Abstract
INTRODUCTION: Hemodialysis patients are at high cardiovascular risk, with sudden death being one of the leading cause of mortality. Sleep disorders are highly prevalent in this population, and obstructive sleep apnea (OSA) has been associated with poorer blood pressure control and cardiovascular damage. OBJECTIVE: To investigate the association between an intermediate or high risk of OSA and the occurrence of major cardiovascular events in hemodialysis patients. METHODS: This prospective multicenter cohort study was conducted in three hemodialysis clinics between May 2022 and May 2024. A total of 165 patients aged 18 to 75 years who had been undergoing hemodialysis for at least 6 months were included. Clinical, labora-tory, and sleep-related variables, were assessed, including OSA risk (STOP-Bang), sleep quality (Pittsburgh Sleep Quality Index), chronotype (Morningness-Eveningness Questionnaire), and the occurrence of major adverse cardiovascular events (MACE+). Patients were followed for 22 to 24 months. RESULTS: Overall 64.8% of patients were classified as being at an intermediate or high risk for OSA. This group showed a higher prevalence of diabetes and obesity, poorer sleep quality, more cases of chronic restless legs syndrome, and lower dialysis adequacy. The incidence of major cardiovascular events was significantly higher among patients at risk of OSA (17.0% vs. 5.2%; p = 0.03), with an independent association observed between OSA and sudden death (OR 1.18, 95% CI 1.01-1.39; p = 0.03). Other sleep disorders were not associated with increased cardiovascular risk. CONCLUSION: Hemodialysis patients had a high risk of OSA, which was independently associated with adverse cardiovascular outcomes.