Prevalence ratios (and 95% CIs) of moderate-to-severe chronic kidney disease (CKD)* for participants with poor sleep characteristics compared with their counterparts with non-poor sleep characteristics, MESA sleep ancillary study (N=1895)
| Moderate-to-severe CKD | |||
| n=380 (20%)†† | |||
| N with exposure | N events among exposed | Prevalence ratio (95% CI) | |
| Short (<7 hours) versus recommended sleep (actigraphy measured)‡ | 1175 | 231 | 0.99 (0.81 to 1.20) |
| Very short (≤5 hours) versus recommended sleep (actigraphy-measured) | 239 | 678 | 1.40 (1.06 to 1.83) |
| Low Sleep Maintenance Efficiency (<85%)§ | 103 | 22 | 0.89 (0.58 to 1.35) |
| Sleep fragmentation (>15%)¶ | 1419 | 292 | 1.05 (0.84 to 1.32) |
| Insomnia** | 681 | 137 | 1.02 (0.85 to 1.23) |
| Obstructive sleep apnoea (OSA)†† | 897 | 206 | 1.20 (1.00 to 1.44) |
| Sleep apnoea-specific hypoxic burden: % min/hour‡‡ (quintile 1 (0.02–16.24] is reference) | 378 | 59 | – |
| Quintile 2 (16.25–29.29) | 378 | 65 | 0.99 (0.72 to 1.36) |
| Quintile 3 (29.30–47.74) | 377 | 79 | 1.20 (0.88 to 1.63) |
| Quintile 4 (47.75–84.395) | 378 | 84 | 1.24 (0.92 to 1.69) |
| Quintile 5 (84.3951–1099.61) | 377 | 92 | 1.36 (1.00 to 1.86) |
| Box-Cox normalised SASHB | – | – | 1.06 (1.02 to 1.12) |
| Sleep apnoea plus highest quintile SASHB | 370 | 89 | 1.28 (1.01 to 1.63) |
| Short sleep plus insomnia§§ | 428 | 85 | 0.98 (0.75 to 1.28) |
| Short sleep plus poor sleep maintenance efficiency¶¶ | 90 | 22 | 1.01 (0.65 to 1.56) |
| Sleep apnoea and fragmentation*** | 724 | 169 | 1.26 (0.92 to 1.72) |
| ‘Suboptimal’ sleep††† | 1624 | 329 | 1.14 (0.85 to 1.53) |
| Daytime sleepiness (Exam 4): often/almost always versus never/rarely/sometimes | 321 | 63 | 1.06 (0.83 to 1.36) |
Bold value estimates denote statistical significance.
*Moderate-to-severe CKD is defined as GFR <60 mL/ min/1.73 m2 or albuminuria ≥30 mg/g of creatinine.
†N with moderate-to-severe CKD and actigraphy data=370 (19.9% of 1862).
‡Average time spent asleep during main sleep periods (sum of all time asleep across recording divided by the total main sleep periods).
§Average sleep maintenance efficiency in main sleeps (percentage of time spent asleep between falling asleep (sleep onset) and waking up (sleep offset)).
¶Sum of per cent mobile epochs and per cent immobile bouts less than 1 min duration to the number of immobile bouts for the given interval. Also known as the index of restlessness or movement and fragmentation index.
**Insomnia based on self-reported questionnaire using a Women’s Health Initiative Insomnia Rating (WHIR) Scale score of ≥9 (range: 0–20).
††OSA/resp. sleep disturbance was measured using the Apnoea-Hypopnoea Index (AHI) ≥3% (ie, the number of all apnoeas and hypopnoeas with ≥3% oxygen desaturations per hour of sleep); OSA was defined as an AHI ≥15 events per hour.
‡‡Hypoxic burden calculated as the area under the oxygen saturation curve associated with each individual respiratory (airflow) disruption (individual apnoeas and hypopnoeas). These individual burden measures are summed and divided by total sleep time.
§§Short sleep <7 hours and insomnia symptoms based on WHIR of ≥9 (range: 0–20).
¶¶Short sleep <7 hours and sleep efficiency <85%.
***AHI ≥15 and fragmentation <15%.
†††‘Suboptimal’ sleep is coded positive if any of the following exists: short sleep (<7 hours), long sleep (>9 hours), low sleep maintenance efficiency (<85%) and insomnia symptoms.
GFR, glomerular filtration rate; MESA, Multi-Ethnic Study of Atherosclerosis.