Is fluid overload a target to treat sleep disordered breathing in patients with end-stage renal disease, and what are the underlying mechanisms?

Sleep problems are more common in patients with renal failure compared to populations without overt severe comorbidities. Both central and obstructive forms of sleep disordered breathing (SDB) are present in patients with renal failure [1, 2]. Other sleep problems, including restless leg syndrome, periodic limb movement syndrome and insomnia, also occur at high rates in this population. As the severity of renal impairment increases so too does the prevalence and severity of sleep disorders [3, 4]. Indeed, in end-stage renal disease, significant SDB (apnoea–hypopnoea index ⩾15 per hour sleep) can occur in up to 70% of cases, regardless of whether such patients are on haemodialysis or peritoneal dialysis [5, 6].