Osteoblasts and osteoclasts appear to follow a circadian rhythm and accordingly function may be affected in case of sleep disturbance. The central nervous system communicates with osteoblasts through sympathetic and glucocorticoid stimuli while synchronization with osteoclasts occurs in a glucocorticoid-only manner Therefore, changes in sleep can reflect on bone formation/resorption.
Because osteoblasts and osteoclasts work on a 24-hour cycle, sleep problems may affect how well they work. Osteoblasts respond to sympathetic and glucocorticoid signals from the central nervous system, while osteoclasts only respond to glucocorticoid signals. Sleep variations may affect bone formation and resorption indicators .
since the sleep apnea is higher in CKD patients.
the interaction between sleep and bone since the osteoblast and osteoclast follow the circadian rhythm their function changes if the there is disturbance in sleep and could have result on bone formation markers and reabsorption.
hypoxia caused by Obstructive sleep apnea is often associated with oxidative stress which will agin lead to bone reabsorption.
The sleep disorder is common among hemodialysis (HD) patients, and it has been associated with cardiovascular disease and premature death. Sleep apnea and restless leg syndrome (RLS) are the most commonly reported sleep disorders in CKD patients and patients with more severe symptoms had lower levels of ionized calcium, higher levels of serum P, 25(OH) vitamin D deficiency and high levels of FGF-23 above 2000 RU/ml, lower iron, and a tendency toward lower transferrin saturation. The prevalence of sleep apnea is much higher in patients with CKD, particularly in those on hemodialysis (up to 50%) Hypoxia due to OSA is often associated with oxidative stress, which in turn contributes to greater bone resorption. However, this data has not yet been fully demonstrated obese individuals had a significant loss of bone mass in the presence of OSA In addition, these patients experience poor sleep quality, with impaired sleep architecture, which seems to be independent of the presence of sleep apnea The interaction between sleep and bone has a physiological basis since osteoblasts and osteoclasts appear to follow a circadian rhythm and may, therefore, have their functions changed in case of sleep disturbance The central nervous system communicates with osteoblasts through sympathetic and glucocorticoid stimuli , while communicates with osteoclasts in a glucocorticoid-only manner, therefore, changes in sleep could have effect on markers of bone formation and resorption. The impact of sleep durationn bone mineralization has been described, with both long time and short time being associated with lower bone mineral density Beyond the above mentioned, there are other factors that could play a role in CKD-MBD pathophysiology, which might decrease renal Klotho expression,and stimulate vascular calcification and osteoclastogenesis
Sleep problems are extremely common in CKD patients.
The most frequent are sleep apnea and restless leg syndrome (RLS). Furthermore, these individuals have poor sleep quality and impaired sleep architecture
A change in total sleep time, either shorter (typically 5 h of sleep) or longer (generally > 8 h of sleep), is also associated with a worse cardiovascular function. Sleep apnea is substantially more common in CKD patients, especially those on hemodialysis (up to 50%).
Obstructive sleep apnea (OSA) is associated with an increased risk of cardiovascular disease, hypertension, stroke, traffic accidents, left ventricular hypertrophy, inflammation, atherosclerosis, insulin resistance, memory and cognition impairment.
Compression stockings help dialysis patients with sleep apnea.
Hypoxia due to OSA is often associated with oxidative stress, which in turn contributes to greater bone resorption.
Sleeping for less than 8 hours has been affect bone growth.
Hyperphosphatemia and vitamin D insufficiency have already been linked to RLS in the general population.
ckd patients has diminished both sleep quality and quantity. FGF-23 and vit d directly proportionate with incidence of restless leg syndrome. decreased sleep hours is assosciated with increased stress hormone glucorticoid which stimulates osteoclasts.
OSA occurs 2ry to shift of fluid during sleep from lower limb to the neck, disturbing the sleep.
Good job Dr. Ahmed. Additionally, Circadian rhythm nature of action of both osteoblast and osteoclast, so sleep problems afflict their functions. Osteoblasts respond to sympathetic and glucocorticoid signals from CNS, while osteoclasts only respond to glucocorticoid signals.
-OSA: Cardiovascular risk, HTN, Stroke, LVH, Inflammation, Atherosclerosis, Insulin resistance, Memory impairment, Cognition impairment. causes hypoxia increases oxidative stress factor that promotes osteoclast activity then bone resorption
-Restless leg associated with FGF-23 and hyperphosphatemia, and low vit D level in CKD
-Impaired sleep architecture and altered sleep time lead to increase osteoclast activity
Great job Dr. Mahmoud. Circadian rhythm nature of action of both osteoblast and osteoclast, so sleep problems afflict their functions. Osteoblasts respond to sympathetic and glucocorticoid signals from CNS, while osteoclasts only respond to glucocorticoid signals.
Sleep disorders are highly prevalent in patients with CKD. Sleep apnea and restless leg syndrome (RLS) are the most commonly reported.
In addition, these patients experience poor sleep quality, with impaired sleep architecture, which seems to be independent of the presence of sleep apnea.
Altered total sleep time, either shorter (usually < 5 h of sleep) or longer (in general > 8 h of sleep), is also related to a worse cardiovascular outcome.
The prevalence of sleep apnea is much higher in patients with CKD, particularly in those on hemodialysis (up to 50%).
Obstructive sleep apnea (OSA) is related to an increased cardiovascular risk, hypertension, stroke, traffic accidents, left ventricular hypertrophy, inflammation, atherosclerosis, insulin resistance, memory impairment, and cognition.
The interaction between sleep and bone has a physiological basis:
1-since osteoblasts and osteoclasts appear to follow a circadian rhythm and may, therefore, have their functions changed in case of sleep disturbance. 2-The central nervous system communicates with osteoblasts through sympathetic and glucocorticoid stimuli, while synchronization with osteoclasts occurs in a glucocorticoid-only manner. Therefore, changes in sleep could have repercussions on markers of bone formation and resorption.
Hypoxia due to OSA is often associated with oxidative stress, which in turn contributes to greater bone resorption.
Sleep time lower than 8 his reported to impair bone formation. Both long time and short time being associated with lower bone mineral density. Though no deleterious effects were found in elderly individuals or animal models, obese individuals had a significant loss of bone mass in the presence of OSA.
The connection between RLS and mineral metabolism is clear. Hyperphosphatemia and deficiency of vitamin D have already been associated with RLS in individuals from the general population. The pathophysiology of RLS in the scenario of CKD is multifactorial and CKD-MBD can certainly play a role. In addition, patients with more severe symptoms had lower levels of ionized calcium, higher levels of serum P, and a higher prevalence of 25(OH) vitamin D deficiency and levels of FGF-23 above 2000 RU/ml.
Disruption in circadian rhythm in CKD -MBD is novel feature. It has been linked to genes and the circadian molecular clock. It could be due to uraemic toxin or disruption of the kidney -cns axis. Osteoblast and osteoclast follow a circadian rhythm and function change as a result of sleep disturbance which can be in form of OSA or RLS more commonly. CNS communicates with osteoblast through sympathetic and glucocorticoid stimuli while for osteoclast its only via glucocorticoid manner affecting bone turnover. OSA leads to hypoxia that can lead to oxidative stress and bone resorption. would patient with ckd5 then going to HD have better sleep as potentially effective dialysis could clear uraemic toxins and as result do we see improvement in CKD MBD?
Thanks Dr. Muhammad for your answer. In addition, People with OSA associated with loss of bone mass. Circadian rhythm nature of action of both osteoblast and osteoclast, so sleep problems afflict their functions. Osteoblasts respond to sympathetic and glucocorticoid signals from CNS, while osteoclasts only respond to glucocorticoid signals.
Regarding your question, answer is no. The prevalence of poor sleep quality has been reported to be as high as 34-78% in patients with ESRD and 14-57% in patients with CKD. However, in a study by Shafi et al, poor sleep quality is common in patients with CKD including hemodialysis patients, which is independent of kidney function in pre-dialysis patients. There is no difference in quality of sleep between patients on hemodialysis and pre-dialysis CKD patients even after adjustment of confounding variables.
Sleep disorders is a high prevalence in CKD patient
the most common two types of sleep disorder:
SOA
RLS
poor sleep quality with either short or long sleep hours is related to worse cardiovascular outcomes.
>>Up to 50% of the prevalence of sleep apnea is in CKD hemodialysis, which demonstrates the greater displacement of fluid from the lower limb towards the neck and upper airways. Hypoxia in OSA is associated with oxidant stress which in turn will contribute to bone resorption.
>>I have a question in this part of the article?? How is the use of compression stockings will improves sleep apnea in dialysis patients???? it supposes that this stocking will divert the fluid upwards toward the neck and will increase the edema in the neck and not the vice.
>>There is an interaction between sleep rhythm and bone since osteoblast and osteoclast appear to follow a circadian rhythm. The CNS communicate with the osteoblast through the sympathetic and glucocorticoids pathway and is through the latter only in the case of osteoclast.
RLS and mineral bone metabolism is clearly linked to the high phosphor and low Vitamin D level. Found to have 28.7% of RLS in patients of CKD in a hemodialysis patient.
IT found to have in this group of patients that they have some markers like :
FGF23 of higher than 2000RU/ml,P >5.2 mg/dl, lower level of ionised Ca , adding to that, increase level of Activin A which decreases renal Kolotho and stimulates vascular calcifications and osteoclastogenesis.
Good answer Dr. Rihab. In addition to your answer, People with OSA associated with loss of bone mass. OSA-induced hypoxia is often associated with oxidative stress resulting in greater bone resorption.
Regarding your question, the study on fourteen HD patients concluded that using compression stocks to avoid fluid retention in legs with accumulation of fluid in intracellular component of the trunk thus avoid fluid shift to reach neck.
Sleep disturbance highly prevalent in ckd, most commonly reported are sleep apnea and restless leg syndrome, also impaired sleep quality and architecture.
Total sleep duration whether short sleep less than 5 hours or long sleep more than 8 hours causes worse CV outcome.
Obesity epidemic causes increase in sleep apnea and these associated with significant bone mass loss.
Obstructive sleep apnea associated with occurrence of CV events like lt ventricular hypertrophy, stroke, road traffic accidents, inflammation, hypoxia, insulin resistance, memory and cognitive disturbance.
Sleep prevalence increases in patients with ckd on HD in 50%, so use of compression stocking will improve sleep apnea.
The function of the osteoblast and osteoclast follow circadian rhythm so their function changes in sleep disturbance. The CNS communicate with the osteoblast through sympathetic NS and glucocorticoids stimuli while the osteoclast through glucocorticoids stimuli only.
Hypoxia in sleep apnea has oxidative stress and increase bone resorption.
Previous study show prolonged sleep causes osteoporosis in postmenopausal women ad middle age men while short sleep increases risk of osteoporosis in women aged 18-80 years, sleep less than 8 hours impaire bone formation in experimental animals and children.
RLS has correlation with the minerals metabolism specially hyperphosphatemia and Vitamin D deficiency, RLS prevalent in HD patients in 28.7%, pathophysiology of it is multifactorial, these patients has bone marker FGF23 more than 2000 RU/ml and p >5.2mg/ml, in sever cases the patient has low ionized calcium, hyperphosphatemia, vitamin D deficiency and FGF23 >2000Ru/ml.
Other factors like Activin A which decrease klotho expression and micro RNA each one causes increase vascular calcification and osteoclastogenesis
The sleep disorder in common CKD patient and manifested as:
Sleep apnea.
Restless leg.
Impaired sleep architecture.
Altered sleep time (<5 hrs.’ or >8 hrs.).
2. Obstructive sleep apnea associated with:
Cardiovascular risk.
HTN.
Stroke.
Traffic accident.
LVH.
Inflammation.
Atherosclerosis.
Insulin resistance.
Memory impairment.
Cognition impairment.
3. Association between sleep and bone has a physiological background as osteoblast and osteoclast appear to follow a circadian rhythm, and experience a disordered function with sleep disturbance. 4.Although not fully evident; CNS communicate with osteoblast via sympathetic and glucorticoid stimuli, so sleep disorder lead to disrupted bone formation and resorption. 5.Recent study suggest association between sleep and the skeleton. 6.Prolong sleep time shown by the review to increase the risk of osteoporosis in postmenopausall women, and in middle-aged men. 7 Shorterr sleep duration seems to increase the risk of osteoporosis in women between 18 and 80 years. 8.Sleep less than 8 hours in children affect bone formation. 9 .Obese patient with OSA has a lower bone density. 10.CKD-MBD (hyperphosphatemia and vitamin D deficiency), can play a role in RLS in CKD patient. 11.Patient with RLS discovered to have FGF-23 level > 2000, low ionized calcium high po4 level, and vit.D deficiency.
Good answer Dr. Asmaa in addition, Circadian rhythm nature of action of both osteoblast and osteoclast, so sleep problems afflict their functions. Osteoblasts respond to sympathetic and glucocorticoid signals from CNS, while osteoclasts only respond to glucocorticoid signals.
SLEEP DISORDERS ARE HIGHLY PREVALENT IN PATIENTS WITH CKD
SLEEP DISORDERS (SLEEP TIME ) RELATED TO WORSE CARDIOVASCULAR OUTCOME.
OSA IS RELATED TO INCREASE CARDIOVASCULAR RISK .
SLEEP DISTURBANCE AFFECT PHYSIOLOGICAL CIRCADIAN RHYTHM OF OSTEOBLASTS AND OSTEOCLASTS.
PROLONGED SLEEP TIME SEEMS TO INCREASE THE RISK OF OSTEOPROSIS .
Thanks Dr. Emad
Also, shorter sleep time leading to increase risk of osteoporosis in women 18-10 years old. People with OSA associated with loss of bone mass. OSA-induced hypoxia is often associated with oxidative stress resulting in greater bone resorption. Hyperphosphatemia, vitamin d deficiency, and increase level of FGF23 may be associated with RLS.
Sleep apnea and restless leg syndrome (RLS) are the most commonly reported sleep disorders in patients with CKD.
CKD patients also have poor sleep quality and impaired sleep architecture.
Altered total sleep time, either shorter or longer ,is also related to a worse cardiovascular outcome .
The prevalence of sleep apnea is much higher in patients with CKD, particularly in those on hemodialysis (up to 50%).
Obstructive sleep apnea (OSA) is related to an increased cardiovascular risk, hypertension, stroke, traffic accidents, left ventricular hypertrophy, inflammation, atherosclerosis, insulin resistance, memory impairment, and cognition .
the use of compression stockings improves sleep apnea in dialysis patients as a result of fluid displacement from lower limbs toward the neck.
There is a physiological basis behind the interaction between sleep and bone .
The osteoblasts and osteoclasts follow a circadian rhythm.
There functions changed if this rhythm change in case of sleep disturbance.
OSA lead to hypoxia which in turn increase the oxidative stress which in turn lead to greater bone resorption .
Sleep duration has impact on bone mineralization with both long and short time associated with lower bone mineral density.
The connection between RLS and mineral metabolism is related to low calcium, high P, low vit.D and levels of FGF-23 above 2000 RU/ml.
sleep disorders are highly prevalent in CKD. the most common disorders are RLS, sleep apnea, and poor sleep quality that is independent of OSA.
Osteoblasts and osteoclasts follow a circadian rhythm. therefore both are affected in CKD.
CNC communicates with osteoblasts through sympathetic and glucocorticoid stimuli while synchronization with osteoclasts occurs through glucocorticoid stimuli only.
sleep disturbances have repercussions on markers of bone formation and resorption.
hyperphosphatemia and Vit. D deficiency are associated with RLS in the general population. in CKD, RLS is multifactorial.
osteoblast and osteoclast follow a circadian rhythm so change function with sleep disturbance .
change in sleep causes repercussion on markers of bone formation and resorption .
Thanks Dr. Ashraf
In addition, Sleep duration either longer or shorter increase risk of osteoporosis and impaired mineralization. People with OSA lose bone mass. OSA-induced hypoxia is often associated with oxidative stress resulting in greater bone resorption. Hyperphosphatemia, vitamin d deficiency, and increase level of FGF23 may be associated with RLS
there were found close association between bone health and sleep pattern.
the sleep more than 8 hr induce osteoporosis .
the sleep little hr or interrupted sleep pattern induce inflammatory condition also cause interruption of circadian rhythm and glucocorticoids secretion.
also if patient with obstructive sleep apnea the effect of hypoxia and release of oxidative stress molecule can induce more bone resorption
Good answer Dr. Rabab Circadian rhythm nature of action of both osteoblast and osteoclast, so sleep problems afflict their functions. Osteoblasts respond to sympathetic and glucocorticoid signals from CNS, while osteoclasts only respond to glucocorticoid signals. Hyperphosphatemia, vitamin d deficiency, and increase level of FGF23 may be associated with RLS
Up to one third of patient with have CKD MBD have a RLS: there is a clear relationship between RLS and hyperphophatemia >5.2 , very high FGF23 2000 RU/ml and low vitamin D.
Up to half of patient on HD have OSAS !. It is suggested that may be an associated with volume displacement from lower limb to ward neck and subsequently swelling of upper Airway. Treatment with compression stockings improve the sleep apnea.
OSAS is associated with increased cardiovascular complications, Insulin resistance and cognitive declinement.
Beside of OSAS, people with CKD have disturbed sleep architecture.
Too much sleep >8h and too little sleep <5h are associated with decreased bone mineralization and osteoporosis.
Thanks Dr. Nour Circadian rhythm nature of action of both osteoblast and osteoclast, so sleep problems afflict their functions. Osteoblasts respond to sympathetic and glucocorticoid signals from CNS, while osteoclasts only respond to glucocorticoid signals. People with OSA associated with loss of bone mass. OSA-induced hypoxia is often associated with oxidative stress resulting in greater bone resorption.
Disturbance is bone cells may occur due sleep disturbances (< 5 hrs or > 8 hrs) because of the disruption of the circadian rythm.
Poor sleep quality and impaired sleep architecture are common in CKD-MBD due to hyperphostamia and low vit D. This may result in :
1.Sleep apnea: up to 50% of CKD5D associated with high cardiovascular risk
2.RLS: up to 28.7% and associated with higher levels FGF-23 > 2000 RU/ml
3.Osteoporsis and lower bone mineral density
Thanks Dr. Ben
In addition to your answer,
Circadian rhythm nature of action of both osteoblast and osteoclast, so sleep problems afflict their functions. Osteoblasts respond to sympathetic and glucocorticoid signals from CNS, while osteoclasts only respond to glucocorticoid signals. Either longer (>8 hrs) or shorter (<5 hrs) increase risk of osteoporosis and impair bone mineral density. People with OSA associated with loss of bone mass. OSA-induced hypoxia is often associated with oxidative stress resulting in greater bone resorption. Hyperphosphatemia, vitamin d deficiency, and increase level of FGF23 may be associated with RLS.
Because osteoblasts and osteoclasts work on a 24-hour cycle, sleep problems may affect how well they work. Osteoblasts respond to sympathetic and glucocorticoid signals from the central nervous system, while osteoclasts only respond to glucocorticoid signals.
Sleep variations may affect bone formation and resorption indicators.
Patients who have CKD have a very high prevalence of sleep problems. The most common conditions are restless leg syndrome (RLS) and sleep apnea.
Recent investigations reveal a skeleton-sleep relationship. Previous research has found that longer sleep duration increases the risk of osteoporosis in postmenopausal women and middle-aged men, while shorter sleep duration increases the risk in women aged 18 to 80.
In experimental animals and children, sleep duration under 8 h impairs bone development. Long and short sleep durations impair bone mineral density.
Obese people with OSA lose bone mass, whereas old people and animals did not.
CKD-MBD may contribute to RLS’s complex pathogenesis. The study found that 28.7% of CKD patients on hemodialysis had RLS, a group that differed from those without RLS by CKD-MBD indicators such as FGF-23 levels greater than 2000 RU/ml and P levels greater than 5.2 mg/dl.
Severe symptoms were also linked to lower ionized calcium levels, higher serum P levels, 25-OH vitamin D deficiency, and FGF-23 levels above 2000 RU/mL.
Osteoblasts and osteoclasts appear to follow a circadian rhythm and accordingly function may be affected in case of sleep disturbance. The central nervous system communicates with osteoblasts through sympathetic and glucocorticoid stimuli while synchronization with osteoclasts occurs in a glucocorticoid-only manner Therefore, changes in sleep can reflect on bone formation/resorption.
Because osteoblasts and osteoclasts work on a 24-hour cycle, sleep problems may affect how well they work. Osteoblasts respond to sympathetic and glucocorticoid signals from the central nervous system, while osteoclasts only respond to glucocorticoid signals.
Sleep variations may affect bone formation and resorption indicators .
since the sleep apnea is higher in CKD patients.
the interaction between sleep and bone since the osteoblast and osteoclast follow the circadian rhythm their function changes if the there is disturbance in sleep and could have result on bone formation markers and reabsorption.
hypoxia caused by Obstructive sleep apnea is often associated with oxidative stress which will agin lead to bone reabsorption.
The sleep disorder is common among hemodialysis (HD) patients, and it has been associated with cardiovascular disease and premature death.
Sleep apnea and restless leg syndrome (RLS) are the
most commonly reported sleep disorders in CKD patients and patients with more severe symptoms had lower levels of ionized calcium, higher levels of serum P, 25(OH) vitamin D deficiency and high levels of FGF-23 above 2000 RU/ml, lower iron, and a tendency toward lower transferrin saturation.
The prevalence of sleep apnea is much higher in patients with CKD, particularly in those on hemodialysis (up to 50%)
Hypoxia due to OSA is often associated with oxidative stress, which in turn contributes to greater bone resorption. However, this data has not yet been fully demonstrated
obese individuals had a significant loss of bone mass in the presence of OSA
In addition, these patients experience poor sleep quality, with impaired sleep architecture, which seems to be independent of the presence of sleep apnea
The interaction between sleep and bone has a physiological basis since osteoblasts and osteoclasts appear to follow a circadian rhythm and may, therefore, have their functions changed in case of sleep disturbance
The central nervous system communicates with osteoblasts through sympathetic and glucocorticoid stimuli , while communicates with osteoclasts in a glucocorticoid-only manner, therefore, changes in sleep could have effect on markers of bone formation and resorption.
The impact of sleep durationn bone mineralization has been described, with both long time and short time being associated with lower bone mineral density
Beyond the above mentioned, there are other factors that could play a role in CKD-MBD pathophysiology, which might decrease renal Klotho expression,and stimulate vascular calcification and osteoclastogenesis
Good job Dr. Rania. Thanks
ckd patients has diminished both sleep quality and quantity. FGF-23 and vit d directly proportionate with incidence of restless leg syndrome. decreased sleep hours is assosciated with increased stress hormone glucorticoid which stimulates osteoclasts.
OSA occurs 2ry to shift of fluid during sleep from lower limb to the neck, disturbing the sleep.
Good job Dr. Ahmed. Additionally, Circadian rhythm nature of action of both osteoblast and osteoclast, so sleep problems afflict their functions. Osteoblasts respond to sympathetic and glucocorticoid signals from CNS, while osteoclasts only respond to glucocorticoid signals.
-OSA: Cardiovascular risk, HTN, Stroke, LVH, Inflammation, Atherosclerosis, Insulin resistance, Memory impairment, Cognition impairment. causes hypoxia increases oxidative stress factor that promotes osteoclast activity then bone resorption
-Restless leg associated with FGF-23 and hyperphosphatemia, and low vit D level in CKD
-Impaired sleep architecture and altered sleep time lead to increase osteoclast activity
Great job Dr. Mahmoud. Circadian rhythm nature of action of both osteoblast and osteoclast, so sleep problems afflict their functions. Osteoblasts respond to sympathetic and glucocorticoid signals from CNS, while osteoclasts only respond to glucocorticoid signals.
Sleep disorders are highly prevalent in patients with CKD. Sleep apnea and restless leg syndrome (RLS) are the most commonly reported.
In addition, these patients experience poor sleep quality, with impaired sleep architecture, which seems to be independent of the presence of sleep apnea.
Altered total sleep time, either shorter (usually < 5 h of sleep) or longer (in general > 8 h of sleep), is also related to a worse cardiovascular outcome.
The prevalence of sleep apnea is much higher in patients with CKD, particularly in those on hemodialysis (up to 50%).
Obstructive sleep apnea (OSA) is related to an increased cardiovascular risk, hypertension, stroke, traffic accidents, left ventricular hypertrophy, inflammation, atherosclerosis, insulin resistance, memory impairment, and cognition.
The interaction between sleep and bone has a physiological basis:
1-since osteoblasts and osteoclasts appear to follow a circadian rhythm and may, therefore, have their functions changed in case of sleep disturbance. 2-The central nervous system communicates with osteoblasts through sympathetic and glucocorticoid stimuli, while synchronization with osteoclasts occurs in a glucocorticoid-only manner. Therefore, changes in sleep could have repercussions on markers of bone formation and resorption.
Hypoxia due to OSA is often associated with oxidative stress, which in turn contributes to greater bone resorption.
Sleep time lower than 8 his reported to impair bone formation. Both long time and short time being associated with lower bone mineral density. Though no deleterious effects were found in elderly individuals or animal models, obese individuals had a significant loss of bone mass in the presence of OSA.
The connection between RLS and mineral metabolism is clear. Hyperphosphatemia and deficiency of vitamin D have already been associated with RLS in individuals from the general population. The pathophysiology of RLS in the scenario of CKD is multifactorial and CKD-MBD can certainly play a role. In addition, patients with more severe symptoms had lower levels of ionized calcium, higher levels of serum P, and a higher prevalence of 25(OH) vitamin D deficiency and levels of FGF-23 above 2000 RU/ml.
Well done. Thanks Dr. Alaa
Disruption in circadian rhythm in CKD -MBD is novel feature. It has been linked to genes and the circadian molecular clock. It could be due to uraemic toxin or disruption of the kidney -cns axis. Osteoblast and osteoclast follow a circadian rhythm and function change as a result of sleep disturbance which can be in form of OSA or RLS more commonly. CNS communicates with osteoblast through sympathetic and glucocorticoid stimuli while for osteoclast its only via glucocorticoid manner affecting bone turnover. OSA leads to hypoxia that can lead to oxidative stress and bone resorption. would patient with ckd5 then going to HD have better sleep as potentially effective dialysis could clear uraemic toxins and as result do we see improvement in CKD MBD?
Thanks Dr. Muhammad for your answer. In addition, People with OSA associated with loss of bone mass. Circadian rhythm nature of action of both osteoblast and osteoclast, so sleep problems afflict their functions. Osteoblasts respond to sympathetic and glucocorticoid signals from CNS, while osteoclasts only respond to glucocorticoid signals.
Regarding your question, answer is no. The prevalence of poor sleep quality has been reported to be as high as 34-78% in patients with ESRD and 14-57% in patients with CKD. However, in a study by Shafi et al, poor sleep quality is common in patients with CKD including hemodialysis patients, which is independent of kidney function in pre-dialysis patients. There is no difference in quality of sleep between patients on hemodialysis and pre-dialysis CKD patients even after adjustment of confounding variables.
Sleep disorders is a high prevalence in CKD patient
the most common two types of sleep disorder:
SOA
RLS
poor sleep quality with either short or long sleep hours is related to worse cardiovascular outcomes.
>>Up to 50% of the prevalence of sleep apnea is in CKD hemodialysis, which demonstrates the greater displacement of fluid from the lower limb towards the neck and upper airways. Hypoxia in OSA is associated with oxidant stress which in turn will contribute to bone resorption.
>>I have a question in this part of the article?? How is the use of compression stockings will improves sleep apnea in dialysis patients???? it supposes that this stocking will divert the fluid upwards toward the neck and will increase the edema in the neck and not the vice.
>>There is an interaction between sleep rhythm and bone since osteoblast and osteoclast appear to follow a circadian rhythm. The CNS communicate with the osteoblast through the sympathetic and glucocorticoids pathway and is through the latter only in the case of osteoclast.
RLS and mineral bone metabolism is clearly linked to the high phosphor and low Vitamin D level. Found to have 28.7% of RLS in patients of CKD in a hemodialysis patient.
IT found to have in this group of patients that they have some markers like :
FGF23 of higher than 2000RU/ml,P >5.2 mg/dl, lower level of ionised Ca , adding to that, increase level of Activin A which decreases renal Kolotho and stimulates vascular calcifications and osteoclastogenesis.
Good answer Dr. Rihab. In addition to your answer, People with OSA associated with loss of bone mass. OSA-induced hypoxia is often associated with oxidative stress resulting in greater bone resorption.
Regarding your question, the study on fourteen HD patients concluded that using compression stocks to avoid fluid retention in legs with accumulation of fluid in intracellular component of the trunk thus avoid fluid shift to reach neck.
Sleep disturbance highly prevalent in ckd, most commonly reported are sleep apnea and restless leg syndrome, also impaired sleep quality and architecture.
Total sleep duration whether short sleep less than 5 hours or long sleep more than 8 hours causes worse CV outcome.
Obesity epidemic causes increase in sleep apnea and these associated with significant bone mass loss.
Obstructive sleep apnea associated with occurrence of CV events like lt ventricular hypertrophy, stroke, road traffic accidents, inflammation, hypoxia, insulin resistance, memory and cognitive disturbance.
Sleep prevalence increases in patients with ckd on HD in 50%, so use of compression stocking will improve sleep apnea.
The function of the osteoblast and osteoclast follow circadian rhythm so their function changes in sleep disturbance. The CNS communicate with the osteoblast through sympathetic NS and glucocorticoids stimuli while the osteoclast through glucocorticoids stimuli only.
Hypoxia in sleep apnea has oxidative stress and increase bone resorption.
Previous study show prolonged sleep causes osteoporosis in postmenopausal women ad middle age men while short sleep increases risk of osteoporosis in women aged 18-80 years, sleep less than 8 hours impaire bone formation in experimental animals and children.
RLS has correlation with the minerals metabolism specially hyperphosphatemia and Vitamin D deficiency, RLS prevalent in HD patients in 28.7%, pathophysiology of it is multifactorial, these patients has bone marker FGF23 more than 2000 RU/ml and p >5.2mg/ml, in sever cases the patient has low ionized calcium, hyperphosphatemia, vitamin D deficiency and FGF23 >2000Ru/ml.
Other factors like Activin A which decrease klotho expression and micro RNA each one causes increase vascular calcification and osteoclastogenesis
Great job Dr. Israa
CKD-MBD and sleep:
2. Obstructive sleep apnea associated with:
3. Association between sleep and bone has a physiological background as osteoblast and osteoclast appear to follow a circadian rhythm, and experience a disordered function with sleep disturbance.
4.Although not fully evident; CNS communicate with osteoblast via sympathetic and glucorticoid stimuli, so sleep disorder lead to disrupted bone formation and resorption.
5.Recent study suggest association between sleep and the skeleton.
6.Prolong sleep time shown by the review to increase the risk of osteoporosis in postmenopausall women, and in middle-aged men.
7 Shorterr sleep duration seems to increase the risk of osteoporosis in women between 18 and 80 years.
8.Sleep less than 8 hours in children affect bone formation.
9 .Obese patient with OSA has a lower bone density.
10.CKD-MBD (hyperphosphatemia and vitamin D deficiency), can play a role in RLS in CKD patient.
11.Patient with RLS discovered to have FGF-23 level > 2000, low ionized calcium high po4 level, and vit.D deficiency.
Well done Dr. Kamal
Sleep and CKD MBD:
Sleep disorders are common in CKD patients.
Sleep duration can contribute to MBD. <5 or >8 hrs of sleep lead to increase osteoclast activity
High FGF-23 in CKD patients-> Hyperphosphatemia, and low vit D level-> high prevalence of restless leg syndrome
Good answer Dr. Asmaa
in addition, Circadian rhythm nature of action of both osteoblast and osteoclast, so sleep problems afflict their functions. Osteoblasts respond to sympathetic and glucocorticoid signals from CNS, while osteoclasts only respond to glucocorticoid signals.
SLEEP DISORDERS ARE HIGHLY PREVALENT IN PATIENTS WITH CKD
SLEEP DISORDERS (SLEEP TIME ) RELATED TO WORSE CARDIOVASCULAR OUTCOME.
OSA IS RELATED TO INCREASE CARDIOVASCULAR RISK .
SLEEP DISTURBANCE AFFECT PHYSIOLOGICAL CIRCADIAN RHYTHM OF OSTEOBLASTS AND OSTEOCLASTS.
PROLONGED SLEEP TIME SEEMS TO INCREASE THE RISK OF OSTEOPROSIS .
Thanks Dr. Emad
Also, shorter sleep time leading to increase risk of osteoporosis in women 18-10 years old.
People with OSA associated with loss of bone mass. OSA-induced hypoxia is often associated with oxidative stress resulting in greater bone resorption.
Hyperphosphatemia, vitamin d deficiency, and increase level of FGF23 may be associated with RLS.
CKD-MBD and Sleep :
Well done Dr. Asmaa
Clarify the interaction between bone and sleep?
Great job Dr. Ibrahim
In addition, OSA might increase bone loss, and hypoxia associated with OSA results in greater bone resorption.
osteoblast and osteoclast follow a circadian rhythm so change function with sleep disturbance .
change in sleep causes repercussion on markers of bone formation and resorption .
Thanks Dr. Ashraf
In addition,
Sleep duration either longer or shorter increase risk of osteoporosis and impaired mineralization.
People with OSA lose bone mass. OSA-induced hypoxia is often associated with oxidative stress resulting in greater bone resorption.
Hyperphosphatemia, vitamin d deficiency, and increase level of FGF23 may be associated with RLS
there were found close association between bone health and sleep pattern.
the sleep more than 8 hr induce osteoporosis .
the sleep little hr or interrupted sleep pattern induce inflammatory condition also cause interruption of circadian rhythm and glucocorticoids secretion.
also if patient with obstructive sleep apnea the effect of hypoxia and release of oxidative stress molecule can induce more bone resorption
Good answer Dr. Rabab
Circadian rhythm nature of action of both osteoblast and osteoclast, so sleep problems afflict their functions.
Osteoblasts respond to sympathetic and glucocorticoid signals from CNS, while osteoclasts only respond to glucocorticoid signals.
Hyperphosphatemia, vitamin d deficiency, and increase level of FGF23 may be associated with RLS
Up to one third of patient with have CKD MBD have a RLS: there is a clear relationship between RLS and hyperphophatemia >5.2 , very high FGF23 2000 RU/ml and low vitamin D.
Up to half of patient on HD have OSAS !. It is suggested that may be an associated with volume displacement from lower limb to ward neck and subsequently swelling of upper Airway. Treatment with compression stockings improve the sleep apnea.
OSAS is associated with increased cardiovascular complications, Insulin resistance and cognitive declinement.
Beside of OSAS, people with CKD have disturbed sleep architecture.
Too much sleep >8h and too little sleep <5h are associated with decreased bone mineralization and osteoporosis.
Thanks Dr. Nour
Circadian rhythm nature of action of both osteoblast and osteoclast, so sleep problems afflict their functions.
Osteoblasts respond to sympathetic and glucocorticoid signals from CNS, while osteoclasts only respond to glucocorticoid signals.
People with OSA associated with loss of bone mass. OSA-induced hypoxia is often associated with oxidative stress resulting in greater bone resorption.
Bone & sleep:
1.Sleep apnea: up to 50% of CKD5D associated with high cardiovascular risk
2.RLS: up to 28.7% and associated with higher levels FGF-23 > 2000 RU/ml
3.Osteoporsis and lower bone mineral density
Thanks Dr. Ben
In addition to your answer,
Circadian rhythm nature of action of both osteoblast and osteoclast, so sleep problems afflict their functions.
Osteoblasts respond to sympathetic and glucocorticoid signals from CNS, while osteoclasts only respond to glucocorticoid signals.
Either longer (>8 hrs) or shorter (<5 hrs) increase risk of osteoporosis and impair bone mineral density.
People with OSA associated with loss of bone mass. OSA-induced hypoxia is often associated with oxidative stress resulting in greater bone resorption.
Hyperphosphatemia, vitamin d deficiency, and increase level of FGF23 may be associated with RLS.
Thanks,Eman
Because osteoblasts and osteoclasts work on a 24-hour cycle, sleep problems may affect how well they work. Osteoblasts respond to sympathetic and glucocorticoid signals from the central nervous system, while osteoclasts only respond to glucocorticoid signals.
Sleep variations may affect bone formation and resorption indicators.
Patients who have CKD have a very high prevalence of sleep problems. The most common conditions are restless leg syndrome (RLS) and sleep apnea.
Recent investigations reveal a skeleton-sleep relationship. Previous research has found that longer sleep duration increases the risk of osteoporosis in postmenopausal women and middle-aged men, while shorter sleep duration increases the risk in women aged 18 to 80.
In experimental animals and children, sleep duration under 8 h impairs bone development. Long and short sleep durations impair bone mineral density.
Obese people with OSA lose bone mass, whereas old people and animals did not.
CKD-MBD may contribute to RLS’s complex pathogenesis. The study found that 28.7% of CKD patients on hemodialysis had RLS, a group that differed from those without RLS by CKD-MBD indicators such as FGF-23 levels greater than 2000 RU/ml and P levels greater than 5.2 mg/dl.
Severe symptoms were also linked to lower ionized calcium levels, higher serum P levels, 25-OH vitamin D deficiency, and FGF-23 levels above 2000 RU/mL.
Good answer Dr. Weam
In addition to your answer, OSA-induced hypoxia is often associated with oxidative stress resulting in greater bone resorption.