Association between Sleep Hours and Incidence of Kidney Failure: Findings from the National Health and Nutrition Examination Survey, 2005-2018

Background: Sleep duration may be associated with chronic kidney disease (CKD) and its progression. However, few studies have examined the association between sleep duration and kidney failure incidence. Methods: We used data from the National Health and Nutrition Examination Surveys (2005–2006 through 2017–2018) linked to the United States Renal Data System to assess the association between self-reported sleep duration and three outcomes: incidence of kidney failure, all-cause death, and the composite of the two. We followed adults aged ≥20 years from the interview date until the date of kidney failure, death, or December 31st, 2018, whichever occurred first. We used multivariable Cox regression models to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) to adjust for demographics, eGFR, log of urine albumin creatinine ratio, diabetes, and hypertension. Results: Among 27,498 adults who met the inclusion criteria, 1,544 (4.4%) reported a sleep duration of <5 hours, 2,497 (7.8%) reported ≥5 to <6 hours, 5,828 (20.7%) reported ≥ 6 to <7 hours, 14,202 (55.4%) reported ≥ 7 to <9 hours and 3,427 (11.6%) reported ≥ 9 hours. The mean age was 47 years; 48% were men and 66.7% were non-Hispanic White, 11.4% were non-Hispanic Black. The median observational period was 6.2 years. Compared to ≥7 to <9 hours of sleep, sleep durations < 5 hours, ≥ 5 to <6 hours and ≥9 hours were associated with higher risk of the composite events (adjusted hazard ratio, 1.67 [95% CI, 1.34-2.08], 1.34 [1.14-1.56], and 1.50 [1.31-1.71], respectively). Similarly, sleep durations < 5 hours and ≥ 9 hours were associated with higher risk of kidney failure (adjusted hazard ratio, 1.44 [95% CI, 0.85-2.42] and 1.64 [0.83-3.21], respectively) although not statistically significant due to low number of events. Conclusion: Both shorter and longer sleep duration may be associated with higher risk of kidney failure and death. Funding: Other U.S. Government Support