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Clinical Research
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The Association of Sleep Duration and Quality with CKD Progression

Ana C. Ricardo, Kristen Knutson, Jinsong Chen, Lawrence J. Appel, Lydia Bazzano, Eunice Carmona-Powell, Janet Cohan, Manjula Kurella Tamura, Susan Steigerwalt, John Daryl Thornton, Matthew Weir, Nicolas F. Turek, Mahboob Rahman, Eve Van Cauter, James P. Lash and the Chronic Renal Insufficiency Cohort (CRIC) Study Investigators
JASN December 2017, 28 (12) 3708-3715; DOI: https://doi.org/10.1681/ASN.2016121288
Ana C. Ricardo
*Department of Medicine, University of Illinois at Chicago, Chicago, Illinois;
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Kristen Knutson
†Department of Medicine, University of Chicago, Chicago, Illinois;
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Jinsong Chen
*Department of Medicine, University of Illinois at Chicago, Chicago, Illinois;
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Lawrence J. Appel
‡Department of Medicine, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland;
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Lydia Bazzano
§Department of Epidemiology, Tulane University, New Orleans, Louisiana;
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Eunice Carmona-Powell
*Department of Medicine, University of Illinois at Chicago, Chicago, Illinois;
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Janet Cohan
*Department of Medicine, University of Illinois at Chicago, Chicago, Illinois;
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Manjula Kurella Tamura
‖Division of Nephrology, Stanford University School of Medicine, Palo Alto, California;
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Susan Steigerwalt
¶Department of Medicine, University of Michigan, Ann Arbor, Michigan;
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John Daryl Thornton
**Department of Medicine, MetroHealth Medical Campus of Case Western Reserve University, Cleveland, Ohio;
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Matthew Weir
††Department of Medicine, University of Maryland, Baltimore, Maryland; and
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Nicolas F. Turek
†Department of Medicine, University of Chicago, Chicago, Illinois;
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Mahboob Rahman
‡‡Department of Medicine, Case Western University, University Hospitals Case Medical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
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Eve Van Cauter
†Department of Medicine, University of Chicago, Chicago, Illinois;
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James P. Lash
*Department of Medicine, University of Illinois at Chicago, Chicago, Illinois;
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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 m2, 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 m2 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 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.

  • chronic kidney disease
  • Epidemiology and outcomes
  • mortality risk
  • Copyright © 2017 by the American Society of Nephrology
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Journal of the American Society of Nephrology: 28 (12)
Journal of the American Society of Nephrology
Vol. 28, Issue 12
December 2017
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The Association of Sleep Duration and Quality with CKD Progression
Ana C. Ricardo, Kristen Knutson, Jinsong Chen, Lawrence J. Appel, Lydia Bazzano, Eunice Carmona-Powell, Janet Cohan, Manjula Kurella Tamura, Susan Steigerwalt, John Daryl Thornton, Matthew Weir, Nicolas F. Turek, Mahboob Rahman, Eve Van Cauter, James P. Lash, the Chronic Renal Insufficiency Cohort (CRIC) Study Investigators
JASN Dec 2017, 28 (12) 3708-3715; DOI: 10.1681/ASN.2016121288

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The Association of Sleep Duration and Quality with CKD Progression
Ana C. Ricardo, Kristen Knutson, Jinsong Chen, Lawrence J. Appel, Lydia Bazzano, Eunice Carmona-Powell, Janet Cohan, Manjula Kurella Tamura, Susan Steigerwalt, John Daryl Thornton, Matthew Weir, Nicolas F. Turek, Mahboob Rahman, Eve Van Cauter, James P. Lash, the Chronic Renal Insufficiency Cohort (CRIC) Study Investigators
JASN Dec 2017, 28 (12) 3708-3715; DOI: 10.1681/ASN.2016121288
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  • epidemiology and outcomes
  • mortality risk

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