SLEEP-APNEA SYNDROME AND END-STAGE RENAL-DISEASE - CURE AFTER RENAL-TRANSPLANTATION

We report two patients undergoing maintenance hemodialysis who present ed with sleep apnea syndrome (SAS). The first patient is a 36-year-old man with a terminal Berger's glomerulopathy and associated obstructiv e sleep apnea syndrome (OSAS) (apnea-hypopnea index [AHI] = 80). He wa s receiving home hemodialysis and was treated by nasal continuous posi tive airway pressure (CPAP). After successful renal transplantation, h is symptoms completely disappeared, and control polysomnography greatl y improved (AHI = 9). The second patient had hypokalemic nephropathy w ith severe, uncontrolled hypertension and hypertensive myocardopathy. He was receiving home dialysis and showed a central sleep apnea syndro me with an AHI of 51. He also was successfully treated by nasal CPAP. After renal transplantation, his sleep improved, insomnia disappeared, and polysomnography showed great improvement (AHI = 5). We discuss th e role of periodic breathing related to end-stage renal disease associ ated metabolic abnormalities, as a pathogenetic factor of these SASs. Respiratory correction of chronic metabolic acidosis, ''uremic toxins, '' ''middle molecules,'' and hemodialysis are all evoked as etiologic factors and their own roles are discussed.