Obstructive sleep apnea risk and associated factors among patients with end-stage kidney disease on maintenance Hemodialysis at Muhimbili national Hospital, Dar es salaam

Abstract

ABSTRACT Background: Obstructive sleep apnea (OSA) is claimed to affect more than 50% of hemodialysis patients, with the reported prevalence being extremely variable. It is known that OSA increases cardiovascular risk in ESRD patients and impairs the QOL with cardiovascular mortality remaining the leading cause of death in these patients. Aim: To determine the prevalence and associated factors of risk of OSA among ESRD patients on maintenance hemodialysis therapy at Muhimbili National Hospital (MNH). Methodology: A hospital-based cross-sectional study was conducted among patients with ESRD on maintenance HD between September 2023 and January 2024 at MNH dialysis centre. The patient’s sociodemographic and clinical characteristics were recorded. The STOP-Bang and ESS questionnaires were administered serially starting with SBQ. The ESS score of  10 points. Comparison of categorical variables was done using Chi-square and Robust Poisson regression was used to identify factors associated with OSA. A significance level was set at p-value <0.05 Results: A total of 350 ESRD patients were enrolled in the study. The median age was 52.0 IQR (43-59) years with a male-to-female ratio of 2.4:1. The prevalence of risk of OSA was 37.1%. A significantly high prevalence of risk of OSA was seen among hypertensive patients (42.4%) (p=0.001) and diabetic patients (62.2%) (p<0.0001). Independent factors associated with OSA were hypertension (aPR(95%CI) =2.91, (2.09 4.06), p<0.0001) and diabetes (aPR(95%CI) =3.37 (2.68-4.23), p<0.0001). Dialysis vintage, number of HD sessions per week, dialysis adequacy, and laboratory parameters were not independently associated with the risk of OSA. Conclusion: The risk of OSA is common among ESRD patients on maintenance hemodialysis. Early detection and effective management of those patients with risk of OSA among ESRD patients by nephrologists is of great significance as it will reduce cardiovascular complications and improve the quality of life.