Growing evidence suggests an association between both short and long duration of habitual sleep and adverse health outcomes. In order to determine whether the population longitudinal evidence supports the presence of a relationship between Chronic Kidney Disease (CKD) and cardiovascular disease (CVD)-mortality, and how sleep duration plays a role in mortality outcomes.
This is a population-based cohort study of National Health and Nutrition Examination Surveys participants between 2005 and 2010 with mortality data obtained through 2015. Adults aged 20 years or older with sleep duration information were categorized into excessive (≥ 8 hours) versus normal. CKD was determined using the Cockcroft-Gault equation and considered positive at GFR<60 mL/min. Outcomes of CVD-mortality were evaluated using Cox regression.
The percentage of deaths from low sleep duration among the population (N=15,586) were higher among individuals without High School (HS) Diploma (12.8%) versus at least some college education (5.7%). The mean follow-up was 7.7 years. For CVD-mortality, the overall unadjusted hazard ratio (HR) of individuals with CKD to no CKD was 1.54 (95% confidence interval [CI], 1.11-2.14, p = 0.01). Adjusted HR was elevated, 1.59 (CI 1.01-2.52, p = .04), among those with excessive sleep duration but closer to 1.0 (0.62 CI 0.25-1.51, p < 0.25) among individuals with normal sleep duration, after controlling for medical (obesity, diabetes, and C-reactive protein) and demographic risk factors (age, gender, poverty-income-ratio, education, and ethnicity).
Our study shows an unambiguous and consistent pattern of increased risk of dying from cardiovascular disease among individuals with CKD. However, this relationship is especially pronounced among individuals who have excessive sleep duration, making it an important determinant of health. Screening for sleep disorders is especially important in the consideration of other chronic diseases like cardiorenal syndrome.
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