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Habitual sleep and kidney function in chronic kidney disease: the Chronic Renal Insufficiency Cohort study
Author(s) -
Knutson Kristen L.,
Lash James,
Ricardo Ana C.,
Herdegen James,
Thornton J. D.,
Rahman Mahboob,
Turek Nicolas,
Cohan Janet,
Appel Lawrence J.,
Bazzano Lydia A.,
Kurella Tamura Manjula,
Steigerwalt Susan P.,
Weir Matthew R.,
Van Cauter Eve
Publication year - 2018
Publication title -
journal of sleep research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.297
H-Index - 117
eISSN - 1365-2869
pISSN - 0962-1105
DOI - 10.1111/jsr.12573
Subject(s) - renal function , medicine , kidney disease , cohort , creatinine , actigraphy , cohort study , endocrinology , urology , circadian rhythm
Summary Physiological evidence suggests that sleep modulates kidney function. Our objective was to examine the cross‐sectional association between kidney function and objectively‐estimated habitual sleep duration, quality and timing in a cohort of patients with mild to moderate chronic kidney disease. This study involved two US clinical centers of the Chronic Renal Insufficiency Cohort ( CRIC ) study, including 432 participants in a CRIC ancillary sleep study. Habitual sleep duration, quality and timing were measured using wrist actigraphy for 5–7 days. Validated sleep questionnaires assessed subjective sleep quality, daytime sleepiness and risk of sleep apnea. Kidney function was assessed with the estimated glomerular filtration rate using the Chronic Kidney Disease Epidemiology Collaboration equation, and the urinary protein to creatinine ratio. Lower estimated glomerular filtration rate was associated with shorter sleep duration (−1.1 mL min −1 1.73 m −2 per hour less sleep, P = 0.03), greater sleep fragmentation (−2.6 mL min −1 1.73 m −2 per 10% higher fragmentation, P < 0.001) and later timing of sleep (−0.9 mL min −1 1.73 m −2 per hour later, P = 0.05). Higher protein to creatinine ratio was also associated with greater sleep fragmentation (approximately 28% higher per 10% higher fragmentation, P < 0.001). Subjective sleep quality, sleepiness and persistent snoring were not associated with estimated glomerular filtration rate or protein to creatinine ratio. Thus, worse objective sleep quality was associated with lower estimated glomerular filtration rate and higher protein to creatinine ratio. Shorter sleep duration and later sleep timing were also associated with lower estimated glomerular filtration rate. Physicians treating patients with chronic kidney disease should consider inquiring about sleep and possibly sending for clinical sleep assessment. Longitudinal and interventional trials are needed to understand causal direction.