Multiple, objectively measured sleep dimensions including hypoxic burden and chronic kidney disease: findings from the Multi-Ethnic Study of Atherosclerosis

dc.contributor.author

Jackson, Chandra L

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Umesi, Chizoba

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Gaston, Symielle A

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Azarbarzin, Ali

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Lunyera, Joseph

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McGrath, John A

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Jackson Ii, W Braxton

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Diamantidis, Clarissa J

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Boulware, Ebony

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Lutsey, Pamela L

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Redline, Susan

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2020-12-09T23:34:37Z

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2020-12-09T23:34:37Z

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2020-12-09T23:34:36Z

dc.description.abstract

<jats:sec><jats:title>Background</jats:title><jats:p>Poor sleep may contribute to chronic kidney disease (CKD) through several pathways, including hypoxia-induced systemic and intraglomerular pressure, inflammation, oxidative stress and endothelial dysfunction. However, few studies have investigated the association between multiple objectively measured sleep dimensions and CKD.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We investigated the cross-sectional association between sleep dimensions and CKD among 1895 Multi-Ethnic Study of Atherosclerosis Sleep Ancillary Study participants who completed in-home polysomnography, wrist actigraphy and a sleep questionnaire. Using Poisson regression models with robust variance, we estimated separate prevalence ratios (PR) and 95% CIs for moderate-to-severe CKD (glomerular filtration rate <60 mL/min/1.73 m<jats:sup>2</jats:sup> or albuminuria >30 mg/g) among participants according to multiple sleep dimensions, including very short (≤5 hours) sleep, Apnoea−Hypopnoea Index and sleep apnoea-specific hypoxic burden (SASHB) (total area under the respiratory event-related desaturation curve divided by total sleep duration, %min/hour)). Regression models were adjusted for sociodemographic characteristics, health behaviours and clinical characteristics.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of the 1895 participants, mean age was 68.2±9.1 years, 54% were women, 37% were white, 28% black, 24% Hispanic/Latino and 11% Asian. Several sleep metrics were associated with higher adjusted PR of moderate-to-severe CKD: very short versus recommended sleep duration (PR=1.40, 95% CI 1.06 to 1.83); SASHB (Box-Cox transformed SASHB: PR=1.06, 95% CI 1.02 to 1.12); and for participants in the highest quintile of SASHB plus sleep apnoea: PR=1.28, 95% CI 1.01 to 1.63.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Sleep apnoea associated hypoxia and very short sleep, likely representing independent biological mechanisms, were associated with a higher moderate-to-severe CKD prevalence, which highlights the potential role for novel interventions.</jats:p></jats:sec>

dc.identifier.issn

0040-6376

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1468-3296

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https://hdl.handle.net/10161/21889

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en

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BMJ

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Thorax

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10.1136/thoraxjnl-2020-214713

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Multiple, objectively measured sleep dimensions including hypoxic burden and chronic kidney disease: findings from the Multi-Ethnic Study of Atherosclerosis

dc.type

Journal article

duke.contributor.orcid

Lunyera, Joseph|0000-0002-9350-320X

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Diamantidis, Clarissa J|0000-0001-8212-6288

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Boulware, Ebony|0000-0002-8650-4212

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Staff

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Medicine, General Internal Medicine

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Duke

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Medicine

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Clinical Science Departments

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School of Medicine

pubs.publication-status

Published online

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