to without SA there was no significant difference in the rate of decline with any domain. We found similar results comparing those with and without nocturnal hypoxia and, in general, across tertiles of TST. However, compared to Veterans with greater TST, those with shorter TST had a trend to faster decline in role-physical (Δ=-7.5 ± 2.7/year vs Δ=-1.1 ± 1.9/ year p=0.06). Conversely, those with shorter TST has slower decline in burden of kidney disease (Δ=0.01 ± 1.8/year vs Δ=-4.4 ± 1.2/year p=0.03). Conclusion: In this first study of SA and change in QOL in Veterans with CKD, TST but not SA or nocturnal hypoxemia impacted QOL over time. Shorter TST was associated with greater decline in role-physical but slower decline in burden of sleep score.