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J Am Soc Nephrol. 2017 Dec;28(12):3708-3715. doi: 10.1681/ASN.2016121288. Epub 2017 Sep 14.

The Association of Sleep Duration and Quality with CKD Progression.

Author information

Department of Medicine, University of Illinois at Chicago, Chicago, Illinois;
Department of Medicine, University of Chicago, Chicago, Illinois.
Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
Department of Medicine, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland.
Department of Epidemiology, Tulane University, New Orleans, Louisiana.
Division of Nephrology, Stanford University School of Medicine, Palo Alto, California.
Department of Medicine, University of Michigan, Ann Arbor, Michigan.
Department of Medicine, MetroHealth Medical Campus of Case Western Reserve University, Cleveland, Ohio.
Department of Medicine, University of Maryland, Baltimore, Maryland; and.
Department of Medicine, Case Western University, University Hospitals Case Medical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.


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.


Epidemiology and outcomes; chronic kidney disease; mortality risk

[Available on 2018-12-01]
[Indexed for MEDLINE]

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