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

Chandra L. Jackson; Chizoba Umesi; Symielle A. Gaston; Ali Azarbarzin; Joseph Lunyera; John A. Mcgrath; W. Braxton Jackson; Clarissa J. Diamantidis; Ebony Boulware; Pamela L. Lutsey; Susan Redline

doi:10.1136/thoraxjnl-2020-214713

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

Chandra L. Jackson, Chizoba Umesi, Symielle A. Gaston, Ali Azarbarzin, Joseph Lunyera, John A. Mcgrath, W. Braxton Jackson, Clarissa J. Diamantidis, Ebony Boulware, Pamela L. Lutsey, Susan Redline

Research output: Contribution to journal › Article › peer-review

28 Scopus citations

Abstract

Background 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. Methods 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 m2 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. Results 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. Conclusions 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.

Original language	English (US)
Pages (from-to)	704-713
Number of pages	10
Journal	Thorax
Volume	76
Issue number	7
Early online date	Dec 4 2020
DOIs	https://doi.org/10.1136/thoraxjnl-2020-214713
State	Published - Jul 1 2021

Bibliographical note

Funding Information:
Contributors Study concept: CLJ. Study design: CLJ and SR. Acquisition of data: SR. Statistical analysis: JAM, WBJ and AA. Interpretation of data: CLJ, CU, SAG, AA, JL, JAM, WBJ, EB, PLL and SR. Drafting of the manuscript: CLJ and CU. Critical revision of the manuscript for important intellectual content: CLJ, CU, SAG, AA, JL, JAM, WBJ, EB, PLL and SR. Quality assurance and control: CLJ and SR. Administrative, technical and material support: CLJ and SR. Obtaining funding: CLJ and SR. Study supervision: SR. Final approval: CLJ, CU, SAG, AA, JL, JAM, WBJ, EB, PLL and SR. Funding This work was funded, in part, by the Intramural Program at the National Institutes of Health (NIH), National Institute of Environmental Health Sciences (NIEHS, Z1AES103325-01). Funding support for Chizoba Umesi was provided by NIEHS Medical Student Research Fellowship. MESA is conducted and supported by the National Heart, Lung and Blood Institute (NHLBI) in collaboration with MESA investigators. Support for MESA is provided by contracts HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, N01-HC-95169, UL1-TR-000040, UL1-TR-001079, UL1-TR-001881 and DK06349. Funding support for the Sleep Polysomnography dataset was provided by grant HL56984. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org. SR is partly funded through the National Heart, Lung and Blood Institute (1R35 HL135818-01).

Funding Information:
This work was funded, in part, by the Intramural Program at the National Institutes of Health (NIH), National Institute of Environmental Health Sciences (NIEHS, Z1AES103325-01). Funding support for Chizoba Umesi was provided by NIEHS Medical Student Research Fellowship. MESA is conducted and supported by the National Heart, Lung and Blood Institute (NHLBI) in collaboration with MESA investigators. Support for MESA is provided by contracts HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, N01-HC-95169, UL1-TR-000040, UL1-TR-001079, UL1-TR-001881 and DK06349. Funding support for the Sleep Polysomnography dataset was provided by grant HL56984. A full list of participating MESA investigators and institutions can be found at http://www. mesa-nhlbi. org. SR is partly funded through the National Heart, Lung and Blood Institute (1R35 HL135818-01).

Publisher Copyright:
© 2021 Author(s) (or their employer(s)).

Keywords

oxidative stress
sleep apnoea

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1136/thoraxjnl-2020-214713

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Jackson, C. L., Umesi, C., Gaston, S. A., Azarbarzin, A., Lunyera, J., Mcgrath, J. A., Jackson, W. B., Diamantidis, C. J., Boulware, E., Lutsey, P. L., & Redline, S. (2021). Multiple, objectively measured sleep dimensions including hypoxic burden and chronic kidney disease: Findings from the Multi-Ethnic Study of Atherosclerosis. Thorax, 76(7), 704-713. https://doi.org/10.1136/thoraxjnl-2020-214713

Jackson, CL, Umesi, C, Gaston, SA, Azarbarzin, A, Lunyera, J, Mcgrath, JA, Jackson, WB, Diamantidis, CJ, Boulware, E, Lutsey, PL & Redline, S 2021, 'Multiple, objectively measured sleep dimensions including hypoxic burden and chronic kidney disease: Findings from the Multi-Ethnic Study of Atherosclerosis', Thorax, vol. 76, no. 7, pp. 704-713. https://doi.org/10.1136/thoraxjnl-2020-214713

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

abstract = "Background 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. Methods 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 m2 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. Results 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. Conclusions 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.",

keywords = "oxidative stress, sleep apnoea",

author = "Jackson, {Chandra L.} and Chizoba Umesi and Gaston, {Symielle A.} and Ali Azarbarzin and Joseph Lunyera and Mcgrath, {John A.} and Jackson, {W. Braxton} and Diamantidis, {Clarissa J.} and Ebony Boulware and Lutsey, {Pamela L.} and Susan Redline",

note = "Funding Information: Contributors Study concept: CLJ. Study design: CLJ and SR. Acquisition of data: SR. Statistical analysis: JAM, WBJ and AA. Interpretation of data: CLJ, CU, SAG, AA, JL, JAM, WBJ, EB, PLL and SR. Drafting of the manuscript: CLJ and CU. Critical revision of the manuscript for important intellectual content: CLJ, CU, SAG, AA, JL, JAM, WBJ, EB, PLL and SR. Quality assurance and control: CLJ and SR. Administrative, technical and material support: CLJ and SR. Obtaining funding: CLJ and SR. Study supervision: SR. Final approval: CLJ, CU, SAG, AA, JL, JAM, WBJ, EB, PLL and SR. Funding This work was funded, in part, by the Intramural Program at the National Institutes of Health (NIH), National Institute of Environmental Health Sciences (NIEHS, Z1AES103325-01). Funding support for Chizoba Umesi was provided by NIEHS Medical Student Research Fellowship. MESA is conducted and supported by the National Heart, Lung and Blood Institute (NHLBI) in collaboration with MESA investigators. Support for MESA is provided by contracts HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, N01-HC-95169, UL1-TR-000040, UL1-TR-001079, UL1-TR-001881 and DK06349. Funding support for the Sleep Polysomnography dataset was provided by grant HL56984. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org. SR is partly funded through the National Heart, Lung and Blood Institute (1R35 HL135818-01). Funding Information: This work was funded, in part, by the Intramural Program at the National Institutes of Health (NIH), National Institute of Environmental Health Sciences (NIEHS, Z1AES103325-01). Funding support for Chizoba Umesi was provided by NIEHS Medical Student Research Fellowship. MESA is conducted and supported by the National Heart, Lung and Blood Institute (NHLBI) in collaboration with MESA investigators. Support for MESA is provided by contracts HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, N01-HC-95169, UL1-TR-000040, UL1-TR-001079, UL1-TR-001881 and DK06349. Funding support for the Sleep Polysomnography dataset was provided by grant HL56984. A full list of participating MESA investigators and institutions can be found at http://www. mesa-nhlbi. org. SR is partly funded through the National Heart, Lung and Blood Institute (1R35 HL135818-01). Publisher Copyright: {\textcopyright} 2021 Author(s) (or their employer(s)).",

year = "2021",

month = jul,

day = "1",

doi = "10.1136/thoraxjnl-2020-214713",

language = "English (US)",

volume = "76",

pages = "704--713",

journal = "Thorax",

issn = "0040-6376",

publisher = "BMJ Publishing Group",

number = "7",

}

TY - JOUR

T1 - Multiple, objectively measured sleep dimensions including hypoxic burden and chronic kidney disease

T2 - Findings from the Multi-Ethnic Study of Atherosclerosis

AU - Jackson, Chandra L.

AU - Umesi, Chizoba

AU - Gaston, Symielle A.

AU - Azarbarzin, Ali

AU - Lunyera, Joseph

AU - Mcgrath, John A.

AU - Jackson, W. Braxton

AU - Diamantidis, Clarissa J.

AU - Boulware, Ebony

AU - Lutsey, Pamela L.

AU - Redline, Susan

N1 - Funding Information: Contributors Study concept: CLJ. Study design: CLJ and SR. Acquisition of data: SR. Statistical analysis: JAM, WBJ and AA. Interpretation of data: CLJ, CU, SAG, AA, JL, JAM, WBJ, EB, PLL and SR. Drafting of the manuscript: CLJ and CU. Critical revision of the manuscript for important intellectual content: CLJ, CU, SAG, AA, JL, JAM, WBJ, EB, PLL and SR. Quality assurance and control: CLJ and SR. Administrative, technical and material support: CLJ and SR. Obtaining funding: CLJ and SR. Study supervision: SR. Final approval: CLJ, CU, SAG, AA, JL, JAM, WBJ, EB, PLL and SR. Funding This work was funded, in part, by the Intramural Program at the National Institutes of Health (NIH), National Institute of Environmental Health Sciences (NIEHS, Z1AES103325-01). Funding support for Chizoba Umesi was provided by NIEHS Medical Student Research Fellowship. MESA is conducted and supported by the National Heart, Lung and Blood Institute (NHLBI) in collaboration with MESA investigators. Support for MESA is provided by contracts HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, N01-HC-95169, UL1-TR-000040, UL1-TR-001079, UL1-TR-001881 and DK06349. Funding support for the Sleep Polysomnography dataset was provided by grant HL56984. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org. SR is partly funded through the National Heart, Lung and Blood Institute (1R35 HL135818-01). Funding Information: This work was funded, in part, by the Intramural Program at the National Institutes of Health (NIH), National Institute of Environmental Health Sciences (NIEHS, Z1AES103325-01). Funding support for Chizoba Umesi was provided by NIEHS Medical Student Research Fellowship. MESA is conducted and supported by the National Heart, Lung and Blood Institute (NHLBI) in collaboration with MESA investigators. Support for MESA is provided by contracts HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, N01-HC-95169, UL1-TR-000040, UL1-TR-001079, UL1-TR-001881 and DK06349. Funding support for the Sleep Polysomnography dataset was provided by grant HL56984. A full list of participating MESA investigators and institutions can be found at http://www. mesa-nhlbi. org. SR is partly funded through the National Heart, Lung and Blood Institute (1R35 HL135818-01). Publisher Copyright: © 2021 Author(s) (or their employer(s)).

PY - 2021/7/1

Y1 - 2021/7/1

N2 - Background 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. Methods 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 m2 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. Results 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. Conclusions 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.

AB - Background 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. Methods 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 m2 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. Results 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. Conclusions 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.

KW - oxidative stress

KW - sleep apnoea

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U2 - 10.1136/thoraxjnl-2020-214713

DO - 10.1136/thoraxjnl-2020-214713

M3 - Article

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AN - SCOPUS:85097420033

SN - 0040-6376

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SP - 704

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JO - Thorax

JF - Thorax

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ER -

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

Abstract

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Keywords

UN SDGs

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