Clinical Investigation

Kidney International (1991) 40, 539–543; doi:10.1038/ki.1991.243

Branched-chain amino acid in chronic renal failure patients: Respiratory and sleep effects

Eldar Söreide1, Björn Skeie1, Olli Kirvelä1, Robert Lynn1, Nancy Ginsberg1, Tuula Manner1, David P Katz1 and Jeffrey Askanazi1

1Division of Critical Care Medicine, Department of Anesthesiology, The Baumritter Kidney Center; Department of Nephrology, and The Sleep Disorders Center; Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA

Correspondence: Jeffrey Askanazi MD, Division of Critical Care Medicine, Department of Anesthesiology, Montefiore Medical Center, 111 East 210th Street, Bronx, New York, 10467, USA.

Received 19 November 1990; Revised 8 April 1991; Accepted 12 April 1991.

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Abstract

Branched-chain amino acid in chronic renal failure patients: Respiratory and sleep effects. Sleep disorders, including a high incidence of sleep apnea, have been recognized as a significant problem in chronic renal failure (CRF) patients. In a preliminary study, we examined CRF patients on maintenance hemodialysis for three nights; one control night, and thereafter randomized to infusion of saline (placebo) for one night and 4% branch-chain amino acid (BCAA) solution for one night. Polysomnographic and respiratory data [respiratory rate, oxygen saturation and end-tidal CO2 (ETCO2)] was recorded continuously throughout the nights and data from each hour compared with baseline (awake) values. The patients studied were characterized by reduced sleep quality and decreased amount of rapid eye movement (REM) sleep. The BCAA infusion was associated with a return of REM sleep to normal and a significant decrease in ETCO2 during both REM and non-REM sleep (P < 0.05). Our findings demonstrate respiratory stimulation during sleep with infusion of BCAA; this stimulatory effect on respiration (in contrast to many respiratory stimulants) is associated with an increased amount of REM sleep.

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