Prevalence and clinical correlates of high risk for obstructive sleep apnea in kidney transplant recipients: a cross-sectional study using the Berlin Questionnaire

Authors

Torki Alotaibi; Ahmad Abbas; Mohamed Albader; Medhat Alawady; Mohamed Balaha; Khaled Abdultawab; Talal Aldousari; Osama Gheith

Citation

Arab J Nephrol Transplant. 2026;8(3):114–120. doi: 10.4103/AJNT.AJNT_2_26

Abstract

Background Obstructive sleep apnea (OSA) is increasingly recognized as a common comorbidity among kidney transplant recipients, yet it remains underdiagnosed in this population. Persistent metabolic abnormalities, weight gain following transplantation, and immunosuppressive therapy may contribute to ongoing sleep‑disordered breathing despite restoration of renal function. This study aimed to evaluate the prevalence of high risk for OSA among kidney transplant recipients using the Berlin Questionnaire and to identify clinical and demographic factors associated with this risk. Patients and methods In this cross‑sectional study, 85 kidney transplant recipients attending the Hamed Alessa Organ Transplant Center in Kuwait, were assessed using the validated Arabic version of the Berlin Questionnaire. Demographic data, comorbid conditions, BMI, immunosuppressive regimens, and renal function parameters (serum creatinine at baseline and most recent follow‑up) were collected. Associations between high‑risk status and clinical variables were analyzed using χ 2 tests, independent t tests, and crude odds ratios. Results Of 85 participants, 34 (40%) were classified as high risk for OSA. Female sex was significantly more prevalent in the high‑risk group (44.1 vs. 23.5% in the low‑risk group, P = 0.04). High‑risk status was significantly associated with graft failure: nine (90%) of 10 graft failure cases occurred in the high‑risk group (crude odds ratio = 18.0, 95% confidence interval: 2.2–149.7, P = 0.001). Patients at high risk had higher BMI at last follow‑up (35.6 ± 6.7 vs. 26.5 ± 7.2 kg/m 2 , P = 0.009) and higher most recent serum creatinine levels (283.8 ± 29.8 vs. 149.7 ± 25.4 µmol/l, P = 0.008). Cyclosporine‑based immunosuppression was more common in the high‑risk group (35.3 vs. 15.6%, P = 0.03), and triglyceride levels were significantly elevated in this group (5.2 ± 0.2 vs. 1.9 ± 0.4 mmol/l, P = 0.001). No significant associations were observed between high‑risk status and age, smoking, diabetes mellitus, hypertension, or ischemic heart disease in this cohort. Conclusions High risk for OSA, as assessed by the Berlin Questionnaire, is prevalent among kidney transplant recipients and is associated with adverse graft outcomes, higher BMI, and cyclosporine‑based immunosuppression. These findings are hypothesis‑generating and support the need for routine screening for high risk of OSA in transplant populations. Prospective studies using polysomnography are needed to confirm these associations and evaluate whether OSA treatment improves graft and cardiovascular outcomes.

Read More in AJNT

The Arab Journal of Nephrology and Transplantation is the peer-reviewed open-access journal of ASNRT, published since 2008.

Issue table of contents — Vol 8, Issue 3 · AJNT archive · Download full-text PDF (open access)