Can Poor Sleep Cause Kidney Disease? Another Step Closer to the Answer.

Journal of Clinical Sleep Medicine, Vol. 15, No. 3 March 15, 2019 Inflammatory mediators and sympathetic overtone contribute to the development of cardiovascular and renovascular disorders.1,2 Obstructive sleep apnea, circadian rhythm disorders, hypersomnia, and insomnia have been linked to a multitude of metabolic disturbances. A growing body of evidence suggests that sleep disturbances affect the development of kidney disease, possibly as a result of the inflammatory milieu and sympathetic activation occurring at the renal vascular bed that damage the glomerular basement membrane and the kidney tubular apparatus.3–6 Most current evidence linking kidney disease and sleep disorders has originated from small epidemiological studies. A previous study by Choi et al. linked longer sleep duration to the development of chronic kidney disease (CKD) in Korean women but findings were not replicated in men.7 Yamamoto et al. found a U-shaped relationship between sleep duration and progression of CKD to end stage renal disease (ESRD), with individuals sleeping less than 5 hours and over 8 hours at greatest risk for disease progression. This study also revealed that poor sleep quality was associated with the incidence of ESRD.8 A meta-analysis suggested an association between short sleep duration and proteinuria, a surrogate marker of kidney disease progression.9 Renal hyperfiltration, a marker of early renal damage, has been linked to short (less than 6 hours) and long (more than 10 hours) sleep duration.10,11 A study by Bo et al. in this issue of the Journal of Clinical Sleep Medicine adds to the existing body of evidence linking poor sleep quality and the development of CKD.12 This appears to be the largest epidemiological study of its kind. The development of kidney disease was analyzed in almost 200,000 patients (after excluding preexisting CKD or proteinuria as well as metabolic risk factors such as hypertension, diabetes, cardiovascular disease and cancer). Short sleep and long sleep duration as well as poor sleep quality were associated with the incident development of CKD. CKD was defined using the modification of diet in renal disease (MDRD) study equation. Despite some limitations outlined below, the study has important global health implications and once again emphasizes the importance of good quality and quantity of sleep to overall health. Another important observation is the link of insomnia and/or the use of sedative agents with the development of CKD. The study population was Asian and mostly well-educated and non-smoking. It is unknown whether the findings of the study carry equally across other populations. Most previous COMMENTARY