The Association of Sleep Duration and Quality with CKD Progression

Abstract

Evidence suggests that sleep disorders are common in individuals with CKD, but the influence of sleep duration and quality on CKD progression is unknown. We examined the association of habitual sleep duration and quality with CKD progression in 431 Chronic Renal Insufficiency Cohort (CRIC) Study participants, of whom 48% were women and 50% had diabetes (mean age of 60 years old, mean eGFR =38 ml/min per 1.73 m, and median urine protein-to-creatinine ratio [UPCR] =0.20 g/g). We assessed sleep duration and quality by 5-7 days of wrist actigraphy and self-report. Primary outcomes were incident ESRD, eGFR slope, log-transformed UPCR slope, and all-cause death. Participants slept an average of 6.5 hours per night; mean sleep fragmentation was 21%. Over a median follow-up of 5 years, we observed 70 ESRD events and 48 deaths. In adjusted analyses, greater sleep fragmentation associated with increased ESRD risk (hazard ratio, 1.04; 95% confidence interval, 1.01 to 1.07 per 1% increase in fragmentation). In adjusted mixed effects regression models, shorter sleep duration (per hour less) and greater sleep fragmentation (per 1% more) each associated with greater eGFR decline (-1.12 and -0.18 ml/min per 1.73 m per year, respectively; =0.02 and<0.01, respectively) and greater log UPCR slope (0.06/yr and 0.01/yr, respectively; =0.02 and<0.001, respectively). Self-reported daytime sleepiness associated with increased risk for all-cause death (hazard ratio, 1.11; 95% confidence interval, 1.02 to 1.20 per one-point increase in the Epworth Sleepiness Scale score). These findings suggest that short and poor-quality sleep are unrecognized risk factors for CKD progression.

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

“…Six studies were from the USA, three from Japan, two from Canada, three from Egypt, three from Australia . Three studies were from China and Hong Kong China .…”

Self-reported sleep duration and daytime napping are associated with renal hyperfiltration and microalbuminuria in apparently healthy Chinese population

“…Several studies had investigated the association between sleep and kidney health outcome. Both short and long sleep duration were reported to be associated with decreased eGFR and the progression to ESRD among CKD 12, 21, 32, 33 or hypertension 18 population, and to be associated with increased eGFR, hyperfiltration, inadequate hydration and the prevalence of CKD among community-based general population 13, 19, 20, 26–28 . In our study, based on same general community population, we further demonstrated that inappropriate sleep duration had converse effects on eGFR in healthy or early-stage nephropathy population, which was consistent to previous studies.…”

“…A few studies selected albuminuria as a terminal outcome to evaluate how sleep affects kidney function. Both short and long sleep duration had been reported to be associated with UACR level among populations from Japan 35 , Korea 36 and US 12 , and daytime napping had been reported to be positively associated with albuminuria in Japan 37 , however, this relationship is racial-specific 13 , whether it exists among Chinese population keeps unknown. This study confirmed the U-shaped relationship between sleep duration and albuminuria and the positive relationship between napping and albuminuria on the basis of the Chinese population.…”

“…Recently, a series of studies suggested extreme sleep duration may contribute to the decline of kidney function, which is closely tied to the vascular system, also an important, independent risk factor for cardiovascular disease. Both extremely short 11, 12 and long 13 sleep duration and poor sleep quality 14, 26 were reported to be related to higher urine albumin-to-creatinine ratio(UACR), which is a sensitive indicator for microalbuminuria or early stage of kidney damage, among US and Japanese population. In addition, short sleep duration was associated with higher odds of inadequate hydration 15 .…”

Sleep Duration and Proteinuria Progression: A Population-Based Cohort Study

“…In another large prospective cohort study involving 3,489 Nurse's Health Study participants in the United States followed for 11 years, those with sleep duration < 5 h have an increased risk of eGFR decrease (adjusted OR 1.79 [95% CI 1.0-3.03, p = 0.03) [35]. In the Chronic Renal Insufficiency Cohort study involving 431 participants followed for a median time of 5.19 years, both shorter sleep duration and sleep fragmentation were associated with eGFR reduction and urinary protein loss [36]. In a recent longitudinal study involving 63,257 Singaporean Chinese with a follow-up of 16.8 years, sleep duration had a U-shaped association with risk of ESRD.…”