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Study Objectives Obstructive sleep apnea (OSA), sleep fragmentation and short sleep duration (SD) have been associated with chronic kidney disease (CKD). However, these potential mechanisms for CKD have not been compared in the same cohort. This study investigated the independent and combined impact of OSA and insomnia with short sleep duration on the risk of CKD progression in a sleep clinic population. Methods In a cross-sectional study design, adults with suspected OSA completed an overnight sleep study and a questionnaire that included the Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI). They also provided blood and urine samples for measurement of the glomerular filtration rate and urine albumin:creatinine ratio, from which the risk of CKD progression was determined. Results Participants (n=732, 41% female, 55±13y) were categorized into four groups: no/mild OSA without insomnia (NM-OSA, n=203), insomnia with SD without OSA (Insomnia-SD, n=104), moderate-to-severe OSA without insomnia (MS-OSA, n=242), and comorbid insomnia and OSA with SD (COMISA-SD, n=183). After stratification, 12.8% of NM-OSA, 15.4% of Insomnia-SD, 28.9% of MS-OSA and 31.7% of the COMISA-SD participants had an increased risk of CKD progression. Compared to NM-OSA, the odds ratio (OR) for an increased risk of CKD progression was not increased in Insomnia-SD (OR 0.95, CI:0.45-1.99) and was increased to the same degree in MS-OSA (OR 2.79, CI:1.60-4.85) and COMISA-SD (OR 3.04, CI:1.69-5.47). However, the ORs were similar between the MS-OSA and COMISA-SD groups across all statistical models (p≥0.883). Conclusion In a sleep clinic population, insomnia with short sleep duration does not increase the risk of CKD progression; nor does it further increase the risk of CKD progression associated with moderate-to-severe OSA.

Association of insomnia and short sleep duration, alone or with comorbid obstructive sleep apnea, and the risk of chronic kidney disease