Impact of Compression Stockings vs. Continuous Positive Airway Pressure on Overnight Fluid Shift and Obstructive Sleep Apnea among Patients on Hemodialysis

Date
2017Author
Silva, Bruno C.
Santos, Roberto S. S.
Drager, Luciano F.
Coelho, Fernando M. [UNIFESP]
Elias, Rosilene M.
Type
ArtigoISSN
2296-858XIs part of
Frontiers In MedicineDOI
10.3389/fmed.2017.00057Metadata
Show full item recordAbstract
Introduction: Obstructive sleep apnea (OSA) is common in edematous states, notably in hemodialysis patients. In this population, overnight fluid shift can play an important role on the pathogenesis of OSA. The effect of compression stockings (CS) and continuous positive airway pressure (CPAP) on fluid shift is barely known. We compared the effects of CS and CPAP on fluid dynamics in a sample of patients with OSA in hemodialysis, through a randomized crossover study. Methods: Each participant performed polysomnography (PSG) at baseline, during CPAP titration, and after 1 week of wearing CS. Neck circumference (NC) and segmental bioelectrical impedance were done before and after PSG. Results: Fourteen patients were studied (53 9 years 57% men body mass index 29.7 6.8 kg/m(2)). Apnea hypopnea index (AHI) decreased from 20.8 (14.2 39.6) at baseline to 7.9 (2.8 25.4) during CPAP titration and to 16.7 (3.5 28.9) events/h after wearing CS (CPAP vs. baseline, p = 0.004 CS vs. baseline, p = 0.017 and CPAP vs. CS, p = 0.017). Nocturnal intracellular trunk water was higher after wearing CS in comparison to baseline and CPAP (p = 0.03). CS reduced the fluid accumulated in lower limbs during the day, although not significantly. Overnight fluid shift at baseline, CPAP, and CS was -183 +/- 72, 343 +/- 220, and 290 +/- 213 ml, respectively (p = 0.006). Overnight NC increased at baseline (0.7 +/- 0.4 cm), decreased after CPAP (-1.0 +/- 0.4 cm), and while wearing CS (-0.4 +/- 0.8 cm) (CPAP vs. baseline, p < 0.0001 CS vs. baseline, p = 0.001 CPAP vs. CS, p = 0.01). Conclusion: CS reduced AHI by avoiding fluid retention in the legs, favoring accumulation of water in the intracellular component of the trunk, thus avoiding fluid shift to reach the neck. CPAP improved OSA by exerting local pressure on upper airway, with no impact on fluid redistribution. CPAP performed significantly better than CS for both reduction of AHI and overnight reduction of NC. Complementary studies are needed to elucidate the mechanisms by which CPAP and CS reduce NC.
Citation
Frontiers In Medicine. Lausanne, v. 4, p. -, 2017.Keywords
obstructive sleep apneacompression stockings
continuous positive airway pressure
fluid shift
hemodialysis
Sponsorship
Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)Collections
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