Sleep and CKD in Chinese Adults: A Cross-Sectional Study

Li, Junjuan; Huang, Ze; Hou, Jinhong; Sawyer, Amy M.; Wu, Zhijun; Cai, Jun; Curhan, Gary C.; Wu, Shouling; Gao, Xiang

doi:10.2215/cjn.09270816

Cited by 73 publications

(67 citation statements)

References 40 publications

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“…As part of the Chronic Renal Insufficiency Cohort (CRIC) study, Knutson et al reported worse objective sleep quality was associated with a lower estimated GFR (eGFR) and higher urinary protein to creatinine ratio [170]. In addition, a shorter duration of sleep and later timing of sleep was associated with a lower eGFR Similar studies involving participants from the Chinese Kailuan cohort [171] and Korean Kangbuk Samsung Health Study [172] also found an association between poor sleep quality and reduced renal function. Given that sleep disturbances are a common problem in dialysis patients [173], and that disturbances in circadian timekeeping have been observed in the peripheral tissues of patients on dialysis as well [174], these studies suggest a possible dyssynchrony between central and peripheral clocks in the body and require further analysis of the circadian clock mechanism in CKD patients to reveal new clinical avenues to treat the disease and its symptoms.…”

Section: Pathologies Associated With Impaired Circadian Rhythmsmentioning

confidence: 99%

Circadian regulation of renal function

Johnston

Pollock

2018

Free Radical Biology and Medicine

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The kidneys regulate many vital functions that require precise control throughout the day. These functions, such as maintaining sodium balance or regulating arterial pressure, rely on an intrinsic clock mechanism that was commonly believed to be controlled by the central nervous system. Mounting evidence in recent years has unveiled previously underappreciated depth of influence by circadian rhythms and clock genes on renal function, at the molecular and physiological level, independent of other external factors. The impact of circadian rhythms in the kidney also affects individuals from a clinical standpoint, as the loss of rhythmic activity or clock gene expression have been documented in various cardiovascular diseases. Fortunately, the prognostic value of examining circadian rhythms may prove useful in determining the progression of a kidney-related disease, and chronotherapy is a clinical intervention that requires consideration of circadian and diurnal rhythms in the kidney. In this review, we discuss evidence of circadian regulation in the kidney from basic and clinical research in order to provide a foundation on which a great deal of future research is needed to expand our understanding of circadian relevant biology.

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Section: Pathologies Associated With Impaired Circadian Rhythmsmentioning

confidence: 99%

Circadian regulation of renal function

Johnston

Pollock

2018

Free Radical Biology and Medicine

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“…Interventional trials to suppress deep nonrapid eye movement sleep, also known as slow-wave sleep, demonstrated adverse metabolic effects on glucose metabolism (24,25), the sympathetic nervous system (25), and adrenocortical activity (25). Although poor sleep quality is common in patients with CKD (26)(27)(28), the clinical effect of sleep quality on ESKD incidence remains to be elucidated (19).…”

Section: Introductionmentioning

confidence: 99%

Sleep Quality and Sleep Duration with CKD are Associated with Progression to ESKD

Yamamoto

Shinzawa

Isaka

et al. 2018

CJASN

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Background and objectives Shorter or longer sleep duration and poor sleep quality are risk factors for numerous cardio-metabolic diseases, cardiovascular disease, and mortality in subjects with normal kidney function. The association of sleep duration and sleep quality with health outcomes in patients with CKD remains uncertain.Design, setting, participants, & measurements A 4-year prospective cohort study in 17 nephrology centers in Japan, the CKD Japan Cohort (CKD-JAC) Study, assessed an association of self-reported sleep duration and sleep quality, on the basis of the Pittsburgh Sleep Quality Index (PSQI) questionnaire, with incidence of ESKD in 1601 patients with eGFR 10-59 ml/min per 1.73 m 2 using multivariable-adjusted Cox proportional hazards models.Results Baseline sleep duration and PSQI global score for the 1601 patients were mean6SD 7.061.3 hours and median 4 (interquartile range, 3-7), respectively. Poor sleep quality (PSQI global score $6) was common (n=588 [37%]). During a median of 4.0 (2.6-4.3) years of the follow-up period, 282 (18%) patients progressed to ESKD. After adjusting for age, sex, eGFR, urinary albumin excretion, smoking status, body mass index, history of diabetes and cardiovascular disease, systolic BP, blockade of the renin-angiotensin system, use of hypnotics, and Beck depression inventory score, both shorter (#5 hour) and longer (.8 hour) sleep duration were associated with ESKD (adjusted hazard ratios [95% confidence intervals] for #5.0, 5.1-6.0, 6.1-7.0, 7.1-8.0, and $8.0 hours were 2.05 [1.31 to3.21], 0.98 [0.67 to 1.44], 1.00 [reference], 1.22 [0.89 to 1.66], and 1.48 [1.01 to 2.16]), suggesting a U-shaped relationship between sleep duration and ESKD. PSQI global score $6 was also associated with incidence of ESKD (adjusted hazard ratios [95% confidence intervals] for PSQI global score #5 and $6 were 1.00 [reference] and 1.33 [1.03 to 1.71]).Conclusions Shorter (#5 hour) and longer (.8 hour) sleep duration and poor sleep quality (PSQI global score $6) were associated with ESKD in patients with CKD.

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“…On the contrary, previous studies have demonstrated that SA is an independent risk factor for CKD in both direct and indirect effects . SA can accelerate the deterioration of kidney function directly by activating renin‐angiotensin‐aldosterone system, sympathetic nervous system and nocturnal hypoxia . Meanwhile, SA can promote the decline of renal function indirectly by contributing to risk factors for CKD, such as, obesity and diabetes .…”

Section: Discussionmentioning

confidence: 99%

Prevalence of sleep apnoea in non‐dialysis chronic kidney disease patients: A systematic review and meta‐analysis

et al. 2019

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This is a meta-analysis evaluating the prevalence of sleep apnoea (SA) in patients with chronic kidney disease (CKD). The authors found that SA is commonly seen in both early and advanced nondialysis CKD patients, and the prevalence of SA increases in advanced CKD. And male patients are more likely to be affected by SA than female patients. ABSTRACT:Aim: The prevalence of sleep apnoea (SA) in chronic kidney disease (CKD) varies greatly across preceding studies. The aim of our study was to provide a summary of the prevalence of SA among non-dialysis CKD patients. Method: Medline, Embase, Web of Science, China Knowledge ResourceIntegrated Database, VIP Chinese scientific journal database (VIP) and Wanfang Digital Periodical Full-text database were searched up to September 2018 to identify publications related to the prevalence of SA in non-dialysis CKD patients assessed by sleep questionnaires or sleep respiration monitoring. Random-effects meta-analysis was used to estimate pooled prevalence of SA. And subgroup analysis and meta-regression were conducted as well.Results: The pooled prevalence of SA in the included 26 studies was 38% (95% confidence interval [CI], 21-70%). In subgroup analyses, the pooled prevalence of SA varied using different diagnostic tools. The pooled prevalence of questionnaire-based SA for CKD was 10% (95% CI, 3-27%), while the prevalence of sleep monitoring-based SA was 56% (95% CI, 49-66%). Also, advanced CKD patients had a greater chance to suffer from moderate-to-severe SA than early stage CKD patients. Male patients were more likely to be affected by moderate-to-severe SA than female patients (47% vs 30%, P = 0.018).

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Sleep and CKD in Chinese Adults: A Cross-Sectional Study

Abstract: Worse overall sleep quality was associated with higher odds of being high or very high risk for CKD and proteinuria in Chinese adults.

Cited by 73 publications

References 40 publications

Circadian regulation of renal function

Circadian regulation of renal function

Sleep Quality and Sleep Duration with CKD are Associated with Progression to ESKD

Prevalence of sleep apnoea in non‐dialysis chronic kidney disease patients: A systematic review and meta‐analysis

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