**7. Clinical significance**

Sleep apnea worsens the symptoms of CKD such as daytime fatigue, sleepiness, and impaired neurocognitive function. Hypoxemia during sleep is associated with nocturnal hypertension, left ventricular hypertrophy, impaired sympathovagal balance, and increased risk of cardiovascular complications including death (68-69). Sleep apnea may exacerbate the infectious complications common in ESRD patients because sleep disruption and deprivation degrade immune function (26). Severe sleep apnea is an independent predictor of graft loss among female kidney transplant patients (27).
