Multiple, objectively measured sleep dimensions including hypoxic burden and chronic kidney disease: Findings from the Multi-Ethnic Study of Atherosclerosis

Chandra L. Jackson, Chizoba Umesi, Symielle A. Gaston, Ali Azarbarzin, Joseph Lunyera, John A. McGrath, W. Braxton Jackson, Clarissa J. Diamantidis, Ebony Boulware, Pamela L. Lutsey, Susan Redline

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Poor sleep may contribute to chronic kidney disease (CKD) through several pathways, including hypoxia-induced systemic and intraglomerular pressure, inflammation, oxidative stress and endothelial dysfunction. However, few studies have investigated the association between multiple objectively measured sleep dimensions and CKD. Methods: We investigated the cross-sectional association between sleep dimensions and CKD among 1895 Multi-Ethnic Study of Atherosclerosis Sleep Ancillary Study participants who completed in-home polysomnography, wrist actigraphy and a sleep questionnaire. Using Poisson regression models with robust variance, we estimated separate prevalence ratios (PR) and 95% CIs for moderate-to-severe CKD (glomerular filtration rate <60 mL/min/1.73 m2 or albuminuria >30 mg/g) among participants according to multiple sleep dimensions, including very short (≤5 hours) sleep, Apnoea-Hypopnoea Index and sleep apnoea-specific hypoxic burden (SASHB) (total area under the respiratory event-related desaturation curve divided by total sleep duration, %min/hour)). Regression models were adjusted for sociodemographic characteristics, health behaviours and clinical characteristics. Results: Of the 1895 participants, mean age was 68.2±9.1 years, 54% were women, 37% were white, 28% black, 24% Hispanic/Latino and 11% Asian. Several sleep metrics were associated with higher adjusted PR of moderate-to-severe CKD: very short versus recommended sleep duration (PR=1.40, 95% CI 1.06 to 1.83); SASHB (Box-Cox transformed SASHB: PR=1.06, 95% CI 1.02 to 1.12); and for participants in the highest quintile of SASHB plus sleep apnoea: PR=1.28, 95% CI 1.01 to 1.63. Conclusions: Sleep apnoea associated hypoxia and very short sleep, likely representing independent biological mechanisms, were associated with a higher moderate-to-severe CKD prevalence, which highlights the potential role for novel interventions.

Original languageEnglish (US)
Article number214713
JournalThorax
DOIs
StateAccepted/In press - 2020
Externally publishedYes

Keywords

  • oxidative stress
  • sleep apnoea

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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