TY - JOUR
T1 - The association of sleep duration and quality with CKD progression
AU - Ricardo, Ana C.
AU - Knutson, Kristen
AU - Chen, Jinsong
AU - Appel, Lawrence J.
AU - Bazzano, Lydia
AU - Carmona-Powell, Eunice
AU - Cohan, Janet
AU - Tamura, Manjula Kurella
AU - Steigerwalt, Susan
AU - Thornton, John Daryl
AU - Weir, Matthew
AU - Turek, Nicolas F.
AU - Rahman, Mahboob
AU - Van Cauter, Eve
AU - Lash, James P.
N1 - Funding Information:
Funding for the Chronic Renal Insufficiency Cohort (CRIC) Study was obtained under a cooperative agreement from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK; grants U01DK060990, U01DK060984, U01DK061022, U01DK061021, U01DK061028, U01DK060980, U01DK060963, and U01DK060902). In addition, this work was supported, in part, by Perelman School of Medicine at the University of Pennsylvania Clinical and Translational Science Award National Institutes of Health (NIH)/National Center for Advancing Translational Sciences (NCATS) grant UL1TR000003, Johns Hopkins University grant UL1 TR-000424, University of Maryland General Clinical Research Center grant M01 RR-16500, the Clinical and Translational Science Collaborative of Cleveland, grant UL1TR000439 from the NCATS component of the NIH and the NIH Roadmap for Medical Research, University of Chicago grant R01DK071696 (to E.V.C.), Michigan Institute for Clinical and Health Research grant UL1TR000433, University of Illinois at Chicago Clinical and Translational Science Award grant UL1RR029879, Tulane University Translational Research in Hypertension and Renal Biology grant P30GM103337, and Kaiser Permanente NIH/National Center for Research Resources University of California, San Francisco-Clinical and Translational Science Institute grant UL1 RR-024131. A.C.R. is funded by NIDDK grant K23DK094829. J.P.L. is funded by NIDDK grants K24DK092290 and R01-DK072231-91.
PY - 2017/12
Y1 - 2017/12
N2 - Evidence suggests that sleep disorders are common in individuals with CKD, but the influence of sleep duration and quality onCKD 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 =38ml/min per 1.73m2, 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 (21.12 and 20.18 ml/min per 1.73m2 per year, respectively; P=0.02 and P,0.01, respectively) and greater log UPCR slope (0.06/yr and 0.01/yr, respectively; P=0.02 and P,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 onepoint increase in the Epworth Sleepiness Scale score). These findings suggest that short and poor-quality sleep are unrecognized risk factors for CKD progression.
AB - Evidence suggests that sleep disorders are common in individuals with CKD, but the influence of sleep duration and quality onCKD 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 =38ml/min per 1.73m2, 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 (21.12 and 20.18 ml/min per 1.73m2 per year, respectively; P=0.02 and P,0.01, respectively) and greater log UPCR slope (0.06/yr and 0.01/yr, respectively; P=0.02 and P,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 onepoint increase in the Epworth Sleepiness Scale score). These findings suggest that short and poor-quality sleep are unrecognized risk factors for CKD progression.
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U2 - 10.1681/ASN.2016121288
DO - 10.1681/ASN.2016121288
M3 - Article
C2 - 28912373
AN - SCOPUS:85038412238
SN - 1046-6673
VL - 28
SP - 3708
EP - 3715
JO - Journal of the American Society of Nephrology
JF - Journal of the American Society of Nephrology
IS - 12
ER -