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

Assessing the Relationship Between Sleep Duration and the Prevalence of Chronic Kidney Disease Among Veterans in the United States: A 2022 Behavior Risk Factor Surveillance System (BRFSS) Cross-Sectional Study

INTRODUCTION

Chronic kidney disease (CKD) is more prevalent among veterans in the United States than in the general population. Similarly, veterans also exhibit higher rates of abnormal sleep duration compared to the general population. The aim of this study was to investigate the association between self-reported length of sleep and the prevalence of CKD among veterans in the United States using responses from the 2022 Behavioral Risk Factor Surveillance System (BRFSS).

METHODS

For this cross-sectional study, a total of 53,211 veterans who responded to the 2022 BRFSS survey were analyzed. Measures include the outcome variable which is self-reported CKD diagnosis and a major independent variable sleep duration. Sleep duration was recategorized into ≤ 5 hours (short sleep duration), 6-10 hours (normal sleep duration), and >10 hours (long sleep duration). Covariates included gender, age, race, residence, insurance, alcohol consumption, diabetes comorbidity, coronary artery disease (CAD) comorbidity, and stroke comorbidity. Descriptive, bivariate, and multivariate logistic regressions were conducted using the SAS software (SAS Institute Inc., Cary, North Carolina, United States).  Results: The prevalence of CKD among veterans in the United States is 3332 (6.29%). Veterans with sleep duration of 6-10 hours had 17.5% lower odds of CKD than veterans who slept for ≤5 hours (adjusted OR (AOR)= 0.825, 95%CI= 0.821-0.830; P=<0.0001). Veterans who slept for more than 10 hours had 68.2% higher odds of having CKD (AOR=1.682, 95%CI= 1.662-1.702; P=<0.0001). Additionally, veterans diagnosed with diabetes, stroke, and coronary artery disease had 2.447-2.103, and 2.838, respectively, higher odds of developing CKD (AOR=2.447, 95%CI= 2.435-2.459; p=<0.0001). Veterans who were 65 years and older had higher odds of developing CKD compared to those aged 35-44 years (AOR= 5.743, 95%CI= 5.669-5.818; P<0.001). The odds of having CKD were also higher among veterans who identified as Black (AOR 1.397, 95%CI =1.388-1.405; P<0.01) or as Hispanic (AOR =1.318, 95%CI = 1.307-1.329; P<0.01) compared to non-Hispanic White veterans. Those who identified as Asian had lower odds of CKD (AOR= 0.87, 95%CI=0.853-0.888; P<0.01). Furthermore, veterans who consumed alcohol had 7.8% lower odds of having CKD as compared to individuals who did not consume alcohol (AOR= 0.922, 95%CI =0.918-0.927; p=<0.0001). Male veterans had 24.7% lower odds of having CKD as compared to female veterans (AOR = 0.753, 95%CI= 0.747-0.758; P<0.001).  Conclusion: This research provides evidence of a greater prevalence of CKD among veterans with short sleep duration (≤ 5 hours) and long sleep duration (> 10 hours). Sleep hygiene education and sleep optimization programs can improve sleep and boost overall kidney health among veterans.

Association of cardiovascular health metrics with all-cause and cardiovascular disease mortality in chronic kidney disease: A cohort study

BACKGROUND AND AIMS

Since the global burden of chronic kidney disease (CKD) is rising rapidly, the study aimed to assess the association of cardiovascular health (CVH) metrics with all-cause and cardiovascular disease (CVD) mortality among individuals with CKD.

METHODS AND RESULTS

The cohort study included 5834 participants with CKD from the National Health and Nutrition Examination Survey 1999-2018. A composite CVH score was calculated based on smoking status, physical activity, body mass index, blood pressure, total cholesterol, diet quality, and glucose control. Primary outcomes were all-cause and CVD mortality as of December 31, 2019. Multivariable-adjusted Cox proportional hazards models were used to estimate the association between CVH metrics and deaths in CKD patients. During a median follow-up of 7.2 years, 2178 all-cause deaths and 779 CVD deaths were documented. Compared to participants with ideal CVH, individuals with intermediate CVH exhibited a 46.0% increase in all-cause mortality (hazard ratio, 1.46; 95% confidence interval: 1.17, 1.83), while those with poor CVH demonstrated a 101.0% increase (2.01; 1.54, 2.62). For CVD mortality, individuals with intermediate CVH experienced a 56.0% increase (1.56; 1.02, 2.39), and those with poor CVH demonstrated a 143.0% increase (2.43; 1.51, 3.91). Linear trends were noted for the associations of CVH with both all-cause mortality (P for trend <0.001) and CVD mortality (P for trend = 0.02).

CONCLUSIONS

Lower CVH levels were associated with higher all-cause and CVD mortality in individuals with CKD, which highlights the importance of maintaining good CVH in CKD patients.

Short sleep duration is associated with worse quality of life in Parkinson's disease: A multicenter cross-sectional study

OBJECTIVE

To characterize sleep duration and investigate its association with quality of life among Parkinson's Disease (PD) patients.

METHODS

In this multicenter cross-sectional study, 970 PD patients were divided into five groups based on self-reported sleep duration: <5, ≥5 to <6, ≥6 to <7, ≥7 to ≤8, and >8 h. The quality of life was evaluated using the 39-Item Parkinson's Disease Questionnaire (PDQ-39). Multivariable linear regression analysis, subgroup analysis, and mediation analysis were conducted to examine the association between sleep duration and quality of life.

RESULTS

In multivariable linear regression model, patients with sleep duration (<5 h) had significantly higher PDQ-39 scores (β = 8.132, 95 % CI: 3.99 to 12.266), especially in mobility, activities of daily living, emotional well-being, stigma, social support, cognition, communication, and bodily discomfort (p < 0.05). The association between sleep duration (<5 h) and worse quality of life was more pronounced in patients with higher HY stage, longer disease duration, and sleep disorders. Moreover, a significant indirect effect of sleep duration (<5 h) on quality of life was observed, with UPDRS I, UPDRS II, and UPDRS IV scores acting as mediators.

CONCLUSIONS

Short sleep duration (<5 h) is associated with worse quality of life among PD patients. This association was stronger among patients with advanced PD and sleep disorders, while non-motor symptoms and motor complications were identified as significant mediators in this association. These findings highlight the significance of adequate sleep duration and suitable interventions for sleep may help improve quality of life.

Sleep duration and mortality in patients with chronic noncommunicable disease: a population-based cohort study

BACKGROUND

Inadequate sleep behaviors may confer a higher risk of premature death, however, evidence in patients with chronic noncommunicable disease (NCD) is scarce. To investigate the relationship between sleep duration and mortality from all-cause and heart diseases in NCD patients from a prospective cohort.

METHODS

Totally, 14,171 participants with at least one NCD, including 8275 with hypertension, 7547 with high cholesterol, 4065 with diabetes, and 5815 with chronic renal failure were enrolled from the National Health and Nutrition Examination Survey during 2005-2014. Cox proportional hazard models were performed to estimate the hazard ratio (HR) for sleep duration and mortality after adjusting for potential confounding factors.

RESULTS

After a median follow-up of 9 years, 2514 all-cause deaths were identified. Compared with sleeping 7-8 h/day, sleeping over 8 h/day was significantly associated with a higher risk of all-cause mortality, where the multivariable-HRs were 1.29 (1.11, 1.50) for hypertension, 1.23 (1.01, 1.51) for high cholesterol, 1.44 (1.13, 1.82) for diabetes, and 1.36 (1.10, 1.68) for chronic renal failure. Similar patterns were observed for heart disease mortality. A nonlinear association was detected between sleep duration and mortality in patients with NCD. Age modified the association in patients with hypertension (P-interaction: 0.036). Trouble sleeping modified the association in patients with diabetes (P-interaction: 0.042).

CONCLUSIONS

Long sleep duration was associated with higher risks of all-cause and heart disease mortality in patients with chronic NCD. Our findings highlight that improving sleep behaviors may decrease the risk of premature deaths and help to NCD tertiary prevention.

Correlation of plasma metabolites and comorbid illnesses with poor sleep quality in patients with coronary heart disease

PURPOSE

This study aimed to examine the relationship between plasma metabolites (biochemical parameters) and comorbid illnesses with sleep quality in individuals with coronary heart disease (CHD).

METHODS

This descriptive cross-sectional study was conducted between 2020 and 2021 at a university hospital. Hospitalized patients with a diagnosis of CHD were analyzed. The Personal Information Form' and Pittsburgh Sleep Quality Index (PSQI) were used to collect data. Laboratory findings including plasma metabolites were examined.

RESULTS

Of 60 hospitalized patients with CHD, 50 (83%) had poor sleep quality. A positive and statistically significant correlation was found between the plasma metabolite blood urea nitrogen and poor sleep quality (r = 0.399; p = 0.002). The presence of CHD and additional chronic diseases (especially diabetes mellitus, hypertension, and chronic kidney disease) are important parameters associated with the risk of poor sleep quality (p = 0.040 < 0.05).

CONCLUSION

Increases in blood urea nitrogen level in individuals with CHD are associated with worse sleep quality. Additional chronic diseases coexisting with CHD correlate with increased risk of poor sleep quality.

Sleep duration and cognitive function among older adults with chronic kidney disease: results from the National Health and Nutrition Examination Survey (2011-2014)

BACKGROUND

Short and long sleep durations are associated with cognitive dysfunction. Given the increased prevalence of sleep abnormalities in the chronic kidney disease (CKD) population, we tested whether the association between sleep duration and cognitive function differed between older adults with and without CKD.

METHODS

This was a study of 3215 older adults (age ≥60 years) enrolled in the National Health and Nutrition Examination Survey (2011-14) evaluating sleep duration, cognitive function (immediate recall, delayed recall, verbal fluency, executive function and processing speed and global cognition) and kidney function. We quantified the association between sleep duration and cognitive function using linear regression and tested whether the associations differed among those with CKD and without using a Wald test for interaction.

RESULTS

Among 3215 participants, 13.3% reported 2-5 hours of sleep/day, 75.2% reported 6-8 hours, and 11.5% reported ≥9 hours. Persons with CKD were more likely to sleep ≥9 hours [odds ratio 1.73 (95% confidence interval 1.22-2.46)]. Among participants with CKD, those with a sleep duration ≥9 hours demonstrated worse global cognitive function (P for interaction = .01), immediate recall (P for interaction = .01) and verbal fluency (P for interaction = .004) than those with a sleep duration of 6-8 h; no differences were observed for participants with CKD who slept 2-5 hours. Among participants without CKD, sleep was not associated with any measures of cognitive function.

CONCLUSIONS

Longer sleep duration is associated with worse cognitive function only among persons with CKD, and global cognition, delayed recall and verbal fluency are particularly affected. Studies should identify interventions to improve sleep patterns and quality in this 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.

The association between night eating syndrome and health-related quality of life in Korean adults: a nationwide study

PURPOSE

Quality of life may be influenced by the presence of eating disorders. This study investigated the association between night eating syndrome (NES) and health-related quality of life in the general population.

METHODS

Data were from the 2019 Korea Community Health Survey. The presence of NES was determined using the Night Eating Questionnaire. Health-related quality of life was measured using the 3-level EuroQoL-5 Dimension Index. Multivariable linear regression analyses assessed the association between NES and health-related quality of life. Subgroup analyses were performed based on daily sleep duration.

RESULTS

A total of 34,434 individuals aged 19 years or older were included in the study population. Participants with NES (β = - 4.85, p < 0.001) reported poorer health-related quality of life scores than those without NES. Decreases in health-related quality of life scores among those with NES were greatest in those who slept over 8 h daily (β = - 12.03, p = 0.004), followed by those who slept less than 6 h (β = - 5.90, p = 0.006) and participants who slept between 6 and 8 h (β = - 3.40, p = 0.026) daily.

CONCLUSION

Individuals with NES were more likely to have a lower health-related quality of life than those without NES. These findings highlight the potential importance of considering NES in investigating the health-related quality of life.

LEVEL OF EVIDENCE

Level III, well-designed case-control analytic studies.

Relationship of sleep duration and sleep quality with health-related quality of life in patients on hemodialysis in Neyshabur

Background

As a public health priority, health-related quality of life (HRQoL) is associated with some factors like sleep disorders. Taking this into consideration, this study aimed at investigating the relationship between sleep duration and sleep quality with HRQoL in patients on hemodialysis.

Methods

This cross-sectional study was carried out among 176 patients on hemodialysis who were admitted to the dialysis ward of 22 Bahman hospital and a private renal clinic in Neyshabur (a city in North-East of Iran) in 2021. Sleep duration and quality were measured using an Iranian version of Pittsburgh Sleep Quality Index (PSQI) and HRQoL was evaluated with the Iranian version of a 12-Item Short Form Survey (SF-12). To analyze the data and examine the independent association of sleep duration and quality with HRQoL, multiple linear regression model was performed.

Results

The mean age of the participants was 51.6 ± 16.4 and 63.6% were male. Moreover, 55.1% and 5.7% of subjects reported a sleep duration shorter than 7 h and equal to or more than 9 h, respectively, and the value prevalence of poor sleep quality was reported as 78.2%. Furthermore, the reported overall score of HRQoL was 57.6 ± 17.9. According to the adjusted models, poor sleep quality was negatively associated with the total HRQoL score (B = -14.5, P < 0.001). Shedding light on sleep duration and Physical Component Summary (PCS), the result indicated that insufficient sleep duration (<7 h) had a borderline negative association with PCS (B = -5.96, p = 0.049).

Conclusions

Sleep duration and quality have important effects on HRQoL in patients on hemodialysis. Therefore, in line with improving sleep quality and HRQoL among these patients, essential interventions should be planned and performed.

Effect of exercise interventions for sleep quality in patients with chronic kidney disease: a systematic review and meta-analysis

INTRODUCTION

Sleep disorder is a common and unpleasant symptom in patients with chronic kidney disease (CKD), bringing a heavy burden on the patients and families. As a non-pharmacological therapy, exercise interventions are widely recommended for CKD patients. However, whether exercise can improve overall sleep quality in such a population remains ambiguous. The systematic review and meta-analysis aimed to evaluate the effect of exercise interventions on sleep quality in CKD patients.

METHODS

PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched from inception to April 22, 2022. A randomized controlled trial (RCT) added an exercise intervention to conventional treatment/usual care to assess the effect on sleep quality in CKD patients. Two authors independently selected literature, extracted data, assessed the risk of bias using the Cochrane risk of bias tool 2, and assessed the certainty of the evidence using the Grading of Recommendations, Assessment, Development, and Evaluation. The outcome was analyzed using a random-effect model using the Hartung-Knapp-Sidik-Jonkman method as a standardized mean difference (SMD). Additional statistical analysis includes the Egger regression test, subgroup analysis, sensitivity analysis, and meta-regression.

RESULTS

Nineteen articles (20 RCTs) enrolling 989 patients with CKD were included. The pooled SMD suggested favorably associated exercise interventions (SMD - 0.16; 95% CI - 0.62 to 0.31; very low evidence) with substantial heterogeneity (I² = 87%). Subgroup analyses demonstrated that SMD for sleep quality favored moderate intensity and aerobic exercise, no matter the time, but not statistically significant. Meta-regression showed that the effect size of exercise interventions on sleep quality was not associated with the total sample size, the proportion of males, duration of intervention, mean age, and exercise volume but was associated with baseline sleep scores. In addition, there may be an exercise threshold for the effect of exercise on sleep in CKD patients (i.e., 80 min/week).

CONCLUSION

This systematic review and meta-analysis suggest that exercise interventions may be associated with improved sleep quality in patients with CKD. However, high heterogeneity and a small effect size limit this result. More studies and standardized reporting of exercise intervention characteristics should be conducted in the future to strengthen the most convincing evidence in this field.

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.

Prevalence and related factors of poor sleep quality in patients with pre-dialysis chronic kidney disease

BACKGROUND

Sleep disturbances in patients with chronic kidney disease (CKD) are related to decreased quality of life and increased health-related risks. There is insufficient data about actual prevalence and related factors of poor sleepers in this group. In this study, we aimed to investigate prevalence and related risk factors of self-reported poor sleep quality in patients with pre-dialysis CKD.

METHODS

In this cross-sectional study, 259 pre-dialysis CKD patients (median age 56 years; range, 19-85) were included. Demographical, clinical and laboratory correlates were recorded. Body mass index (BMI) was calculated. Estimated glomerular filtration rate (eGFR) was calculated by the Modification of Diet in Renal Disease (MDRD) formula. Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI), a self-rated questionnaire. Depression was evaluated using the Beck Depression Inventory (BDI).

RESULTS

Median eGFR was 27.6 ml/min/1.73 m² (range, 9-56). Of the 259 patients, 110 (42.5%) were poor sleepers with global PSQI score >5. The univariate correlation analysis revealed that global PSQI score was positively correlated with age, BMI, waist circumferences (WC), hip circumferences (HC), serum phosphorus and triglyceride levels, systolic blood pressure (BP), pulse pressure and BDI score, and negatively correlated with male gender and hemoglobin level. Logistic regression analysis, showed that HC, systolic BP, and BDI scores were independently associated with poor sleep quality (p = 0.001, p = 0.020 and p < 0.001, respectively).

CONCLUSION

Prevalence of poor sleep quality in our pre-dialysis CKD patients was 42.5%. Systolic BP, depression and HC, all of these are potentially correctable factors, were associated with poor sleep quality independently.

Sleeping, Smoking, and Kidney Diseases: Evidence From the NHANES 2017-2018

Study Objectives: Smoking and sleep are modifiable factors associated with the chronic kidney diseases. However, the interaction of smoking and sleep on the renal function are still unclear. Therefore, we aimed to evaluate the interactive impacts of smoking and sleep on the renal function. Methods: Data were obtained from the National Health and Nutrition Examination Survey. The study population were categorized into nine subgroups by smoking (smoking every day, sometimes, and non-smokers recently) and sleep duration (short duration ≤ 6 h, normal duration 6-9 h, and longer duration ≥ 9 h on the weekdays). Results: The study group with a short sleep duration had significantly higher serum cotinine and hydrocotinine levels compared with the other two sleep groups. After adjusting the demographic characteristics (age, race, body mass index, and marital status), sleep quality (snoring or breathing cessation), and comorbidities (diabetes mellitus, hypertension, high cholesterol, anemia, congestive heart failure, coronary heart disease, and stroke), non-smokers with short or long sleep duration had significant lower estimated glomerular filtration rate (eGFR) levels than the study group who smoked every day and slept ≤ 6 h. The effects of sleep duration on eGFR levels varied with smoking status. For the study group smoking every day, eGFR levels increased as sleep duration decreased, whereas for the study group smoking sometimes, eGFR levels increased as sleep duration increased. The U-shaped effects of eGFR levels were observed among non-smokers whose normal sleep duration was associated with better eGFR levels. Normal sleep duration was an important protective factor of the renal function for non-smokers than smokers. Conclusions: The effects of sleep duration on eGFR levels varied with smoking status. Normal sleep duration was a protective factor and more crucial for non-smokers than for smokers.