Obstructive sleep apnea risk and associated factors among patients with end-stage kidney disease on maintenance hemodialysis in Tanzania: cross-sectional study

Obstructive sleep apnea risk and associated factors among patients with end-stage kidney disease on maintenance hemodialysis in Tanzania: cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Obstructive sleep apnea risk and associated factors among patients with end-stage kidney disease on maintenance hemodialysis in Tanzania: cross-sectional study Frank Peter, Reuben Mutagaywa, Sibtain Moledina, Alfred Luvakule This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9015758/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background: Obstructive sleep apnea (OSA) is claimed to affect more than 50% of hemodialysis patients. It is known that OSA increases cardiovascular risk in end-stage kidney disease (ESKD) patients and impairs the quality of life with cardiovascular mortality remaining the leading cause of death in these patients. This study aimed to determine the prevalence and associated factors of risk of Obstructive sleep apnea (OSA) among end-stage kidney disease (ESKD) patients on maintenance hemodialysis therapy at Muhimbili National Hospital (MNH). Methods: A hospital-based cross-sectional study was conducted among patients with end-stage kidney disease (ESKD)between September 2023 and January 2024 at Muhimbili National Hospital (MNH) dialysis centre. The STOP-Bang and Epworth Sleepiness Score were administered. Comparison of categorical variables was done using Chi-square and Robust Poisson regression was used to identify factors associated with Obstructive sleep apnea (OSA). A significance level was set at p-value <0.05. Results: A total of 350 end-stage kidney disease (ESKD) patients were enrolled in the study. The median age was 52.0 IQR (43–59) years with a male-to-female ratio of 2.4:1.The prevalence of risk of Obstructive sleep apnea (OSA) was 37.1%. Independent factors associated with Obstructive sleep apnea (OSA) were hypertension (aPR(95%CI) =2.91, (2.09–4.06), p<0.0001) and diabetes (aPR(95%CI) =3.37 (2.68–4.23), p<0.0001). Conclusions: The risk of Obstructive sleep apnea (OSA) is common among end-stage kidney disease (ESKD) patients on maintenance hemodialysis. Early detection and effective management by nephrologists is of great significance as it will reduce cardiovascular complications and improve the quality of life. Obstructive sleep apnea End-stage kidney disease Dialysis Chronic kidney diseases Figures Figure 1 Figure 2 Introduction End-stage kidney disease (ESKD) occurs as an outcome of a progressive decline in kidney function over months or years. The global burden of End-stage kidney disease (ESKD) is increasing at a rate of about 7% per year ( 7 )( 8 ). Despite the increase in the burden of End-stage kidney disease (ESKD), there is still under-recognition of sleep complaints by health workers including clinicians ( 9 )( 10 ). It has been reported that up to 80% of patients receiving hemodialysis (HD) report some level of sleep disturbance ( 11 – 13 ) unfortunately, little attention has been paid to the impact of these disorders on patients with end-stage renal disease End-stage kidney disease (ESKD) who are on dialysis ( 14 ). Obstructive Sleep Apnea (OSA) is a prevalent sleep disorder characterized by episodes of complete or partial cessation of airflow, known as apneas and hypopneas, respectively, as well as respiratory effort-related arousals (RERAs). ( 15 ) The estimated prevalence of Obstructive sleep apnea (OSA) in the general population ranges from 3% to 7%, affecting approximately 1 billion people aged 30 to 70 worldwide. The rise in obesity over the past two decades has contributed significantly to the increase in Obstructive sleep apnea (OSA) cases. Among End-Stage Kidney Disease (ESKD) patients, the prevalence of OSA is notably higher, exceeding 50%, though there are currently no specific clinical guidelines for screening or managing Obstructive sleep apnea (OSA) in this population, resulting in infrequent assessment in clinical practice. ( 13 , 16 – 19 ). End-stage kidney disease is a dramatically increasing global health and healthcare burden with about 500 million people reported to have Chronic Kidney Disease (CKD) globally where 80% live in developing countries. In Tanzania, the prevalence of End-stage kidney disease (ESKD) is reported to range between 7% − 15%, majority of these patients progress to End-stage kidney disease (ESKD) needing hemodialysis( 30 , 49 , 50 ) However, the prevalence of Obstructive sleep apnea (OSA) in patients with End-stage kidney disease (ESKD) on hemodialysis is 10–fold higher than in the general population resulting in worsening of the clinical manifestations and cardiovascular complications. No studies have been done to evaluate the magnitude of Obstructive sleep apnea (OSA) among End-stage kidney disease (ESKD) patients on hemodialysis in Tanzania. The paucity of local data on the burden of Obstructive sleep apnea (OSA) among patients with End-stage kidney disease (ESKD) on hemodialysis provides less attention to this condition by most of the clinicians hence resulting in the higher prevalence of undiagnosed patients with Obstructive sleep apnea (OSA). ( 9 , 20 ) This study is essential to determine the burden of Obstructive sleep apnea (OSA) and the factors associated among patients with End-stage kidney disease (ESKD) on dialysis. 'Therefore, this study aimed to determine the prevalence and factors associated with OSA risk among ESKD patients on maintenance hemodialysis at Muhimbili National Hospital, Tanzania. Materials and Methods A hospital-based cross-sectional study was conducted among patients with End-stage kidney disease (ESKD) on maintenance hemodialysis (HD) between September 2023 and January 2024 at Muhimbili National Hospital dialysis centre. The facility provides dialysis treatments on a daily basis and has a capacity of 42 dialysis machines, which can run four sessions per day. Each dialysis machine has a digital BP machine incorporated within it. Fresenius dialysis machine is the brand used at Muhimbili National Hospital. Every month, approximately 300 patients are on hemodialysis (HD), with new patients being admitted virtually every day. Kish and Leslie’s formula was used to calculate the minimum sample size necessary: n = Z 2 P (100 − P)/ε 2 , where n = minimum sample size, z = standard normal deviate (1.96) responding to a 95% confidence interval, ε = margin of error (5.2%), p = 34.8% of ESKD patients on hemodialysis patient at Kenyatta Hospital in Kenya had a high risk of OSA based on validated berlin questionnaire (BQ), a study done in 2016 by Jivanji et al( 19 ) thus, n = 1.96 2 𝑋 34.8 (100–34.8) / 5.2 2 = 322. Taking a none response of 10%, n’= (322 X 100%) / (100%–10%), then N = 350. This study included all patient with End-stage kidney disease (ESKD) aged 18 and above which are on maintenance hemodialysis for at least 3 months. Patients who refused or were unable to provide informed consent (e.g., those on sedatives) were excluded. The research included various variables to thoroughly investigate the factors related to the risk of obstructive sleep apnea (OSA). The independent variables comprised both clinical and socio-demographic characteristics. The socio-demographic factors included age, sex, marital status, education level, health insurance status, alcohol consumption, and smoking habits. Clinical characteristics included the body mass index (BMI), neck circumference, presence of comorbidities like hypertension (HTN) or diabetes mellitus (DM), frequency of hemodialysis (HD) sessions each week, duration of dialysis, adequacy of hemodialysis assessed by urea reduction ratio (URR%), and important laboratory parameters such as hemoglobin levels, serum calcium, serum phosphates, and albumin. Conversely, the dependent variable represented the risk of OSA and was the study's main outcome measure. These variables provided a solid basis for examining how socio-demographic and clinical factors interact in evaluating OSA risk. Data obtained from questionnaires was entered into SPSS Version 26.0 for Windows which was used for data analysis. Data cleaning and reviewing the filled questionnaires were done to ensure quality control of data. Categorical variables were presented as frequencies and percentages, continuous variables were presented as median and interquartile range. Association between categorical variables was explored using Chi-square. Variables with a p-value < 0.2 on univariate analysis were further tested in the multivariable analysis using Robust Poisson Regression for factors associated with risk of OSA. A two-tailed p-value < 0.05 was used as a cut-off level for statistical significance. Results A total of 350 ESKD patients on maintenance hemodialysis were enrolled in this study. The participant selection process is illustrated in figure 1. Figure 1 Flow diagram showing participant enrolment and selection of end-stage kidney Disease (ESKD) patients on maintenance haemodialysis at Muhimbili National Hospital, Dar es Salaam, Tanzania (September 2023–January 2024). Sociodemographic characteristics of study participants A total of 350 end-stage kidney disease patients on hemodialysis were studied, out of which 70.6% (247/350) were males. The median age of the study participants was 52.0 (43–59) years and 56.9 % (199/350) were above 50 years. There were 89.4% (313/350) married participants, 38.6% (135/350) with primary and below education level, 51.1% (179/350) employed participants, and 85.7% (300/350) insured participants. Table 1 below summarizes the socio-demographic characteristics of the study participants. Table 1: Social-demographic characteristics of study participants (ESKD patients) (n=350) VARIABLE FREQUENCY, N (%) MEDIAN (IQR) Age in years 52.0 (43.0–59.0) ≤50 151 (43.1) >50 199 (56.9) Sex Female 103 (29.4%) Male 247 (70.6%) Marital status Married 313 (89.4%) Unmarried 37 (10.6%) Education level Primary and below 135 (38.6%) Secondary 170 (48.6%) College/University 45 (12.8%) Occupation Unemployed 171 (48.9%) Employed 179 (51.1%) Health insurance status Uninsured 50 (14.3%) Insured 300 (85.7%) Clinical characteristics of study participants (ESKD patients) (n=350) Hypertension was reported by 71.7% (251/350) participants followed by diabetes 21.2% (74/350). There were 4.0% (14/350) smokers, 11.1% (39/350) alcohol drinkers, median BMI was 25.0 (22.8–27.4) kg/m 2 while 40.9% of participants (143/350) were overweight, 8.2% (29/350) were obese respondents and median NC was 36.0 IQR (36–38) cm with 4.9% (17/350) of respondents having NC of above 40cm. The median dialysis vintage was 38 IQR (30–48) months, 82.3% (288/350) of the participants had 3 HD sessions per week. As far as vascular access of HD, 43.7% (153/350) of the participants had AVF access for HD and 36.3% (127/350) had permanent catheter. Adequate dialysis was present in 88.6% (310/350) of participants with median dialysis adequacy of 84.0 [72.7–90.0]. There were 97.7% (342/350) participants with anemia, 75.1% (263/350) participants with hypocalcemia, 53.1% (186/350) participants with hyperphosphatemia and 35.4% (124/350) participants with hypoalbuminemia. Table 2 below summarizes the clinical characteristics of the study participants. Table 2: Clinical characteristics of study participants ( ESKD patients ) (n=350) VARIABLE FREQUENCY, N (%) MEDIAN (IQR) Comorbid Hypertension 251(71.7%) Diabetes Mellitus 74 (21.1%) Glomerulonephritis 13 (3.7%) Smoking No 336 (96.0%) Yes 14 (4.0%) Alcohol drinking No 311 (88.9%) Yes 39 (11.1%) BMI in Kg/m 2 25.0 (22.8–27.4) 40 17 (4.9) Dialysis vintage (Months) 38.0 (30.0–48.0) 84 2 (0.3) Number of HD session/week 3.0 (3.0–3.0) 3 288 (82.3) Vascular access AVF 153 (43.7) Temporary catheter 70 (20.0) Permanent catheter 127 (36.3) Dialysis adequacy (URR %) 84.0(72.7–90.0) ³65 310 (88.6) <65 40 (11.4) Anemia (g/dl) 9.7 (8.5–10.5) No 8 (2.3) Yes 342 (97.7) Hypocalcemia (mmol/L) 1.9 (1.4–2.1) No 87 (24.9) Yes 263(75.1) Hyperphosphatemia(mmol/L) 1.6 (1.0–7.1) No 164 (46.9) Yes 186 (53.1) Hypoalbuminemia (g/L) 36.0 (33.0–39.0) No 226 (64.6) Yes 124 (35.4) Table 2: Clinical characteristics of study participants ( ESKD patients ) (n=350) Prevalence of risk of obstructive sleep apnea among ESKD patients on hemodialysis at MNH The study revealed that the prevalence of risk of obstructive sleep apnea in ESKD patients was 37.1%. Of the 350 participants, 130 (37.1%) were classified as having risk of OSA and 220 (62.9%) were classified as not having risk of OSA, based on the STOP-Bang questionnaire (Figure. 2). Figure 2: Prevalence of risk of obstructive sleep apnea (OSA) among end-stage kidney disease (ESKD) patients on maintenance hemodialysis at Muhimbili National Hospital, Dar es Salaam, Tanzania (N = 350). The bar chart shows that 37.1% of participants were classified as having risk of OSA and 62.9% were classified as not having risk of OSA, based on the STOP-Bang questionnaire. OSA by social-demographic and clinical characteristics of study participants Generally, in this study, 37.1% (130/350) of individuals were considered to have the risk of OSA. A significantly high prevalence of OSA was seen among hypertensive respondents (42.4%, 107/251) (p=0.001) and among diabetics (62.2%, 46/74) (p<0.0001). Glomerulonephritis , dialysis vintage, number of HD sessions per week, dialysis adequacy, and laboratory profile were not significantly associated with OSA.Table 3 below summarizes the results. Table 3: Risk of OSA by social-demographic and clinical characteristics of study participants (ESKD patients) (N=350) VARIABLE TOTAL NUMBER(N=350) Risk of OSA p -value No (n=220) Yes (n=130) Hypertension 0.001 No 99 76 (76.8) 23 (23.2) Yes 251 144 (57.4) 107 (42.6) Diabetes <0.0001 No 276 192 (69.6) 84 (30.4) Yes 74 28 (37.8) 46 (62.2) Glomerulonephritis 0.386 No 337 210 (62.3) 127 (37.7) Yes 13 10 (76.9) 3 (23.1) Dialysis vintage (Months) <0.0001 84 2 1(50.0) 1 (50.0) Number of HD session/week 0.389 3 288 184 (63.9) 104 (36.1) Dialysis adequacy (URR %) 0.766 ³65 310 194 (62.6) 116 (37.4) <65 40 26 (65.0) 14 (35.0) Anemia (g/dl) 0.983 No 8 5 (62.5) 3 (37.5) Yes 342 215 (62.9) 127 (37.1) Hypocalcemia (mmol/L) 0.666 No 87 53 (60.9) 34 (39.1) Yes 263 167 (63.5) 96 (36.5) Hyperphosphatemia( mmol/L) 0.365 No 164 99 (60.4) 65 (39.6) Yes 186 121 (65.1) 65 (34.9) Hypoalbuminemia ( g/L) 0.989 No 226 142 (62.8) 84 (37.2) Yes 124 78 (62.9) 46 (37.1) NB : Age, sex, neck circumference, BMI and Excessive daytime sleepiness (EDS) were excluded due to collinearity as they were involved in achieving the outcome (risk of OSA) Bivariable and Multivariable robust Poisson Regression analysis for factors associated with risk of Obstructive Sleep Apnea in patients with ESKD A multivariable analysis was done involving variables with p<0.2 in bivariable analysis and after adjusting for confounders. Hypertensive patients had a prevalence of OSA that was 2.91 times greater than normotensive, aPR (95%CI) =2.91, (2.09–4.06), p<0.0001. Participants with diabetes had a prevalence of OSA that was 3.37 times greater than the participants with no diabetes, aPR(95%CI) =3.37 (2.68–4.23), p<0.0001. The dialysis vintage was not independently associated with OSA. Table 4 below summarizes the bivariable and multivariable robust Poisson regression results for factors associated with the risk of OSA." Table 4: Bivariable and Multivariable robust Poisson regression for the factors associated with OSA VARIABLE YES, n (%) BIVARIABLE MULTIVARIABLE cPR (95%CI) p-value aPR(95%CI) P-value Hypertension No 23 (23.2) Ref Ref Yes 107 (42.6) 1.83 (1.25–2.70) 0.002 2.91 (2.09–4.06) <0.0001 Diabetes No 84 (30.4) Ref Ref Yes 46 (62.2) 2.04 (1.59–2.63) <0.0001 3.37 (2.68–4.23) <0.0001 Dialysis vintage (Months) 84 1 (50.0) 1.75 (0.62–10.77) 0.546 2.74 (0.27–28.05) 0.369 cPR =crude Prevalence Ratio, aPR =adjusted Prevalence Ratio Discussion Understanding the magnitude and associated factors of OSA among patients with ESKD on hemodialysis is critical in efforts to control the burden of OSA. In the present study, the prevalence of risk of OSA among ESKD patients on maintenance HD attending at MNH–Upanga dialysis center was 37.1% (32.0% and 39.3% for females and males respectively). Our prevalence of 37.1% was lower than reports from Senegal (49.1%), Spain (44%), and Japan (42%), but higher than those from the USA (12%), China (20%), and Egypt (21.6%) ( 12 , 52 , 58 , 60 ). The main reasons that explain the variability of prevalence in these studies include the differences in definitions of OSA, the study sample size, participant characteristics, and methods used for diagnosis of OSA ( 43 ) Notably, variations in sample size, definitions of OSA, screening tools, and diagnostic methods have been found across different studies contributing to a wide range of prevalence of OSA. In the present study, diabetes mellitus and hypertension were found to be significantly associated with the risk of OSA. This conformity with the findings in other studies done in the same population in Saudi Arabia, Switzerland, and Egypt, ( 10 , 13 , 54 , 60 ) In diabetic patients, this can be attributed to additional possible causes of upper-airway dilator muscle dysfunction like neuropathy associated with diabetes mellitus. ( 20 , 33 , 38 ) Significant association between hypertension and OSA can be attributed partly as the result of particularly intermittent hypoxia that triggers sympathetic nerve activity, systemic inflammation, and oxidative stress, causing endothelial cell dysfunction and arteriosclerosis commonly occurring in patients with OSA ( 20 , 21 ). However, this cannot explain fully this finding as the existence of hypertension could be present before the onset of OSA in a particular patient. In contrast, some studies found that DM was not significantly associated with OSA. ( 19 , 31 , 58 , 59 , 67 , 85 ) Nevertheless, in our patients, there has been no discernible correlation found between risk of OSA and factors including, dialysis vintage, dialysis adequacy, number of HD sessions/week, anemia, hypocalcemia, hyperphosphatemia, and hypoalbuminemia. LIMITATION ( 1 ) Use of screening tools (STOP-Bang, ESS) rather than gold-standard polysomnography ( 2 ) Cross-sectional design prevents causal inference; ( 3 ) Single-center study limits generalizability. Conclusion In this study, we found that the risk of OSA is considerably common in dialysis patients at MNH. Hypertension and diabetes were independently associated with the risk of OSA among patients with ESKD on maintenance hemodialysis. Based on our study findings and conclusions, the following recommendations are suggested. Regular screening programs be designed and implemented for the early detection of this disorder, especially clinicians should therefore actively look for the risk of OSA in hypertensive and diabetic patients on maintenance HD. Moreover, larger cohort studies with polysomnographic exploration are needed to better describe the epidemiology of OSA among Tanzanian dialysis patients. Abbreviations AVF Arteriovenous fistula BMI Body mass Index ESKD End stage kidney disease HD Hemodialysis MNH Muhimbili National Hospital OSA Obstructive sleep Apnea Declarations Ethics approval and consent to participate This study was conducted in accordance with the Declaration of Helsinki and was approved by the Senate Research and Publications Committee of Muhimbili University of Health and Allied Sciences (MUHAS). Ethical approval was granted Ref. No.DA.282/298/01.C/1837. Written informed consent was obtained from all participants prior to enrollment in the study. Consent for publication Not applicable Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This study received no specific funding. Acknowledgements Not applicable. References Flemons WW, Buysse D, Redline S, Oack A, Strohl K, Wheatley J, et al. Sleep-related breathing disorders in adults: Recommendations for syndrome definition and measurement techniques in clinical research. Sleep. 1999;22(5):667–89. The United Republic Of Tanzania Ministry Of Health , Community Development , Gender , Elderly And Children National Guidelines For Dialysis Services April , 2019. 2019; National Kidney Foundation. Update of the KDOQI TM Clinical Practice Guideline for Hemodialysis Adequacy. National Kidney Foundation. 2015. 1–78 p. Stradling JR. Obstructive sleep apnoea syndrome. Vol. 285, British Medical Journal. 1982. 528–530 p. Milik A, Hrynkiewicz E. On translation of LD, IL and SFC given according to IEC-61131 for hardware synthesis of reconfigurable logic controller. IFAC Proc Vol. 2014;19(1):4477–83. Zheng Z, Zhang Y, Chen M, Chen X, Li C, Wang C, et al. Application value of joint STOP-Bang questionnaire and Epworth Sleepiness Scale in screening for obstructive sleep apnea. Front Public Heal. 2022;10. Visweswaran K, Shaffi M, Mathew P, Abraham M, Lordson J, Rajeev P, et al. Quality of Life of End Stage Renal Disease Patients Undergoing Dialysis in Southern Part of Kerala , India : Financial Stability and Inter-dialysis Weight Gain as Key Determinants. 2020;10:344–50. Thurlow JS, Joshi M, Yan G, Norris KC, Agodoa LY, Yuan CM, et al. Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy. Am J Nephrol. 2021;20889(2):98–107. Chang JR, Akemokwe FM, Marangu DM, Chisunkha B, Irekpita E, Obasikene G, et al. Obstructive Sleep Apnea Awareness among Primary Care Physicians in Africa. 2020;17(1):98–106. Ogna VF, Ogna A, Pruijm M, Bassi I, Zuercher E, Halabi G, et al. Prevalence and Diagnostic Approach to Sleep Apnea in Hemodialysis Patients : A Population Study. 2015;2015. Kamal M, Zaki NFW, Yousef EA, Eltoraby E, Manzar MD, Pandi-Perumal SR. An Egyptian Study of Sleep Disorders and Its Correlates in End-Stage Renal Disease Patients Receiving Hemodialysis. Sleep Vigil. 2020;4(2):213–20. Chen WC, Lim PS, Wu WC, Chiu HC, Chen CH, Kuo HY, et al. Sleep Behavior Disorders in a Large Cohort of Chinese (Taiwanese) Patients Maintained by Long-Term Hemodialysis. Am J Kidney Dis. 2006;48(2):277–84. Al-Jahdali H. Prevalence of sleep apnea and excessive day time sleepiness in patients with end-stage renal disease on dialysis. Saudi J Kidney Dis Transpl. 2012;23(2):251–61. Dialysis CP. Original Article. 2011;22(5):922–30. Chang ET, Riaz M. Exploring sleep disorders in patients with chronic kidney disease. 2018;35–43. Abuyassin B, Sharma K, Ayas NT, Laher I. Obstructive Sleep Apnea and Kidney Disease : 2015;11(8). Lyons MM, Bhatt NY, Pack AI, Magalang UJ. Global burden of sleep-disordered breathing and its implications. Respirology. 2020;25(7):690–702. Lyons OD, Inami T, Perger E, Yadollahi A, Chan CT, Bradley TD. The effect of fluid overload on sleep apnoea severity in haemodialysis patients. 2017;1–8. Available from: http://dx.doi.org/10.1183/13993003.01789-2016 Onally H, Nairobi O. Quality Of Sleep And Sleep Disorders In Adult Patients With End Stage Renal Disease Undergoing Hemodialysis At Kenyatta National Hospital. Sakaguchi Y, Shoji T, Kawabata H, Niihata K, Suzuki A, Kaneko T, et al. High prevalence of obstructive sleep apnea and its association with renal function among nondialysis chronic kidney disease patients in Japan: A cross-sectional study. Clin J Am Soc Nephrol. 2011;6(5):995–1000. Penzel T, Fietze I, Schoebel C. Comparison of Berlin Questionnaire , STOP-Bang , and Epworth Sleepiness Scale for Diagnosing Obstructive Sleep Apnea in Persian Patients. 2018;1–5. Rosas SE. NIH Public Access. 2011;12(5):378–83. Medicine AA of S. International Classification of Sleep Disorders. American Academy of Sleep Medicine; 2014. Kohler M. Risk factors and treatment for obstructive sleep apnea amongst obese children and adults. Curr Opin Allergy Clin Immunol. 2009;9(1):4–9. Margareth H. No Title طرق تدريس اللغة العربية. Экономика Региона. 2017. 32 p. Sankri-Tarbichi AG. Obstructive sleep apnea-hypopnea syndrome: Etiology and diagnosis. Avicenna J Med. 2012;02(01):3–8. Fonseca NT, Urbano JJ, Nacif SR, Silva AS, Peixoto RAO, Urbano GJ, et al. A systematic review of sleep disorders in patients with chronic kidney disease undergoing hemodialysis. J Phys Ther Sci. 2016;28(7):2164–70. Ersoy E, Mercan Y. Risk Factors for Obstructive Sleep Apnea and the Association of Obstructive Sleep Apnea with Daytime Sleepiness, Obesity and Comorbidity. J Turkish Sleep Med. 2021;8(1):20–7. Nicholl DDM, Ahmed SB, Loewen AHS, Hemmelgarn BR, Sola DY, Beecroft JM, et al. Diagnostic value of screening instruments for identifying obstructive sleep apnea in kidney failure. J Clin Sleep Med. 2013;9(1):31–8. Furia FF, Shoo J, Ruggajo PJ, Kilonzo K, Basu G, Yeates K, et al. Developing nephrology services in low income countries: A case of Tanzania. BMC Nephrol. 2019;20(1):1–9. Chu G, Suthers B, Moore L, Paech GM, Hensley MJ, McDonald VM, et al. Risk factors of sleep-disordered breathing in haemodialysis patients. PLoS One [Internet]. 2019;14(8):1–11. Available from: http://dx.doi.org/10.1371/journal.pone.0220932 Marrone O, Bonsignore MR. Obstructive sleep apnea and chronic kidney disease : open questions on a potential public health problem. 2018;10(22):45–8. Marrone O, Bonsignore MR. Sleep Apnea and the Kidney. 2020;85–93. Huang H, Walters G, Talaulikar G, Figurski D, Carroll A, Hurwitz M, et al. Sleep apnea prevalence in chronic kidney disease - association with total body water and symptoms. 2017;1–9. Chang ET, Riaz M, Nigam G, Camacho M, Chang ET, Riaz M. Exploring sleep disorders in patients with chronic kidney disease. Nat Sci Sleep. 2018;10:35–43. Kerns ES, Kim D, Meoni A, Sozio M, Kim ED, Meoni LA, et al. Nephrology Obstructive Sleep Apnea Increases Sudden Cardiac Death in Incident Hemodialysis Patients. Am J Nephrol. 2018;8(2):147–56. Beecroft JM, Hoffstein V, Pierratos A, Chan CT, McFarlane PA, Hanly PJ. Pharyngeal narrowing in end-stage renal disease: Implications for obstructive sleep apnoea. Eur Respir J. 2007;30(5):965–71. Chakravorty I, Shastry M, Farrington K. Sleep apnoea in end-stage renal disease : a short review of mechanisms and potential benefit from its treatment. 2007;(October 2006):28–31. Nicholl DDM, Loewen AHS, Hemmelgarn BR, Sola DY, Beecroft JM, Turin TC, et al. Clinical Presentation of Obstructive Sleep Apnea in Patients with Chronic Kidney Disease. 2012;8(4). Kania A, Polok K, Celejewska-Wójcik N, Nastałek P, Opaliński A, Mrzygłód B, et al. Clinical and Polysomnographic Features Associated with Poor Sleep Quality in Patients with Obstructive Sleep Apnea. Med. 2022;58(7). Ozoh OB, Okubadejo NU, Akinkugbe AO, Ojo OO, Asoegwu CN, Amadi C, et al. Prospective assessment of the risk of obstructive sleep apnea in patients attending a tertiary health facility in Sub-Saharan Africa. Pan Afr Med J. 2014;17:1–7. Editors S, Naughton M, Cistulli PA, Chazal PDE, Lyons MME. INVITED REVIEW SERIES : NEW FRONTIERS IN SLEEP-DISORDERED BREATHING Global burden of sleep-disordered breathing and its implications. 2020;(March). Pisano A, Zoccali C, Bolignano D, D’Arrigo G, Mallamaci F. Sleep apnoea syndrome prevalence in chronic kidney disease and end-stage kidney disease patients: a systematic review and meta-analysis. Clin Kidney J [Internet]. 2024;17(1):1–12. Available from: https://doi.org/10.1093/ckj/sfad179 Chafekar N, Chafekar D, Deogaonkar V. Sun-213 Prevalence Of Obstructive Sleep Apnea (Osa) In End Stage Renal Disease (Eskd) Patients On Maintainance Hemodialysis (Hd) Independent Of Body Mass Index (Bmi). Kidney Int Reports [Internet]. 2020;5(3):S287. Available From: https://doi.org/10.1016/j.ekir.2020.02.747 Raine R. Can we afford to treat obstructive sleep apnoea ? 2020;26(3):2017–8. Aziz F, Chaudhary K. The triad of sleep apnea, hypertension, and chronic kidney disease: A spectrum of common pathology. CardioRenal Med. 2016;7(1):74–82. Mohamedi S, Mosha IH. Hemodialysis Therapy Adherence and Contributing Factors among End-Stage Renal Disease Patients at Muhimbili National Hospital , Dar es Salaam , Tanzania. 2022;123–30. Thurlow JS, Norris KC. Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy. 2021;20889:98–107. Kilonzo SB, Seiffudin AT, Bakshi FA, Gunda DW. Renal dysfunction among adult patients in Mwanza, Tanzania: Prevalence, outcomes and associated factors. Tanzan J Health Res. 2016;18(3):1–8. J Meremo A, B Masalu M, Sabi I, P Ngilangwa D, Kapinga J, Tagalile R, et al. Prevalence and Risk Factors Associated With Chronic Kidney Disease Among Patients Presenting at a Haemodialysis Unit in Dodoma, Tanzania. East African Heal Res J. 2018;2(1):53–7. Kerns ES, Kim D, Meoni A, Sozio M. Nephrology Obstructive Sleep Apnea Increases Sudden Cardiac Death in Incident Hemodialysis Patients. 2018;8:147–56. Merlino G, Piani A, Dolso P, Adorati M, Cancelli I, Valente M, et al. Sleep disorders in patients with end-stage renal disease undergoing dialysis therapy. Nephrol Dial Transplant. 2006;21(1):184–90. Mucsi I, Molnar MZ, Rethelyi J, Vamos E, Csepanyi G, Tompa G, et al. Sleep disorders and illness intrusiveness in patients on chronic dialysis. Nephrol Dial Transplant. 2004;19(7):1815–22. Wali SO, Alkhouli A, Howladar M, Ahmad I, Alshohaib S, Al-Ghamdi S, et al. Risk of obstructive sleep apnea among Saudis with chronic renal failure on hemodialysis. Ann Thorac Med. 2022;10(4):263–8. Amini M, Roohafza F, Nazemian F, Morovatdar N, Hatefi Olaee A. Risk of obstructive sleep apnea and hemodialysis efficacy. J Nephropathol. 2018;7(3):201–6. Moradzadeh M, Mirmohammadkhani M, Tamadon MR, Mansori K, Malek F. Prevalence of Sleep Apnea and its Associated Factors in Chronic Kidney Disease Patients. Tanaffos. 2021;20(2):116–25. Georges TD, Cyrille N, Wantoh NH, Mbua GR, Clovis N, Divine M, et al. Sleep disorders in patients on maintenance haemodialysis at the Buea Regional Hospital : prevalence and associated factors Sleep disorders in patients on maintenance haemodialysis at the Buea Regional Hospital : prevalence and associated factors. 2021;(December). Seck SM, Maiga Z, Tondi M, Niang S. of Kidney Diseases and Transplantation Original Article Risk of Obstructive Sleep Apnea among Senegalese Dialysis Patients. 2019;30(5):1097–102. Maiga Z, Tondi M, Seck SM, Ka EF, Cisse MM, Dia AD, et al. Epidemiology of Sleep Disorders among Chronic Hemodialysis Patients in Senegal : A Multicentric Study. 2016;(January):42–8. Ibrahim JM, Wegdan OM. Epidemiology of sleep disorders in patients with chronic renal disease in Cairo, Egypt. J Egypt Public Health Assoc. 2011;86(3–4):68–72. Pallangyo P. Obstructive Sleep Apnea and Associated Factors Among Hypertensive Patients Attending a Tertiary Cardiac Center in Tanzania : a Comparative Cross- sectional Study. :1–23. Shayo GA, Mugusi FM. Prevalence and risk factors for obstructive sleep apnoea in dar es salaam, tanzania. Tanzan J Health Res. 2015;17(1):1–8. Tada T, Kusano KF, Ogawa A, Iwasaki J, Sakuragi S, Kusano I, et al. The predictors of central and obstructive sleep apnoea in haemodialysis patients. Nephrol Dial Transplant. 2007;22(4):1190–7. Edwards BA, O’Driscoll DM, Ali A, Jordan AS, Trinder J, Malhotra A. Aging and sleep: Physiology and pathophysiology. Semin Respir Crit Care Med. 2010;31(5):618–33. Martins FO, Conde S V. Gender Differences in the Context of Obstructive Sleep Apnea and Metabolic Diseases. Front Physiol. 2021;12(December):1–15. Ibrahim MIS, Mohamad H, Mohamad A, Mohamad I. Association between neck circumference and the severity of obstructive sleep apnea. Polish Ann Med. 2020;27(1):1–6. Arache W, Laboudi F, Ouanass A, El Kabbaj D, Kabbaj D El, El Kabbaj D. Poor quality of sleep in patients on chronic hemodialysis. Ibnosina J Med Biomed Sci. 2019;11(01):20–4. Holder S, Narula NS. Common Sleep Disorders in Adults: Diagnosis and Management. Am Fam Physician [Internet]. 2022;105(4):397–405. Available from: http://dx.doi.org/ Velu S, Rajagopalan A, Arunachalam J, Prasath A, Durai R. Subjective Assessment of Sleep Quality and Excessive Daytime Sleepiness in Conventional Hemodialysis Population: A Single-Center Experience. Int J Nephrol Renovasc Dis. 2022;15(March):103–14. Sabry AA, Abo-Zenah H, Wafa E, Mahmoud K, El-Dahshan K, Hassan A, et al. Sleep disorders in hemodialysis patients. Saudi J Kidney Dis Transpl. 2010;21(2):300–5. Santos IR, Fernandes V, Alves V, Fernandes T, Cristina V, Lopes D, et al. Excessive daytime sleepiness in patients with chronic kidney disease undergone hemodialysis. 2014;27(4):653–60. Chu G, Price E, Paech GM, Choi P, Mcdonald VM. Sleep Apnea in Maintenance Hemodialysis: A Mixed-Methods Study. Kidney Med [Internet]. 2020;2(4):388–97. Available from: https://doi.org/10.1016/j.xkme.2020.02.006 Somji SS, Ruggajo P, Moledina S. Adequacy of Hemodialysis and Its Associated Factors among Patients Undergoing Chronic Hemodialysis in Dar es Salaam , Tanzania. 2020;2020. Who, Chan M. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva, Switz World Heal Organ. 2011;1–6. Centers of disease control. Body mass index: Considerations for practitioners. Cdc [Internet]. 2011;4. Available from: http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Body+Mass+Index+:+Considerations+for+Practitioners#3%5Cnhttp://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Body+mass+index:+Considerations+for+practitioners#3 Journal O, Society I. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. 2013;3(1). Klawe JJ, Jeske K, Laudencka A, Bielicka B, Manitius J. PREVALENCE OF SLEEP APNEA SYNDROME IN HEMODIALYZED PATIENTS WITH END-STAGE RENAL DISEASE Studies concerning sleep problems in hemodialyzed patients clearly demonstrate that sleep disturbance is a common feature of end-stage renal hour of sleep ( apnea / h. Physiology. 2006;207–11. Adams RJ, Appleton SL, Vakulin A, Hanly PJ, McDonald SP, Martin SA, et al. Chronic kidney disease and sleep apnea association of kidney disease with obstructive sleep apnea in a population study of men. Sleep. 2017;40(1). Scale S. End-stage Renal Disease. Elias RM, Chan CT, Paul N, Motwani SS, Kasai T, Gabriel JM, et al. Relationship of pharyngeal water content and jugular volume with severity of obstructive sleep apnea in renal failure. Nephrol Dial Transplant. 2013;28(4):937–44. Elias RM, Bradley TD, Kasai T, Motwani SS, Chan CT. Rostral overnight fluid shift in end-stage renal disease: Relationship with obstructive sleep apnea. Nephrol Dial Transplant. 2012;27(4):1569–73. Beecroft JM, Hoffstein V, Pierratos A, Chan CT, McFarlane P, Hanly PJ. Nocturnal haemodialysis increases pharyngeal size in patients with sleep apnoea and end-stage renal disease. Nephrol Dial Transplant. 2008;23(2):673–9. Roumelioti ME, Buysse DJ, Sanders MH, Strollo P, Newman AB, Unruh ML. Sleep-disordered breathing and excessive daytime sleepiness in chronic kidney disease and hemodialysis. Clin J Am Soc Nephrol. 2011;6(5):986–94. Lyons OD, Chan CT, Yadollahi A, Bradley TD. Effect of ultrafiltration on sleep apnea and sleep structure in patients with end-stage renal disease. Am J Respir Crit Care Med. 2015;191(11):1287–94. Moradzadeh M. Prevalence of Sleep Apnea and its Associated Factors in Chronic Kidney Disease Patients. 2021;20(2):116–25. Additional Declarations No competing interests reported. Supplementary Files STOPBANGQUESTIONNAIRESBQ.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 03 May, 2026 Reviewers agreed at journal 22 Apr, 2026 Reviewers agreed at journal 17 Apr, 2026 Reviewers invited by journal 08 Apr, 2026 Editor assigned by journal 07 Mar, 2026 Submission checks completed at journal 07 Mar, 2026 First submitted to journal 02 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9015758","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":622548669,"identity":"8d13c901-7954-4ad3-98b9-6bf470bbb897","order_by":0,"name":"Frank Peter","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5ElEQVRIiWNgGAWjYHACg8MMDHJAmo3xAZDk4SNSizFIC7MBSAsbMVqYoVrYJEBcglp02w9vPFzYZpDPP7strfJrjp0MGwPzw0c38GgxO5NWcHhmm4HljDvHjt2W3ZYMdBibsXEOPi0HcgwO87b9MWC4kd52W3IbM1ALD5s0Xi3n34C0GBjIA7UUS26rJ0LLjRyIFoMbaccYP247TIyWZwWHZ5wzMDC8kZYszbjtOA8bMyG/nE/e/LmgzMBA7kaa4cef26rt+dmbHz7GpwUFMPOASWKVgwDjD1JUj4JRMApGwYgBADHpSHcxUcqZAAAAAElFTkSuQmCC","orcid":"","institution":"Muhimbili University of Health and Allied science","correspondingAuthor":true,"prefix":"","firstName":"Frank","middleName":"","lastName":"Peter","suffix":""},{"id":622548672,"identity":"64e7f948-f19e-4382-b3d2-80aa839650fd","order_by":1,"name":"Reuben Mutagaywa","email":"","orcid":"","institution":"Muhimbili University of Health and Allied science","correspondingAuthor":false,"prefix":"","firstName":"Reuben","middleName":"","lastName":"Mutagaywa","suffix":""},{"id":622548675,"identity":"65ebd349-6f37-4030-9e28-b21ff3072817","order_by":2,"name":"Sibtain Moledina","email":"","orcid":"","institution":"Muhimbili University of Health and Allied science","correspondingAuthor":false,"prefix":"","firstName":"Sibtain","middleName":"","lastName":"Moledina","suffix":""},{"id":622548680,"identity":"da09d117-ede1-4714-961f-3de7cac7b5ef","order_by":3,"name":"Alfred Luvakule","email":"","orcid":"","institution":"Benjamin Mkapa Hospital","correspondingAuthor":false,"prefix":"","firstName":"Alfred","middleName":"","lastName":"Luvakule","suffix":""}],"badges":[],"createdAt":"2026-03-03 04:38:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9015758/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9015758/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107244573,"identity":"90b024ca-2f31-4db2-af2b-ffeb795e0171","added_by":"auto","created_at":"2026-04-19 07:55:06","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":49680,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram showing participant enrolment and selection of end-stage kidney\u003c/p\u003e\n\u003cp\u003eDisease (ESKD) patients on maintenance haemodialysis at Muhimbili National Hospital, Dar\u003c/p\u003e\n\u003cp\u003ees Salaam, Tanzania (September 2023–January 2024).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9015758/v1/c8386fc63031716c3854d063.png"},{"id":107244680,"identity":"d8e1f55f-9237-4352-abf6-57f6174c4ea6","added_by":"auto","created_at":"2026-04-19 07:55:24","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":17756,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of risk of obstructive sleep apnea (OSA) among end-stage kidney disease (ESKD) patients on maintenance hemodialysis at Muhimbili National Hospital, Dar es Salaam, Tanzania (N = 350). The bar chart shows that 37.1% of participants were classified as having risk of OSA and 62.9% were classified as not having risk of OSA, based on the STOP-Bang questionnaire.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9015758/v1/a176975bf4f5d7fe460370a5.png"},{"id":107244707,"identity":"18987869-8ada-43af-8e7c-5d42bd1264fe","added_by":"auto","created_at":"2026-04-19 07:55:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":807178,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9015758/v1/10171ca2-eb87-4ce6-bab8-5bdc1d5c70b8.pdf"},{"id":107244589,"identity":"8e445469-c564-43bc-8942-0fe5827af282","added_by":"auto","created_at":"2026-04-19 07:55:11","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20556,"visible":true,"origin":"","legend":"","description":"","filename":"STOPBANGQUESTIONNAIRESBQ.docx","url":"https://assets-eu.researchsquare.com/files/rs-9015758/v1/bb10695320e48035f3187761.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Obstructive sleep apnea risk and associated factors among patients with end-stage kidney disease on maintenance hemodialysis in Tanzania: cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEnd-stage kidney disease (ESKD) occurs as an outcome of a progressive decline in kidney function over months or years. The global burden of End-stage kidney disease (ESKD) is increasing at a rate of about 7% per year (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Despite the increase in the burden of End-stage kidney disease (ESKD), there is still under-recognition of sleep complaints by health workers including clinicians (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). It has been reported that up to 80% of patients receiving hemodialysis (HD) report some level of sleep disturbance (\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) unfortunately, little attention has been paid to the impact of these disorders on patients with end-stage renal disease End-stage kidney disease (ESKD) who are on dialysis (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Obstructive Sleep Apnea (OSA) is a prevalent sleep disorder characterized by episodes of complete or partial cessation of airflow, known as apneas and hypopneas, respectively, as well as respiratory effort-related arousals (RERAs). (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) The estimated prevalence of Obstructive sleep apnea (OSA) in the general population ranges from 3% to 7%, affecting approximately 1\u0026nbsp;billion people aged 30 to 70 worldwide. The rise in obesity over the past two decades has contributed significantly to the increase in Obstructive sleep apnea (OSA) cases. Among End-Stage Kidney Disease (ESKD) patients, the prevalence of OSA is notably higher, exceeding 50%, though there are currently no specific clinical guidelines for screening or managing Obstructive sleep apnea (OSA) in this population, resulting in infrequent assessment in clinical practice. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan additionalcitationids=\"CR17 CR18\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). End-stage kidney disease is a dramatically increasing global health and healthcare burden with about 500\u0026nbsp;million people reported to have Chronic Kidney Disease (CKD) globally where 80% live in developing countries. In Tanzania, the prevalence of End-stage kidney disease (ESKD) is reported to range between 7% \u0026minus;\u0026thinsp;15%, majority of these patients progress to End-stage kidney disease (ESKD) needing hemodialysis(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e) However, the prevalence of Obstructive sleep apnea (OSA) in patients with End-stage kidney disease (ESKD) on hemodialysis is 10\u0026ndash;fold higher than in the general population resulting in worsening of the clinical manifestations and cardiovascular complications. No studies have been done to evaluate the magnitude of Obstructive sleep apnea (OSA) among End-stage kidney disease (ESKD) patients on hemodialysis in Tanzania. The paucity of local data on the burden of Obstructive sleep apnea (OSA) among patients with End-stage kidney disease (ESKD) on hemodialysis provides less attention to this condition by most of the clinicians hence resulting in the higher prevalence of undiagnosed patients with Obstructive sleep apnea (OSA). (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) This study is essential to determine the burden of Obstructive sleep apnea (OSA) and the factors associated among patients with End-stage kidney disease (ESKD) on dialysis. 'Therefore, this study aimed to determine the prevalence and factors associated with OSA risk among ESKD patients on maintenance hemodialysis at Muhimbili National Hospital, Tanzania.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eA hospital-based cross-sectional study was conducted among patients with End-stage kidney disease (ESKD) on maintenance hemodialysis (HD) between September 2023 and January 2024 at Muhimbili National Hospital dialysis centre. The facility provides dialysis treatments on a daily basis and has a capacity of 42 dialysis machines, which can run four sessions per day. Each dialysis machine has a digital BP machine incorporated within it. Fresenius dialysis machine is the brand used at Muhimbili National Hospital. Every month, approximately 300 patients are on hemodialysis (HD), with new patients being admitted virtually every day.\u003c/p\u003e \u003cp\u003eKish and Leslie\u0026rsquo;s formula was used to calculate the minimum sample size necessary: n\u0026thinsp;=\u0026thinsp;Z\u003csup\u003e2\u003c/sup\u003e P (100\u0026thinsp;\u0026minus;\u0026thinsp;P)/ε \u003csup\u003e2\u003c/sup\u003e, where n\u0026thinsp;=\u0026thinsp;minimum sample size, z\u0026thinsp;=\u0026thinsp;standard normal deviate (1.96) responding to a 95% confidence interval, ε\u0026thinsp;=\u0026thinsp;margin of error (5.2%), p\u0026thinsp;=\u0026thinsp;34.8% of ESKD patients on hemodialysis patient at Kenyatta Hospital in Kenya had a high risk of OSA based on validated berlin questionnaire (BQ), a study done in 2016 by Jivanji et al(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) thus, n\u0026thinsp;=\u0026thinsp;1.96\u003csup\u003e2\u003c/sup\u003e \u0026#119883; 34.8 (100\u0026ndash;34.8) / 5.2\u003csup\u003e2\u003c/sup\u003e =\u0026thinsp;322. Taking a none response of 10%, n\u0026rsquo;= (322 X 100%) / (100%\u0026ndash;10%), then N\u0026thinsp;=\u0026thinsp;350.\u003c/p\u003e \u003cp\u003eThis study included all patient with End-stage kidney disease (ESKD) aged 18 and above which are on maintenance hemodialysis for at least 3 months. Patients who refused or were unable to provide informed consent (e.g., those on sedatives) were excluded.\u003c/p\u003e \u003cp\u003eThe research included various variables to thoroughly investigate the factors related to the risk of obstructive sleep apnea (OSA). The independent variables comprised both clinical and socio-demographic characteristics. The socio-demographic factors included age, sex, marital status, education level, health insurance status, alcohol consumption, and smoking habits. Clinical characteristics included the body mass index (BMI), neck circumference, presence of comorbidities like hypertension (HTN) or diabetes mellitus (DM), frequency of hemodialysis (HD) sessions each week, duration of dialysis, adequacy of hemodialysis assessed by urea reduction ratio (URR%), and important laboratory parameters such as hemoglobin levels, serum calcium, serum phosphates, and albumin. Conversely, the dependent variable represented the risk of OSA and was the study's main outcome measure. These variables provided a solid basis for examining how socio-demographic and clinical factors interact in evaluating OSA risk.\u003c/p\u003e \u003cp\u003eData obtained from questionnaires was entered into SPSS Version 26.0 for Windows which was used for data analysis. Data cleaning and reviewing the filled questionnaires were done to ensure quality control of data.\u003c/p\u003e \u003cp\u003eCategorical variables were presented as frequencies and percentages, continuous variables were presented as median and interquartile range. Association between categorical variables was explored using Chi-square. Variables with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.2 on univariate analysis were further tested in the multivariable analysis using Robust Poisson Regression for factors associated with risk of OSA. A two-tailed p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was used as a cut-off level for statistical significance.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 350 ESKD patients on maintenance hemodialysis were enrolled in this study. The participant selection process is illustrated in figure 1.\u003c/p\u003e\n\u003cp\u003eFigure 1 Flow diagram showing participant enrolment and selection of end-stage kidney\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDisease (ESKD) patients on maintenance haemodialysis at Muhimbili National Hospital, Dar\u003c/p\u003e\n\u003cp\u003ees Salaam, Tanzania (September 2023\u0026ndash;January 2024).\u003c/p\u003e\n\u003ch2\u003e\u003cu\u003eSociodemographic characteristics of study participants\u003c/u\u003e\u003c/h2\u003e\n\u003cp\u003eA total of 350 end-stage kidney disease patients on hemodialysis were studied, out of which 70.6% (247/350) were males. The median age of the study participants was 52.0 (43\u0026ndash;59) years and 56.9 % (199/350) were above 50 years. \u0026nbsp;There were 89.4% (313/350) married participants, 38.6% (135/350) with primary and below education level, 51.1% (179/350) employed participants, and 85.7% (300/350) insured participants. Table 1 below summarizes the socio-demographic characteristics of the study participants.\u003c/p\u003e\n\u003cp id=\"_Toc167513557\"\u003eTable 1: Social-demographic characteristics of study participants (ESKD patients) (n=350)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"589\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVARIABLE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFREQUENCY, N (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMEDIAN (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge in years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e52.0 (43.0\u0026ndash;59.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026le;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e151 (43.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026gt;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e199 (56.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e103 (29.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e247 (70.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eMarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e313 (89.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e37 (10.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003ePrimary and below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e135 (38.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e170 (48.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eCollege/University\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e45 (12.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e171 (48.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e179 (51.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealth insurance status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eUninsured\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e50 (14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eInsured\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e300 (85.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eClinical characteristics of study participants\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cu\u003e(ESKD patients) (n=350)\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan id=\"_Toc167513558\"\u003eHypertension was reported by 71.7% (251/350) participants followed by diabetes 21.2% (74/350). There were 4.0% (14/350) smokers, 11.1% (39/350) alcohol drinkers, median BMI was 25.0 (22.8\u0026ndash;27.4) kg/m\u003csup\u003e2\u003c/sup\u003e while 40.9% of participants (143/350) were overweight, 8.2% (29/350) were obese respondents and median NC was 36.0 IQR (36\u0026ndash;38) cm with 4.9% (17/350) of respondents having NC of above 40cm. The median dialysis vintage was 38 IQR (30\u0026ndash;48) months, 82.3% (288/350) of the participants had 3 HD sessions per week. As far as vascular access of HD, 43.7% (153/350) of the participants had AVF access for HD and 36.3% (127/350) had permanent catheter. Adequate dialysis was present in 88.6% (310/350) of participants with median dialysis adequacy of 84.0 [72.7\u0026ndash;90.0]. There were 97.7% (342/350) participants with anemia, 75.1% (263/350) participants with hypocalcemia, 53.1% (186/350) participants with hyperphosphatemia and 35.4% (124/350) participants with hypoalbuminemia. Table 2 below summarizes the clinical characteristics of the study participants.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan id=\"_Toc167513558\"\u003e\u003cstrong\u003eTable 2: Clinical characteristics of study participants (\u003c/strong\u003e\u003cstrong\u003eESKD patients\u003c/strong\u003e\u003cstrong\u003e) (n=350)\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"589\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eVARIABLE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003eFREQUENCY, N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003eMEDIAN (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eComorbid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e251(71.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eDiabetes Mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e74 (21.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eGlomerulonephritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e13 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e336 (96.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e14 (4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eAlcohol drinking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e311 (88.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e39 (11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eBMI in Kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e25.0 (22.8\u0026ndash;27.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u0026lt;18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e21 (6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e18.5\u0026ndash;24.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e157 (44.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e25.0\u0026ndash;29.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e143 (40.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u0026sup3;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e29 (8.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eNeck circumference(cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e36.0 (36.0\u0026ndash;38.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u0026le;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e333 (95.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u0026gt;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e17 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eDialysis vintage (Months)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e38.0 (30.0\u0026ndash;48.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u0026lt;12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e7 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e12\u0026ndash;48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e263 (75.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e49\u0026ndash;84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e78 (22.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u0026gt;84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e2 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eNumber of HD session/week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e3.0 (3.0\u0026ndash;3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u0026lt;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e62 (17.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026gt;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e288 (82.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eVascular access\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eAVF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e153 (43.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eTemporary catheter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e70 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003ePermanent catheter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e127 (36.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eDialysis adequacy (URR %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e84.0(72.7\u0026ndash;90.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u0026sup3;65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e310 (88.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u0026lt;65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e40 (11.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eAnemia (g/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e9.7 (8.5\u0026ndash;10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e8 (2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e342 (97.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eHypocalcemia (mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e1.9 (1.4\u0026ndash;2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e87 (24.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e263(75.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eHyperphosphatemia(mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e1.6 (1.0\u0026ndash;7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e164 (46.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e186 (53.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eHypoalbuminemia (g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e36.0 (33.0\u0026ndash;39.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e226 (64.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e124 (35.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp id=\"_Toc167513539\"\u003e\u003cstrong\u003eTable 2: Clinical characteristics of study participants (\u003c/strong\u003e\u003cstrong\u003eESKD patients\u003c/strong\u003e\u003cstrong\u003e) (n=350)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003ePrevalence\u0026nbsp;of risk of obstructive sleep apnea among ESKD patients on hemodialysis at MNH\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study revealed that the prevalence of risk of obstructive sleep apnea in ESKD patients was 37.1%. Of the 350 participants, 130 (37.1%) were classified as having risk of OSA and 220 (62.9%) were classified as not having risk of OSA, based on the STOP-Bang questionnaire (Figure. 2).\u003c/p\u003e\n\u003cp\u003eFigure 2: Prevalence of risk of obstructive sleep apnea (OSA) among end-stage kidney disease (ESKD) patients on maintenance hemodialysis at Muhimbili National Hospital, Dar es Salaam, Tanzania (N = 350). The bar chart shows that 37.1% of participants were classified as having risk of OSA and 62.9% were classified as not having risk of OSA, based on the STOP-Bang questionnaire.\u003c/p\u003e\n\u003cp id=\"_Toc167513540\"\u003e\u003cu\u003eOSA by social-demographic and clinical characteristics of study participants\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eGenerally, in this study, 37.1% (130/350) of individuals were considered to have the risk of OSA. A significantly high prevalence of OSA was seen among hypertensive respondents (42.4%, 107/251) (p=0.001) and among diabetics (62.2%, 46/74) (p\u0026lt;0.0001). Glomerulonephritis\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003edialysis vintage, number of HD sessions per week, dialysis adequacy, and laboratory profile were not significantly associated with OSA.Table 3 below summarizes the results.\u003c/p\u003e\n\u003cp\u003eTable 3: Risk of OSA by social-demographic and clinical characteristics of study participants (ESKD patients) (N=350)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" rowspan=\"2\" valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVARIABLE\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" rowspan=\"2\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTOTAL NUMBER(N=350)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRisk of OSA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo (n=220)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes (n=130)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e76 (76.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e23 (23.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e144 (57.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e107 (42.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e192 (69.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e84 (30.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e28 (37.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e46 (62.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGlomerulonephritis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.386\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e337\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e210 (62.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e127 (37.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e10 (76.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e3 (23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDialysis vintage (Months)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u0026lt;12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e7\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e5 (71.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e2 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 207px;\"\u003e\n \u003cp\u003e12\u0026ndash;48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e263\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e185 (70.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e78 (29.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 207px;\"\u003e\n \u003cp\u003e49\u0026ndash;84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e78\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e29 (37.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e49 (62.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u0026gt;84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e1(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e1 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of HD session/week\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.389\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u0026lt;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e62\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e36 (58.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e26 (41.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026gt;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e288\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e184 (63.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e104 (36.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDialysis adequacy (URR %)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.766\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u0026sup3;65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e310\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e194 (62.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e116 (37.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u0026lt;65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e40\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e26 (65.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e14 (35.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnemia (g/dl)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.983\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 207px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e8\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e5 (62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e3 (37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 207px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e342\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e215 (62.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e127 (37.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypocalcemia\u0026nbsp;\u003c/strong\u003e(mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.666\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 207px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e87\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e53 (60.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e34 (39.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 207px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e263\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e167 (63.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e96 (36.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHyperphosphatemia(\u003c/strong\u003emmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.365\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 207px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e164\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e99 (60.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e65 (39.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 207px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e186\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e121 (65.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e65 (34.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypoalbuminemia (\u003c/strong\u003eg/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.989\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 207px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e226\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e142 (62.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e84 (37.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 207px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e124\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e78 (62.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e46 (37.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNB\u003c/strong\u003e: Age, sex, neck circumference, BMI and Excessive daytime sleepiness (EDS) were excluded due to collinearity as they were involved in achieving the outcome (risk of OSA)\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eBivariable and Multivariable robust Poisson Regression analysis for factors associated with risk of Obstructive Sleep Apnea in patients with ESKD\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eA multivariable analysis was done involving variables with p\u0026lt;0.2 in bivariable analysis and after adjusting for confounders. Hypertensive patients had a prevalence of OSA that was 2.91 times greater than normotensive, aPR (95%CI) =2.91, (2.09\u0026ndash;4.06), p\u0026lt;0.0001. Participants with diabetes had a prevalence of OSA that was 3.37 times greater than the participants with no diabetes, aPR(95%CI) =3.37 (2.68\u0026ndash;4.23), p\u0026lt;0.0001. The dialysis vintage was not independently associated with OSA. Table 4 below summarizes the bivariable and multivariable robust Poisson regression results for factors associated with the risk of OSA.\u0026quot;\u003c/p\u003e\n\u003cp id=\"_Toc167513560\"\u003eTable 4: Bivariable and Multivariable robust Poisson regression for the factors associated with OSA\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"650\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" rowspan=\"2\" valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVARIABLE\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" rowspan=\"2\" valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYES, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" colspan=\"2\" valign=\"bottom\" style=\"width: 219px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBIVARIABLE\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" colspan=\"2\" valign=\"bottom\" style=\"width: 247px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMULTIVARIABLE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ecPR (95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eaPR(95%CI)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e23 (23.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e107 (42.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.83 (1.25\u0026ndash;2.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e2.91 (2.09\u0026ndash;4.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e84 (30.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e46 (62.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e2.04 (1.59\u0026ndash;2.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e3.37 (2.68\u0026ndash;4.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDialysis vintage (Months)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026lt;12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e2 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e12\u0026ndash;48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e78 (29.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.04 (0.32\u0026ndash;3.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.951\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e1.11 (0.45\u0026ndash;2.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.828\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e49\u0026ndash;84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e49 (62.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e2.20 (0.67\u0026ndash;7.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e2.33 (0.94\u0026ndash;5.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026gt;84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e1 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.75 (0.62\u0026ndash;10.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.546\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e2.74 (0.27\u0026ndash;28.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.369\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cspan id=\"_Toc45500961\"\u003ecPR =crude Prevalence Ratio, aPR =adjusted Prevalence Ratio\u003c/span\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eUnderstanding the magnitude and associated factors of OSA among patients with ESKD on hemodialysis is critical in efforts to control the burden of OSA. In the present study, the prevalence of risk of OSA among ESKD patients on maintenance HD attending at MNH\u0026ndash;Upanga dialysis center was 37.1% (32.0% and 39.3% for females and males respectively).\u003c/p\u003e \u003cp\u003eOur prevalence of 37.1% was lower than reports from Senegal (49.1%), Spain (44%), and Japan (42%), but higher than those from the USA (12%), China (20%), and Egypt (21.6%) (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe main reasons that explain the variability of prevalence in these studies include the differences in definitions of OSA, the study sample size, participant characteristics, and methods used for diagnosis of OSA (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e) Notably, variations in sample size, definitions of OSA, screening tools, and diagnostic methods have been found across different studies contributing to a wide range of prevalence of OSA.\u003c/p\u003e \u003cp\u003eIn the present study, diabetes mellitus and hypertension were found to be significantly associated with the risk of OSA. This conformity with the findings in other studies done in the same population in Saudi Arabia, Switzerland, and Egypt, (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e) In diabetic patients, this can be attributed to additional possible causes of upper-airway dilator muscle dysfunction like neuropathy associated with diabetes mellitus. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e) Significant association between hypertension and OSA can be attributed partly as the result of particularly intermittent hypoxia that triggers sympathetic nerve activity, systemic inflammation, and oxidative stress, causing endothelial cell dysfunction and arteriosclerosis commonly occurring in patients with OSA (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). However, this cannot explain fully this finding as the existence of hypertension could be present before the onset of OSA in a particular patient. In contrast, some studies found that DM was not significantly associated with OSA. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eNevertheless, in our patients, there has been no discernible correlation found between risk of OSA and factors including, dialysis vintage, dialysis adequacy, number of HD sessions/week, anemia, hypocalcemia, hyperphosphatemia, and hypoalbuminemia.\u003c/p\u003e\n\u003ch3\u003eLIMITATION\u003c/h3\u003e\n\u003cp\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Use of screening tools (STOP-Bang, ESS) rather than gold-standard polysomnography\u003c/p\u003e \u003cp\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Cross-sectional design prevents causal inference;\u003c/p\u003e \u003cp\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Single-center study limits generalizability.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this study, we found that the risk of OSA is considerably common in dialysis patients at MNH. Hypertension and diabetes were independently associated with the risk of OSA among patients with ESKD on maintenance hemodialysis. Based on our study findings and conclusions, the following recommendations are suggested. Regular screening programs be designed and implemented for the early detection of this disorder, especially clinicians should therefore actively look for the risk of OSA in hypertensive and diabetic patients on maintenance HD. Moreover, larger cohort studies with polysomnographic exploration are needed to better describe the epidemiology of OSA among Tanzanian dialysis patients.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"626\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAVF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eArteriovenous fistula\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBody mass Index\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eESKD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEnd stage kidney disease\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHemodialysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMNH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMuhimbili National Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eObstructive sleep Apnea\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki and was approved by the Senate Research and Publications Committee of Muhimbili University of Health and Allied Sciences (MUHAS). Ethical approval was granted Ref. No.DA.282/298/01.C/1837. Written informed consent was obtained from all participants prior to enrollment in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received no specific funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eFlemons WW, Buysse D, Redline S, Oack A, Strohl K, Wheatley J, et al. Sleep-related breathing disorders in adults: Recommendations for syndrome definition and measurement techniques in clinical research. Sleep. 1999;22(5):667–89. \u003c/li\u003e\n \u003cli\u003eThe United Republic Of Tanzania Ministry Of Health , Community Development , Gender , Elderly And Children National Guidelines For Dialysis Services April , 2019. 2019; \u003c/li\u003e\n \u003cli\u003eNational Kidney Foundation. Update of the KDOQI \u003csup\u003eTM\u003c/sup\u003e Clinical Practice Guideline for Hemodialysis Adequacy. National Kidney Foundation. 2015. 1–78 p. \u003c/li\u003e\n \u003cli\u003eStradling JR. Obstructive sleep apnoea syndrome. Vol. 285, British Medical Journal. 1982. 528–530 p. \u003c/li\u003e\n \u003cli\u003eMilik A, Hrynkiewicz E. On translation of LD, IL and SFC given according to IEC-61131 for hardware synthesis of reconfigurable logic controller. IFAC Proc Vol. 2014;19(1):4477–83. \u003c/li\u003e\n \u003cli\u003eZheng Z, Zhang Y, Chen M, Chen X, Li C, Wang C, et al. Application value of joint STOP-Bang questionnaire and Epworth Sleepiness Scale in screening for obstructive sleep apnea. Front Public Heal. 2022;10. \u003c/li\u003e\n \u003cli\u003eVisweswaran K, Shaffi M, Mathew P, Abraham M, Lordson J, Rajeev P, et al. Quality of Life of End Stage Renal Disease Patients Undergoing Dialysis in Southern Part of Kerala , India : Financial Stability and Inter-dialysis Weight Gain as Key Determinants. 2020;10:344–50. \u003c/li\u003e\n \u003cli\u003eThurlow JS, Joshi M, Yan G, Norris KC, Agodoa LY, Yuan CM, et al. Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy. Am J Nephrol. 2021;20889(2):98–107. \u003c/li\u003e\n \u003cli\u003eChang JR, Akemokwe FM, Marangu DM, Chisunkha B, Irekpita E, Obasikene G, et al. Obstructive Sleep Apnea Awareness among Primary Care Physicians in Africa. 2020;17(1):98–106. \u003c/li\u003e\n \u003cli\u003eOgna VF, Ogna A, Pruijm M, Bassi I, Zuercher E, Halabi G, et al. Prevalence and Diagnostic Approach to Sleep Apnea in Hemodialysis Patients : A Population Study. 2015;2015. \u003c/li\u003e\n \u003cli\u003eKamal M, Zaki NFW, Yousef EA, Eltoraby E, Manzar MD, Pandi-Perumal SR. An Egyptian Study of Sleep Disorders and Its Correlates in End-Stage Renal Disease Patients Receiving Hemodialysis. Sleep Vigil. 2020;4(2):213–20. \u003c/li\u003e\n \u003cli\u003eChen WC, Lim PS, Wu WC, Chiu HC, Chen CH, Kuo HY, et al. Sleep Behavior Disorders in a Large Cohort of Chinese (Taiwanese) Patients Maintained by Long-Term Hemodialysis. Am J Kidney Dis. 2006;48(2):277–84. \u003c/li\u003e\n \u003cli\u003eAl-Jahdali H. Prevalence of sleep apnea and excessive day time sleepiness in patients with end-stage renal disease on dialysis. Saudi J Kidney Dis Transpl. 2012;23(2):251–61. \u003c/li\u003e\n \u003cli\u003eDialysis CP. Original Article. 2011;22(5):922–30. \u003c/li\u003e\n \u003cli\u003eChang ET, Riaz M. Exploring sleep disorders in patients with chronic kidney disease. 2018;35–43. \u003c/li\u003e\n \u003cli\u003eAbuyassin B, Sharma K, Ayas NT, Laher I. Obstructive Sleep Apnea and Kidney Disease : 2015;11(8). \u003c/li\u003e\n \u003cli\u003eLyons MM, Bhatt NY, Pack AI, Magalang UJ. Global burden of sleep-disordered breathing and its implications. Respirology. 2020;25(7):690–702. \u003c/li\u003e\n \u003cli\u003eLyons OD, Inami T, Perger E, Yadollahi A, Chan CT, Bradley TD. The effect of fluid overload on sleep apnoea severity in haemodialysis patients. 2017;1–8. Available from: http://dx.doi.org/10.1183/13993003.01789-2016\u003c/li\u003e\n \u003cli\u003eOnally H, Nairobi O. Quality Of Sleep And Sleep Disorders In Adult Patients With End Stage Renal Disease Undergoing Hemodialysis At Kenyatta National Hospital. \u003c/li\u003e\n \u003cli\u003eSakaguchi Y, Shoji T, Kawabata H, Niihata K, Suzuki A, Kaneko T, et al. High prevalence of obstructive sleep apnea and its association with renal function among nondialysis chronic kidney disease patients in Japan: A cross-sectional study. Clin J Am Soc Nephrol. 2011;6(5):995–1000. \u003c/li\u003e\n \u003cli\u003ePenzel T, Fietze I, Schoebel C. Comparison of Berlin Questionnaire , STOP-Bang , and Epworth Sleepiness Scale for Diagnosing Obstructive Sleep Apnea in Persian Patients. 2018;1–5. \u003c/li\u003e\n \u003cli\u003eRosas SE. NIH Public Access. 2011;12(5):378–83. \u003c/li\u003e\n \u003cli\u003eMedicine AA of S. International Classification of Sleep Disorders. American Academy of Sleep Medicine; 2014. \u003c/li\u003e\n \u003cli\u003eKohler M. Risk factors and treatment for obstructive sleep apnea amongst obese children and adults. Curr Opin Allergy Clin Immunol. 2009;9(1):4–9. \u003c/li\u003e\n \u003cli\u003eMargareth H. No Title طرق تدريس اللغة العربية. Экономика Региона. 2017. 32 p. \u003c/li\u003e\n \u003cli\u003eSankri-Tarbichi AG. Obstructive sleep apnea-hypopnea syndrome: Etiology and diagnosis. Avicenna J Med. 2012;02(01):3–8. \u003c/li\u003e\n \u003cli\u003eFonseca NT, Urbano JJ, Nacif SR, Silva AS, Peixoto RAO, Urbano GJ, et al. A systematic review of sleep disorders in patients with chronic kidney disease undergoing hemodialysis. J Phys Ther Sci. 2016;28(7):2164–70. \u003c/li\u003e\n \u003cli\u003eErsoy E, Mercan Y. Risk Factors for Obstructive Sleep Apnea and the Association of Obstructive Sleep Apnea with Daytime Sleepiness, Obesity and Comorbidity. J Turkish Sleep Med. 2021;8(1):20–7. \u003c/li\u003e\n \u003cli\u003eNicholl DDM, Ahmed SB, Loewen AHS, Hemmelgarn BR, Sola DY, Beecroft JM, et al. Diagnostic value of screening instruments for identifying obstructive sleep apnea in kidney failure. J Clin Sleep Med. 2013;9(1):31–8. \u003c/li\u003e\n \u003cli\u003eFuria FF, Shoo J, Ruggajo PJ, Kilonzo K, Basu G, Yeates K, et al. Developing nephrology services in low income countries: A case of Tanzania. BMC Nephrol. 2019;20(1):1–9. \u003c/li\u003e\n \u003cli\u003eChu G, Suthers B, Moore L, Paech GM, Hensley MJ, McDonald VM, et al. Risk factors of sleep-disordered breathing in haemodialysis patients. PLoS One [Internet]. 2019;14(8):1–11. Available from: http://dx.doi.org/10.1371/journal.pone.0220932\u003c/li\u003e\n \u003cli\u003eMarrone O, Bonsignore MR. Obstructive sleep apnea and chronic kidney disease : open questions on a potential public health problem. 2018;10(22):45–8. \u003c/li\u003e\n \u003cli\u003eMarrone O, Bonsignore MR. Sleep Apnea and the Kidney. 2020;85–93. \u003c/li\u003e\n \u003cli\u003eHuang H, Walters G, Talaulikar G, Figurski D, Carroll A, Hurwitz M, et al. Sleep apnea prevalence in chronic kidney disease - association with total body water and symptoms. 2017;1–9. \u003c/li\u003e\n \u003cli\u003eChang ET, Riaz M, Nigam G, Camacho M, Chang ET, Riaz M. Exploring sleep disorders in patients with chronic kidney disease. Nat Sci Sleep. 2018;10:35–43. \u003c/li\u003e\n \u003cli\u003eKerns ES, Kim D, Meoni A, Sozio M, Kim ED, Meoni LA, et al. Nephrology Obstructive Sleep Apnea Increases Sudden Cardiac Death in Incident Hemodialysis Patients. Am J Nephrol. 2018;8(2):147–56. \u003c/li\u003e\n \u003cli\u003eBeecroft JM, Hoffstein V, Pierratos A, Chan CT, McFarlane PA, Hanly PJ. Pharyngeal narrowing in end-stage renal disease: Implications for obstructive sleep apnoea. Eur Respir J. 2007;30(5):965–71. \u003c/li\u003e\n \u003cli\u003eChakravorty I, Shastry M, Farrington K. Sleep apnoea in end-stage renal disease : a short review of mechanisms and potential benefit from its treatment. 2007;(October 2006):28–31. \u003c/li\u003e\n \u003cli\u003eNicholl DDM, Loewen AHS, Hemmelgarn BR, Sola DY, Beecroft JM, Turin TC, et al. Clinical Presentation of Obstructive Sleep Apnea in Patients with Chronic Kidney Disease. 2012;8(4). \u003c/li\u003e\n \u003cli\u003eKania A, Polok K, Celejewska-Wójcik N, Nastałek P, Opaliński A, Mrzygłód B, et al. Clinical and Polysomnographic Features Associated with Poor Sleep Quality in Patients with Obstructive Sleep Apnea. Med. 2022;58(7). \u003c/li\u003e\n \u003cli\u003eOzoh OB, Okubadejo NU, Akinkugbe AO, Ojo OO, Asoegwu CN, Amadi C, et al. Prospective assessment of the risk of obstructive sleep apnea in patients attending a tertiary health facility in Sub-Saharan Africa. Pan Afr Med J. 2014;17:1–7. \u003c/li\u003e\n \u003cli\u003eEditors S, Naughton M, Cistulli PA, Chazal PDE, Lyons MME. INVITED REVIEW SERIES : NEW FRONTIERS IN SLEEP-DISORDERED BREATHING Global burden of sleep-disordered breathing and its implications. 2020;(March). \u003c/li\u003e\n \u003cli\u003ePisano A, Zoccali C, Bolignano D, D’Arrigo G, Mallamaci F. Sleep apnoea syndrome prevalence in chronic kidney disease and end-stage kidney disease patients: a systematic review and meta-analysis. Clin Kidney J [Internet]. 2024;17(1):1–12. Available from: https://doi.org/10.1093/ckj/sfad179\u003c/li\u003e\n \u003cli\u003eChafekar N, Chafekar D, Deogaonkar V. Sun-213 Prevalence Of Obstructive Sleep Apnea (Osa) In End Stage Renal Disease (Eskd) Patients On Maintainance Hemodialysis (Hd) Independent Of Body Mass Index (Bmi). Kidney Int Reports [Internet]. 2020;5(3):S287. Available From: https://doi.org/10.1016/j.ekir.2020.02.747\u003c/li\u003e\n \u003cli\u003eRaine R. Can we afford to treat obstructive sleep apnoea ? 2020;26(3):2017–8. \u003c/li\u003e\n \u003cli\u003eAziz F, Chaudhary K. The triad of sleep apnea, hypertension, and chronic kidney disease: A spectrum of common pathology. CardioRenal Med. 2016;7(1):74–82. \u003c/li\u003e\n \u003cli\u003eMohamedi S, Mosha IH. Hemodialysis Therapy Adherence and Contributing Factors among End-Stage Renal Disease Patients at Muhimbili National Hospital , Dar es Salaam , Tanzania. 2022;123–30. \u003c/li\u003e\n \u003cli\u003eThurlow JS, Norris KC. Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy. 2021;20889:98–107. \u003c/li\u003e\n \u003cli\u003eKilonzo SB, Seiffudin AT, Bakshi FA, Gunda DW. Renal dysfunction among adult patients in Mwanza, Tanzania: Prevalence, outcomes and associated factors. Tanzan J Health Res. 2016;18(3):1–8. \u003c/li\u003e\n \u003cli\u003eJ Meremo A, B Masalu M, Sabi I, P Ngilangwa D, Kapinga J, Tagalile R, et al. Prevalence and Risk Factors Associated With Chronic Kidney Disease Among Patients Presenting at a Haemodialysis Unit in Dodoma, Tanzania. East African Heal Res J. 2018;2(1):53–7. \u003c/li\u003e\n \u003cli\u003eKerns ES, Kim D, Meoni A, Sozio M. Nephrology Obstructive Sleep Apnea Increases Sudden Cardiac Death in Incident Hemodialysis Patients. 2018;8:147–56. \u003c/li\u003e\n \u003cli\u003eMerlino G, Piani A, Dolso P, Adorati M, Cancelli I, Valente M, et al. Sleep disorders in patients with end-stage renal disease undergoing dialysis therapy. Nephrol Dial Transplant. 2006;21(1):184–90. \u003c/li\u003e\n \u003cli\u003eMucsi I, Molnar MZ, Rethelyi J, Vamos E, Csepanyi G, Tompa G, et al. Sleep disorders and illness intrusiveness in patients on chronic dialysis. Nephrol Dial Transplant. 2004;19(7):1815–22. \u003c/li\u003e\n \u003cli\u003eWali SO, Alkhouli A, Howladar M, Ahmad I, Alshohaib S, Al-Ghamdi S, et al. Risk of obstructive sleep apnea among Saudis with chronic renal failure on hemodialysis. Ann Thorac Med. 2022;10(4):263–8. \u003c/li\u003e\n \u003cli\u003eAmini M, Roohafza F, Nazemian F, Morovatdar N, Hatefi Olaee A. Risk of obstructive sleep apnea and hemodialysis efficacy. J Nephropathol. 2018;7(3):201–6. \u003c/li\u003e\n \u003cli\u003eMoradzadeh M, Mirmohammadkhani M, Tamadon MR, Mansori K, Malek F. Prevalence of Sleep Apnea and its Associated Factors in Chronic Kidney Disease Patients. Tanaffos. 2021;20(2):116–25. \u003c/li\u003e\n \u003cli\u003eGeorges TD, Cyrille N, Wantoh NH, Mbua GR, Clovis N, Divine M, et al. Sleep disorders in patients on maintenance haemodialysis at the Buea Regional Hospital : prevalence and associated factors Sleep disorders in patients on maintenance haemodialysis at the Buea Regional Hospital : prevalence and associated factors. 2021;(December). \u003c/li\u003e\n \u003cli\u003eSeck SM, Maiga Z, Tondi M, Niang S. of Kidney Diseases and Transplantation Original Article Risk of Obstructive Sleep Apnea among Senegalese Dialysis Patients. 2019;30(5):1097–102. \u003c/li\u003e\n \u003cli\u003eMaiga Z, Tondi M, Seck SM, Ka EF, Cisse MM, Dia AD, et al. Epidemiology of Sleep Disorders among Chronic Hemodialysis Patients in Senegal : A Multicentric Study. 2016;(January):42–8. \u003c/li\u003e\n \u003cli\u003eIbrahim JM, Wegdan OM. Epidemiology of sleep disorders in patients with chronic renal disease in Cairo, Egypt. J Egypt Public Health Assoc. 2011;86(3–4):68–72. \u003c/li\u003e\n \u003cli\u003ePallangyo P. Obstructive Sleep Apnea and Associated Factors Among Hypertensive Patients Attending a Tertiary Cardiac Center in Tanzania : a Comparative Cross- sectional Study. :1–23. \u003c/li\u003e\n \u003cli\u003eShayo GA, Mugusi FM. Prevalence and risk factors for obstructive sleep apnoea in dar es salaam, tanzania. Tanzan J Health Res. 2015;17(1):1–8. \u003c/li\u003e\n \u003cli\u003eTada T, Kusano KF, Ogawa A, Iwasaki J, Sakuragi S, Kusano I, et al. The predictors of central and obstructive sleep apnoea in haemodialysis patients. Nephrol Dial Transplant. 2007;22(4):1190–7. \u003c/li\u003e\n \u003cli\u003eEdwards BA, O’Driscoll DM, Ali A, Jordan AS, Trinder J, Malhotra A. Aging and sleep: Physiology and pathophysiology. Semin Respir Crit Care Med. 2010;31(5):618–33. \u003c/li\u003e\n \u003cli\u003eMartins FO, Conde S V. Gender Differences in the Context of Obstructive Sleep Apnea and Metabolic Diseases. Front Physiol. 2021;12(December):1–15. \u003c/li\u003e\n \u003cli\u003eIbrahim MIS, Mohamad H, Mohamad A, Mohamad I. Association between neck circumference and the severity of obstructive sleep apnea. Polish Ann Med. 2020;27(1):1–6. \u003c/li\u003e\n \u003cli\u003eArache W, Laboudi F, Ouanass A, El Kabbaj D, Kabbaj D El, El Kabbaj D. Poor quality of sleep in patients on chronic hemodialysis. Ibnosina J Med Biomed Sci. 2019;11(01):20–4. \u003c/li\u003e\n \u003cli\u003eHolder S, Narula NS. Common Sleep Disorders in Adults: Diagnosis and Management. Am Fam Physician [Internet]. 2022;105(4):397–405. Available from: http://dx.doi.org/\u003c/li\u003e\n \u003cli\u003eVelu S, Rajagopalan A, Arunachalam J, Prasath A, Durai R. Subjective Assessment of Sleep Quality and Excessive Daytime Sleepiness in Conventional Hemodialysis Population: A Single-Center Experience. Int J Nephrol Renovasc Dis. 2022;15(March):103–14. \u003c/li\u003e\n \u003cli\u003eSabry AA, Abo-Zenah H, Wafa E, Mahmoud K, El-Dahshan K, Hassan A, et al. Sleep disorders in hemodialysis patients. Saudi J Kidney Dis Transpl. 2010;21(2):300–5. \u003c/li\u003e\n \u003cli\u003eSantos IR, Fernandes V, Alves V, Fernandes T, Cristina V, Lopes D, et al. Excessive daytime sleepiness in patients with chronic kidney disease undergone hemodialysis. 2014;27(4):653–60. \u003c/li\u003e\n \u003cli\u003eChu G, Price E, Paech GM, Choi P, Mcdonald VM. Sleep Apnea in Maintenance Hemodialysis: A Mixed-Methods Study. Kidney Med [Internet]. 2020;2(4):388–97. Available from: https://doi.org/10.1016/j.xkme.2020.02.006\u003c/li\u003e\n \u003cli\u003eSomji SS, Ruggajo P, Moledina S. Adequacy of Hemodialysis and Its Associated Factors among Patients Undergoing Chronic Hemodialysis in Dar es Salaam , Tanzania. 2020;2020. \u003c/li\u003e\n \u003cli\u003eWho, Chan M. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva, Switz World Heal Organ. 2011;1–6. \u003c/li\u003e\n \u003cli\u003eCenters of disease control. Body mass index: Considerations for practitioners. Cdc [Internet]. 2011;4. Available from: http://scholar.google.com/scholar?hl=en\u0026amp;btnG=Search\u0026amp;q=intitle:Body+Mass+Index+:+Considerations+for+Practitioners#3%5Cnhttp://scholar.google.com/scholar?hl=en\u0026amp;btnG=Search\u0026amp;q=intitle:Body+mass+index:+Considerations+for+practitioners#3\u003c/li\u003e\n \u003cli\u003eJournal O, Society I. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. 2013;3(1). \u003c/li\u003e\n \u003cli\u003eKlawe JJ, Jeske K, Laudencka A, Bielicka B, Manitius J. PREVALENCE OF SLEEP APNEA SYNDROME IN HEMODIALYZED PATIENTS WITH END-STAGE RENAL DISEASE Studies concerning sleep problems in hemodialyzed patients clearly demonstrate that sleep disturbance is a common feature of end-stage renal hour of sleep ( apnea / h. Physiology. 2006;207–11. \u003c/li\u003e\n \u003cli\u003eAdams RJ, Appleton SL, Vakulin A, Hanly PJ, McDonald SP, Martin SA, et al. Chronic kidney disease and sleep apnea association of kidney disease with obstructive sleep apnea in a population study of men. Sleep. 2017;40(1). \u003c/li\u003e\n \u003cli\u003eScale S. End-stage Renal Disease. \u003c/li\u003e\n \u003cli\u003eElias RM, Chan CT, Paul N, Motwani SS, Kasai T, Gabriel JM, et al. Relationship of pharyngeal water content and jugular volume with severity of obstructive sleep apnea in renal failure. Nephrol Dial Transplant. 2013;28(4):937–44. \u003c/li\u003e\n \u003cli\u003eElias RM, Bradley TD, Kasai T, Motwani SS, Chan CT. Rostral overnight fluid shift in end-stage renal disease: Relationship with obstructive sleep apnea. Nephrol Dial Transplant. 2012;27(4):1569–73. \u003c/li\u003e\n \u003cli\u003eBeecroft JM, Hoffstein V, Pierratos A, Chan CT, McFarlane P, Hanly PJ. Nocturnal haemodialysis increases pharyngeal size in patients with sleep apnoea and end-stage renal disease. Nephrol Dial Transplant. 2008;23(2):673–9. \u003c/li\u003e\n \u003cli\u003eRoumelioti ME, Buysse DJ, Sanders MH, Strollo P, Newman AB, Unruh ML. Sleep-disordered breathing and excessive daytime sleepiness in chronic kidney disease and hemodialysis. Clin J Am Soc Nephrol. 2011;6(5):986–94. \u003c/li\u003e\n \u003cli\u003eLyons OD, Chan CT, Yadollahi A, Bradley TD. Effect of ultrafiltration on sleep apnea and sleep structure in patients with end-stage renal disease. Am J Respir Crit Care Med. 2015;191(11):1287–94. \u003c/li\u003e\n \u003cli\u003eMoradzadeh M. Prevalence of Sleep Apnea and its Associated Factors in Chronic Kidney Disease Patients. 2021;20(2):116–25. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Obstructive sleep apnea, End-stage kidney disease, Dialysis, Chronic kidney diseases","lastPublishedDoi":"10.21203/rs.3.rs-9015758/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9015758/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Obstructive sleep apnea (OSA) is claimed to affect more than 50% of hemodialysis patients. It is known that OSA increases cardiovascular risk in end-stage kidney disease (ESKD) patients and impairs the quality of life with cardiovascular mortality remaining the leading cause of death in these patients. This study aimed to determine the prevalence and associated factors of risk of Obstructive sleep apnea (OSA) among end-stage kidney disease (ESKD) patients on maintenance hemodialysis therapy at Muhimbili National Hospital (MNH).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A hospital-based cross-sectional study was conducted among patients with end-stage kidney disease (ESKD)between September 2023 and January 2024 at Muhimbili National Hospital (MNH) dialysis centre. The STOP-Bang and Epworth Sleepiness Score were administered. Comparison of categorical variables was done using Chi-square and Robust Poisson regression was used to identify factors associated with Obstructive sleep apnea (OSA). A significance level was set at p-value \u0026lt;0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A total of 350 end-stage kidney disease (ESKD) patients were enrolled in the study. The median age was 52.0 IQR (43–59) years with a male-to-female ratio of 2.4:1.The prevalence of risk of Obstructive sleep apnea (OSA) was 37.1%. Independent factors associated with Obstructive sleep apnea (OSA) were hypertension (aPR(95%CI) =2.91, (2.09–4.06), p\u0026lt;0.0001) and diabetes (aPR(95%CI) =3.37 (2.68–4.23), p\u0026lt;0.0001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e The risk of Obstructive sleep apnea (OSA) is common among end-stage kidney disease (ESKD) patients on maintenance hemodialysis. Early detection and effective management by nephrologists is of great significance as it will reduce cardiovascular complications and improve the quality of life.\u003c/p\u003e","manuscriptTitle":"Obstructive sleep apnea risk and associated factors among patients with end-stage kidney disease on maintenance hemodialysis in Tanzania: cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-19 07:54:17","doi":"10.21203/rs.3.rs-9015758/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-04T01:18:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"212206560665211936219861710821152979228","date":"2026-04-22T13:31:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"79706351735836583580353062328353613391","date":"2026-04-17T11:49:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-08T11:07:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-07T11:47:15+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-07T11:46:29+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nephrology","date":"2026-03-03T04:23:41+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bc0c7dd2-b845-4360-a9f5-32aba90f2cb7","owner":[],"postedDate":"April 19th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-04T01:18:32+00:00","index":46,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-19T07:54:20+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-19 07:54:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9015758","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9015758","identity":"rs-9015758","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}