0470 Real-time Data Showing Immediate Improvement of Obstructive Sleep Apnea Following Renal Transplant

Introduction There is a well-documented correlation between end stage renal disease (ESRD) and obstructive sleep apnea (OSA). Prevalence of OSA in the ESRD population has been show to be as high as 51%. There is a complicated interrelation between the two pathologies. Hypertension, is a major contributing factor to the progression chronic kidney disease and subsequently ESRD. It is a consequence of the cascade of increased sympathetic tone, vasoconstriction, and oxidative stress caused by the hypoxic episodes of OSA. Volume overload and fluid shifts during recumbence leads to an increase in tissue fluid around the upper airway in patients with ESRD and has been shown to worsen OSA4. Data on improvement in OSA after renal transplantation has been mixed, with some case reports of OSA resolution after transplantation, but a greater number of studies showed no significant improvement of OSA following transplantation. Most studies review long term SDB in relation to transplant, few studies measure sleep disordered breathing in the immediate post-op period Methods Our patient is a 54-year-old African-American male with ESRD secondary to systemic lupus erythematosus on HD since 2017. He had been treated with methotrexate, hydroxychloroquine, mycophenolate mofetil, and corticosteroids prior to transplant. Medical history other than the above includes rheumatoid arthritis, pericarditis, hypertension, osteoporosis, and OSA treated with CPAP. The patient had been compliant with CPAP prior to transplant. OSA was diagnosed in 2014 with AHI of 26.1 events/ hour, with a nadir Sao2 of 60%. Results He underwent deceased donor renal transplant on 11/11/2018. During this hospitalization he was using his home CPAP, which recorded his compliance and treatment data. Evaluation of his downloaded CPAP compliance report revealed a dramatic improvement in respiratory events starting the day of transplant. AHI improved from 0.6 events/hour to 0.2 events/hour immediately following transplant. Conclusion Although recent studies have not shown resolution of obstructive sleep apnea in ESRD patients following transplantation, this case does show a dramatic improvement in the degree of sleep-disordered breathing immediately following surgery. This case also provides real time data regarding the effects of renal transplantation on sleep disordered breathing. Support (if any)