Sleep Quality, Duration Increases Kidney Disease Progression
Short sleep duration and poor sleep quality are associated with an increased risk for chronic kidney disease (CKD) progression among patients with CKD, according to a recent study.Previous studies have indicated that sleep disorders are frequent among patients with CKD. However, less is known about the influence of sleep duration and quality on the progression of CKD.
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To explore this association further, the researchers assessed 431 patients with CKD who were enrolled in the Chronic Renal Insufficiency Cohort (CRIC). Mean patient age was 60 years, and 50% of patients had diabetes. Patients’ mean estimated glomerular filtration rate (eGFR) was 38 ml/min per 1.73 m2, and median urine protein-to-creatinine ratio (UPCR) was 0.20 g/g. Median follow-up lasted 5 years.
Sleep duration and quality were assessed via self-reporting and 5 to 7 days of wrist actigraphy. The primary outcomes were defined as incident end-stage renal disease (ESRD), eGFR slope, log-transformed UPCR slope, and all-cause mortality.
Results indicated that participants had slept an average of 6.5 hours per night, and mean sleep fragmentation had been 21%. Over the course of follow-up, the researchers had recorded 70 ESRD events and 48 deaths. Adjusted analyses showed that greater sleep fragmentation was associated with a higher risk of ESRD. Adjusted mixed effects regression models showed that shorter sleep duration was associated with a greater decrease in eGFR decline (-1.12 ml/min per 1.73 m2 per year), a greater log UPCR slope (0.06/yr), and greater sleep fragmentation (-0.18 ml/min per 1.73 m2 per year; 0.01/yr).
The researchers also noted that self-reported daytime sleepiness was associated with a higher risk for all-cause mortality (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,” the researchers concluded.
—Christina Vogt
Reference:
Ricardo AC, Knutsen K, Chen J, et al; the Chronic Renal Insufficiency Cohort. The association of sleep duration and quality with CKD progression [Published online September 14, 2017]. J Am Soc Nephrol. doi:10.1681/ASN.2016121288.