Association between Sleep Duration and Incident Chronic Kidney Disease: A Population-Based Cohort Analysis of the NAGALA Study

The risk of chronic kidney disease or proteinuria with long or short sleep duration: a systematic review and meta-analysis of cohort studies

OBJECTIVE

Irregular sleep duration has been linked with systemic diseases as well as chronic kidney disease (CKD). However, most of the evidence is low-quality and from cross-sectional data. We hereby present a meta-analysis of cohort studies examining the longitudinal association between short and long sleep with the risk of CKD or proteinuria.

METHODS

Databases of Embase, PubMed, CENTRAL, Web of Science, and Scopus were searched up to 5th April 2024. The risk of CKD/proteinuria was assessed with short or long sleep duration.

RESULTS

Nine studies were included. Both short and long sleep duration were associated with a mild increase in the risk of CKD/proteinuria. Based on different cutoffs for short sleep, we noted that sleep of ≤ 7 h was not associated with a significantly increased risk of CKD/proteinuria. A mild significant risk was noted in the subgroup of ≤ 6 h while a significant association was noted for sleep ≤ 5 h. For longer sleep duration, individuals with ≥ 8 h of sleep had an increased risk of CKD/proteinuria. However, the results were non-significant for individuals with ≥ 9 h of sleep. Non-significant results were noted for separate analyses on male, female, high body mass index, and elderly (≥ 60 years) individuals.

CONCLUSION

Both short and long sleep durations are associated with a significant increase in the risk of CKD/proteinuria in the adult population.

Sleep duration and risk of mortality from chronic kidney disease among Japanese adults

OBJECTIVE

To explore the association between sleep duration and death from chronic kidney disease in the general Japanese population.

METHODS

We conducted an 19.3-year follow-up study of 40,272 men and 54,902 women aged 40-79years and free of renal disease, cardiovascular disease and cancer in the Japan Collaborative Cohort Study for Evaluation of Cancer Risk at baseline (between 1986 and 1990). Sleep duration was categorized into five groups: <6, 6 to <7, 7 to <8, 8 to <9, and ≥9 hours per day. Cox proportional hazard models were used to analyze the association between sleep duration and death from chronic kidney disease.

RESULTS

Compared with persons with 7 to <8 hours sleep duration, those who slept 8 to <9 hours (HR: 1.41, 95% CI: 1.05-1.88) or ≥9hours (HR: 1.82, 95% CI: 1.28-2.58) per day had a higher risk of developing chronic kidney disease mortality. This association was particularly pronounced in individuals aged younger than 65years.

CONCLUSIONS

Sleep duration of 8 or more hours per day was associated with increased risk of chronic kidney disease mortality in the general Japanese population.

The association of sleep duration with the risk of chronic kidney disease: a systematic review and meta-analysis

Background and hypothesis

Published literature suggests that sleep duration and quality may be affected in adults with chronic kidney disease. However, the relationship between these two entities remains a matter of debate. The objective of this systematic review and meta-analysis is to assess the effect of sleep duration and quality on chronic kidney disease.

Methods

A systematic review of the Medline/PubMed, Embase, Cochrane Library, and CINAHL databases was conducted for articles pertaining to the association between sleep duration and quality on chronic kidney disease. The main outcome was the hazard/risk ratio of chronic kidney disease in patients of varying sleep durations and quality.

Results

In total, 42 studies (2 613 971 patients) with a mean age of 43.55 ± 14.01 years were included in the meta-analysis. Compared with a reference range of 7 to 8 hours of sleep, short sleep durations of ≤4 hours (RR 1.41, 95% CI: 1.16 to 1.71, P < 0.01), ≤5 hours (RR 1.46, 95% CI: 1.22 to 1.76, P < 0.01), ≤6 hours (RR 1.18, 95% CI: 1.09 to 1.29, P < 0.01), and ≤7 hours (RR 1.19, 95% CI: 1.12 to 1.28, P < 0.01) were significantly associated with an increased risk of incident chronic kidney disease. Long sleep durations of ≥8 hours (RR 1.15, 95% CI: 1.03 to 1.28, P < 0.01) and ≥9 hours (RR 1.46, 95% CI: 1.28 to 1.68, P < 0.01) were also significantly associated with an increased risk of incident chronic kidney disease. Meta-regression did not find any significant effect of age, gender, geographical region, and BMI and an association with sleep duration and risk of incident chronic kidney disease.

Conclusion

Both short and long sleep durations were significantly associated with a higher risk of chronic kidney disease. Interventions targeted toward achieving an optimal duration of sleep may reduce the risk of incident chronic kidney disease.

Screening the General Population for Non-Alcoholic Fatty Liver Disease: Model Development and Validation

BACKGROUND

The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing worldwide. Screening the general population for this may help to select appropriate diagnostic and preventive measures before disease progression.

AIMS

We aimed to develop a screening method to identify patients with NAFLD in the general population.

METHODS

We analyzed cross-sectional data from a large Japanese study of NAFLD. Principal component analysis was used to analyze the data. Candidate predictors were patients' demographic, clinical, and laboratory characteristics. The resulting model was externally validated using three data sets from different populations.

RESULTS

Of 15,464 (54.5% men) included patients, 2,741 (17.7%) had NAFLD as determined by ultrasonography. An index was calculated as the arithmetic mean of the scaled body mass index and serum triglyceride levels for both men and women. The area under the receiver operating characteristic curve, sensitivity, specificity, and false positive rate were 0.875, 0.824, 0.770, and 17.6%, respectively. The mean index values were significantly different between the patients with and without non-alcoholic fatty liver disease (p <0.001). The odds ratio of the index cutoff was 15.6 (95% confidence interval [CI]:14.05, 17.39). The model yielded areas under the curve of 0.828, 0.851, and 0.836 for a Chinese (N = 2,319), an Iranian (N = 2,160), and a Brazilian (N = 45,029) data set, respectively.

CONCLUSIONS

The proposed composite index demonstrated high performance and generalizability, suggesting its potential use as a screening tool for NAFLD in the general population.

U-Shaped Relationship between Sleep Duration and CKD in US Adults: Data from National Health and Nutrition Examination Survey (NHANES) 2005-2014

INTRODUCTION

Short and long sleep durations have been associated with adverse health outcomes. The objective of this study was to examine the association between self-reported sleep duration and chronic kidney disease (CKD) in the general population on the basis of the National Health and Nutrition Examination Survey (NHANES) database.

METHODS

A total of 28,239 adults aged ≥18 years who participated in the 2005-2014 NHANES were analyzed. CKD was defined as an estimated glomerular filtration rate <60 mL/min per 1.73 m2 or urinary albumin/urine creatinine ratio ≥300 mg/g. Very short sleepers and short sleepers were defined as those who sleep ≤5 h or 5.1-6.9 h per day, respectively. Long sleepers and very long sleepers were defined as those who sleep 9.0-10.9 h or ≥11 h per day, respectively. Normal sleepers were defined as those who sleep 7.0-8.9 h. The association between sleep duration and CKD was assessed using a logistic regression model.

RESULTS

Very short (≤5 h) sleep duration was associated with higher odds of CKD (multiadjusted OR, 1.38; 95% confidence interval, 1.17-1.62 comparing normal categories of 7.0-8.9 h; P trend = 0.01), after adjusting for potential confounders. Participants with long (9-10.9 h) sleep duration also tended to have a higher odds of CKD (multiadjusted OR, 1.39; 95% confidence interval, 1.20-1.61 comparing normal categories of 7.0-8.9 h; P trend = 0.01). This risk was further increased in those whose sleep duration exceeded 11 h (multiadjusted OR, 2.35; 95% confidence interval, 1.64-3.37 comparing normal categories of 7.0-8.9; P trend = 0.01). However, there was no statistically significant association between short (≤6.0-7.9 h) sleep duration and CKD (multiadjusted OR, 1.05; 95% confidence interval, 0.96-1.14 comparing normal categories of 7.0-8.9 h; P trend = 0.32).

CONCLUSION

We demonstrated that the higher CKD prevalence estimates were found in very short (≤5 h) and long (9.0-10.9 h) sleep durations in an apparently healthy population aged ≥18 years in the USA. This prevalence of CKD is further increased in those whose sleep duration exceeds 11 h. Our cross-sectional analyses clarified the U-shaped temporal relationship between sleep duration and CKD.

Association of Self-Reported Nighttime Sleep Duration with Chronic Kidney Disease: China Health and Retirement Longitudinal Study

INTRODUCTION

The cohort study aimed to assess the association of nighttime sleep duration and the change in nighttime sleep duration with chronic kidney disease (CKD) and whether the association between nighttime sleep duration and CKD differed by daytime napping.

METHODS

This study included 11,677 individuals from the China Health and Retirement Longitudinal Study (CHARLS) and used data from the 2011 baseline survey and four follow-up waves. Nighttime sleep duration was divided into three groups: short (<7 h per night), optimal (7-9 h), and long nighttime sleep duration (>9 h). Daytime napping was divided into two groups: no nap and with a nap. We used Cox proportional hazards model to examine the effect of nighttime sleep duration at baseline and change in nighttime sleep duration on incident CKD and a joint effect of nighttime sleep duration and nap time on onset CKD.

RESULTS

With a follow-up of 7 years, the incidence of CKD among those with short, optimal, and long nighttime sleep duration was 9.89, 6.75, and 9.05 per 1,000 person-years, respectively. Compared to individuals with optimal nighttime sleep duration, short nighttime sleepers had a 44% higher risk of onset CKD (hazard ratio [HR]: 1.44, 95% confidence interval [CI]: 1.21-1.72). Compared to participants with persistent optimal nighttime sleep duration, those with persistent short or long nighttime sleep duration had an increased risk of incident CKD (HR: 1.44, 95% CI: 1.15-1.80). We found a lower incidence of CKD in participants with short nighttime sleep duration and a nap (HR: 0.74, 95% CI: 0.60-0.93), compared to those with short nighttime sleep duration and no nap.

CONCLUSION

Short nighttime sleep duration and persistent long or short nighttime sleep duration were associated with a higher risk of onset CKD. Keeping persistent optimal nighttime sleep duration may help reduce CKD risk later in life. Daytime napping may be protective against CKD incidence.

Association between sleep parameters and chronic kidney disease: findings from iranian ravansar cohort study

INTRODUCTION

The relationship between sleep duration and chronic kidney disease (CKD) has received relatively little attention in the Kurdish community. Considering the ethnic diversity of Iran and the importance of the Kurdish community, the present study investigated the association between sleep parameters and CKD among a large sample of Iranian-Kurds.

METHODS

This cross-sectional study was conducted among 9,766 participants (Mage: 47.33, SD = 8.27, 51% female) from the Ravansar Non Communicable Disease (RaNCD) cohort study database. Logistic regression analyses were applied to examine the association between sleep parameters and CKD.

RESULTS

Results showed that prevalence of CKD was detected in 1,058 (10.83%) individuals. Time to fall asleep (p = 0.012) and dozing off during the day (p = 0.041) were significantly higher in the non-CKD group compared to the CKD group. Daytime napping and dozing off during the day in females with CKD were significantly more than males with CKD. A long sleep duration (> 8 h/day) was associated with 28% (95% CI: 1.05, 1.57) higher odds of CKD compared to normal sleep duration (7 h/d), after adjusting for confounding factors. Participants who experienced leg restlessness had a 32% higher probability of developing CKD than those who did not experience leg restlessness (95% CI: 1.03, 1.69).

CONCLUSION

Results suggest that sleep duration and leg restlessness may be associated with an increased likelihood of CKD. Consequently, regulating sleep parameters may play a role in improving sleep and preventing CKD.

Association between sleep duration and quality with rapid kidney function decline and development of chronic kidney diseases in adults with normal kidney function: The China health and retirement longitudinal study

Research have shown that sleep is associated with renal function. However, the potential effects of sleep duration or quality on kidney function in middle-aged and older Chinese adults with normal kidney function has rarely been studied. Our study aimed to investigate the association of sleep and kidney function in middle-aged and older Chinese adults. Four thousand and eighty six participants with an eGFR ≥60 ml/min/1.73 m2 at baseline were enrolled between 2011 and 2015 from the China Health and Retirement Longitudinal Study. Survey questionnaire data were collected from conducted interviews in the 2011. The eGFR was estimated from serum creatinine and/or cystatin C using the Chronic Kidney Disease Epidemiology Collaboration equations (CKD-EPI). The primary outcome was defined as rapid kidney function decline. Secondary outcome was defined as rapid kidney function decline with clinical eGFR of <60 ml/min/1.73 m2 at the exit visit. The associations between sleep duration, sleep quality and renal function decline or chronic kidney disease (CKD) were assessed based with logistic regression model. Our results showed that 244 (6.0%) participants developed rapid decline in kidney function, while 102 (2.5%) developed CKD. In addition, participants who had 3-7 days of poor sleep quality per week had higher risks of CKD development (OR 1.86, 95% CI 1.24-2.80). However, compared with those who had 6-8 h of night-time sleep, no significantly higher risks of rapid decline in kidney function was found among those who had <6 h or >8 h of night time sleep after adjustments for demographic, clinical, or psychosocial covariates. Furthermore, daytime nap did not present significant risk in both rapid eGFR decline or CKD development. In conclusion, sleep quality was significantly associated with the development of CKD in middle-aged and older Chinese adults with normal kidney function.

Effects and differences of sleep duration on the risk of new-onset chronic disease conditions in middle-aged and elderly populations

BACKGROUND

Few longitude cohort studies investigated the risk of the duration of nighttime sleep and naps to the new-onset common chronic disease conditions (CDCs) in middle-aged (45-60) and the elderly (age ≥ 60) populations using an age-stratified strategy.

METHODS

The 7025 participants from The China Health and Retirement Longitudinal Study were screened as eligible subjects. Established 13 cohorts with CDCs, acquired their' sleep records in 2011, and obtained new-onset incidents of CDCs during follow-up in 2011-2018. Performed risk association analyses between sleep duration and 13 new-onset CDCs respectively.

RESULTS

New-onset risk of four CDCs decreased with increasing nighttime sleep (p-nonlinear>0.05). The risk threshold was approximately 7 hours in middle-aged people and 6 hours in the elderly. For the middle-aged population, compared with 7-9hours sleep, <5hour and 5-7hours nighttime sleep were associated with 1.312∼1.675 times more risk of hypertension, kidney disease, diabetes or high blood sugar status, and multimorbidity; Compared with no nap, a 0-30 min nap was associated with 1.413(1.087∼1.837) times the heart disease risk. In the elderly, < 5 hours of night sleep was a significant risk factor for four CDCs including kidney disease and multimorbidity, etc. A long night's sleep (>9 hours) was connected with 61.2% reduction in risk of memory disease, a >90 min nap increased 62% risk of memory disease, and a 0-30 min nap was associated with higher risks of heart disease, hypertension, and a lower kidney disease risk.

CONCLUSIONS

Nighttime sleep and daytime naps may have their own implications for the new-onset CDCs' risk in the aging process.

Impact of Sleep Duration on Decline in Kidney Function in Adult Patients with Hypertension: A Community-Based Prospective Cohort Study

Background

Sleep duration is associated with various health conditions, including chronic kidney disease. However, the association between sleep duration and decline in kidney function in the South Korean population remains unclear. We aimed to investigate the impact of sleep duration on kidney function decline in adult patients with hypertension.

Methods

This cohort study was performed using data obtained from the Korean Genome and Epidemiology Study; 2,837 patients with hypertension who initially had normal kidney function were included. Glomerular filtration rates (GFRs) were estimated at baseline and throughout the 16 years of follow-up. A person was considered to have a decline in kidney function if they had a GFR <60 mL/min/1.73 m². Sleep duration data were obtained through interviewer-assisted questionnaires. Sleep durations were classified as short (<6 hours), normal (≥6 hours but <9 hours), and long (≥9 hours). The Cox proportional hazards model was applied, with adjustments for covariates.

Results

After adjusting for covariates, sleep duration was not associated with a decline in kidney function. However, among men with poorly controlled hypertension at baseline, compared to men with normal sleep durations, men with sleep durations <6 hours had a significantly higher risk of kidney function decline (hazard ratio, 1.56; 95% confidence interval, 1.02–2.36).

Conclusion

Short sleep duration did not seem to be associated with an increased risk of decline in kidney function; however, it may be a risk factor for the decline in kidney function in men with poorly controlled hypertension.

Duração do sono autorrelatada e objetiva em pacientes com DRC: contam a mesma história?

Resumo Introdução: Há discordância entre os dados sobre duração do sono obtidos a partir de questionários e medições objetivas. Não se sabe se isto também é verdade para indivíduos com DRC. Aqui comparamos a duração do sono autorrelatada com a duração do sono obtida por meio de actigrafia. Métodos: Este estudo prospectivo incluiu indivíduos adultos com DRC estadio 3 recrutados entre Setembro/2016 e Fevereiro/2019. Avaliamos a duração subjetiva do sono, fazendo a seguinte questão: “Quantas horas de sono real você teve à noite?” Resultados: Os pacientes (N=34) eram relativamente jovens (51 ± 13 anos). A duração do sono autorrelatada e mensurada foi de 7,1 ± 1,7 e 6,9 ± 1,6 horas, respectivamente, sem correlação entre elas (p=0,165). Embora a diferença média entre as medições tenha sido de 0,21 h, os limites de concordância variaram de -3,7 a 4,1 h. Conclusão: Pacientes com DRC que não estão em diálise apresentam uma percepção equivocada do sono. Dados sobre a duração do sono devem ser obtidos preferencialmente a partir de medições objetivas em pacientes com DRC.

Self-reported and objective sleep duration in patients with CKD: are they telling the same story?

Abstract Introduction: There is disagreement between data on sleep duration obtained from questionnaires and objective measurements. Whether this is also true for individuals with CKD is unknown. Here we compared self-reported sleep duration with sleep duration obtained by actigraphy. Methods: This prospective study included adult individuals with stage 3 CKD recruited between September/2016 and February/2019. We evaluated subjective sleep duration by asking the following question: “How many hours of actual sleep did you get at night?” Results: Patients (N=34) were relatively young (51 ± 13 years). Self-reported and measured sleep duration were 7.1 ± 1.7 and 6.9 ± 1.6 hours, respectively, with no correlation between them (p=0.165). Although the mean difference between measurements was 0.21 h, the limits of agreement ranged from -3.7 to 4.1 h. Conclusion: Patients with CKD who are not on dialysis have an erroneous sleep perception. Data on sleep duration should be preferentially obtained from objective measurements in patients with CKD.

The association of nighttime sleep duration and quality with chronic kidney disease in middle-aged and older Chinese: a cohort study

OBJECTIVE

This cohort study aimed to assess the associations between sleep duration and quality with the risk of incident chronic kidney disease (CKD) in middle-aged and older Chinese.

METHODS

We used the 2011 and 2015 surveys of the China Health and Retirement Longitudinal Study (CHARLS). Nighttime sleep duration was categorized into five groups: ≤4, (4-6], (6-8], (8-10], and >10 h/night. Sleep quality was assessed by restless days in the past week (<1, 1-2, 3-4, and 5-7 days/week). Multivariate logistic regression was used to assess the association between sleep duration and quality with incident CKD.

RESULTS

A total of 11,339 participants free of CKD at baseline were included in this study. After four years follow-up, the incidence of CKD was 7.8%. There was a "U-shaped" association between sleep duration and risk of CKD. Compared to 6-8 h of nighttime sleep duration, those who slept ≤4 h/night (RR: 1.639, 95% CI: 1.287-2.087) or >10 h/night (RR: 2.342, 95% CI: 1.007-5.451) had increased risk of developing CKD after adjustment for confounders. Participants with 5-7 restless days per week had significantly increased risk of CKD (adjusted RR: 1.686, 95% CI: 1.352-2.102), compared to those who rarely or never had a restless sleep.

CONCLUSIONS

Extreme nighttime sleep duration and poor sleep quality were associated with increased risk of CKD in middle-aged and older Chinese. Obtaining an optimal nighttime sleep duration and better sleep quality might reduce the risk of CKD.

Impact of Sleep Duration on Mortality and Quality of Life in Chronic Kidney Disease: Results from the 2007-2015 KNHANES

INTRODUCTION

In the general population, short and long sleep durations have been associated with adverse health outcomes. However, this association remains unclear in patients with chronic kidney disease (CKD). We examined the relationship of sleep duration to mortality and health-related quality of life (HRQOL) in individuals with CKD.

METHODS

A total of 1,783 adults with CKD who participated in the 2007-2015 Korea National Health and Nutrition Examination Survey were analyzed. CKD was defined as an estimated glomerular filtration rate of <60 mL/min per 1.73 m2. Participants were categorized into 3 groups according to self-reported sleep duration: <6 h (short sleepers), 6-8 h, and >8 h (long sleepers). The outcome variables were all-cause mortality and HRQOL. HRQOL was assessed using the European Quality of Life-5 Dimensions (EQ-5D) index.

RESULTS

During a median of 6.4 years, 481 (27%) deaths occurred. In unadjusted Cox regression analysis, long sleepers with CKD had an increased risk of death (hazard ratio [HR], 1.62; 95% confidence interval [CI]: 1.26-2.09). This significant association remained after adjusting for age, sex, and BMI (HR, 1.36; 95% CI: 1.05-1.75); however, it was lost after adjusting for CKD stage, social and lifestyle factors, and presence of comorbidities (HR, 1.15; 95% CI: 0.89-1.49). Compared with 6- to 8-h sleepers with CKD, long sleepers with CKD had significantly worse HRQOL in multivariable linear regression models. The adjusted means of the EQ-5D index were 0.80 (95% CI: 0.77-0.82) for short sleepers, 0.81 (95% CI: 0.80-0.82) for 6- to 8-h sleepers, and 0.76 (95% CI: 0.73-0.79) for long sleepers (p = 0.01).

DISCUSSION/CONCLUSION

Long sleep duration is associated with poor HRQOL in Korean adults with CKD. The weak association between long sleep duration and mortality was attenuated after multivariable adjustment in this study.