Sleep, cardiovascular risk factors, and kidney function: The Multi-Ethnic Study of Atherosclerosis (MESA)

Published:October 07, 2022DOI:



      Examine the associations of sleep measures with kidney function changes over time among individuals from a community-based study.


      The sample includes 1657 participants (287 with chronic kidney disease [CKD]) in the Multi-Ethnic Study of Atherosclerosis Sleep Cohort (mean age: 57.7 years, male: 46.0%). We examined associations between a large set of sleep variables (polysomnography, actigraphy, and questionnaires) and cardiovascular disease risk factors and changes in estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio over approximately 5 years using high-dimensional regression. We investigated the modifying effect of sleep on the associations between cardiovascular disease risk factors and kidney function.


      Sleep metrics predicted kidney function decline only among individuals with baseline CKD. Among this group, eGFR decline was associated with decreased stage N3 sleep (0.32 mL/min/1.73 m2/y per 10% decrease in N3, p < .001); increased actigraphy napping frequency (beta: -0.20 [-0.30, -0.07]); and actigraphy sleep midpoint trajectory in early morning (ref: midnight, beta: -0.84 [-1.19, -0.50]). Urinary albumin-to-creatinine ratio increase was associated with high wake bouts trajectory (ref: low, beta: 0.97 [0.28, 1.67]) and increased sleep-related hypoxemia (oxygen saturation %time<90 [≥5%], beta: 2.17 [1.26, 3.08]). Sleep metrics--N3 sleep, naps, and midpoint trajectory--significantly modified associations between hemoglobin A1C and eGFR decline.


      Reduced deep sleep, daytime napping, increased wake bouts, delayed sleep rhythms, and overnight hypoxemia are associated with longitudinal kidney function decline, with effects most apparent in individuals with CKD. Deep sleep, napping, and sleep timing modified the association between hemoglobin A1C and kidney function.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Sleep Health: Journal of the National Sleep Foundation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Jha V
        • Garcia-Garcia G
        • Iseki K
        • et al.
        Chronic kidney disease: global dimension and perspectives.
        Lancet. 2013; 382: 260-272
        • Franke FJ
        • Arzt M
        • Kroner T
        • et al.
        Daytime napping and diabetes-associated kidney disease.
        Sleep Med. 2019; 54: 205-212
        • Petrov ME
        • Kim Y
        • Lauderdale DS
        • et al.
        Objective sleep, a novel risk factor for alterations in kidney function: the CARDIA study.
        Sleep Med. 2014; 15: 1140-1146
        • Guo X
        • Yu S
        • Li Z
        • et al.
        Self-reported sleep duration is associated with reduced glomerular filtration rate among adults with hypertension: a population based study from rural northeast China.
        J Sleep Res. 2015; 24: 351e8
        • Nigam G
        • Camacho M
        • Chang E
        • et al.
        Exploring sleep disorders in patients with chronic kidney disease.
        Nat Sci Sleep. 2018; 10: 35-43
        • Ohkuma T
        • Fujii H
        • Iwase M
        • et al.
        Association between sleep duration and urinary albumin excretion in patients with type 2 diabetes: the Fukuoka diabetes registry.
        PLoS One. 2013; 8e78968
        • Jackson CL
        • Umesi C
        • Gaston SA
        • et al.
        Multiple, objectively-measured sleep dimensions including hypoxic burden and chronic kidney disease: finding from the Muti-Ethic Study of Atherosclerosis.
        Thorax. 2021; 76: 704-713
        • Full KM
        • Jackson CL
        • Rebholz CM
        • et al.
        Obstructive sleep apnea, other sleep characteristics, and risk of CKD in the atherosclerosis risk in Communities Sleep Heart Health Study.
        Clin J Am Soc Nephrol. 2020; 31: 1859-1869
      1. Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States. Available at:

        • Huang Z
        • Tang X
        • Zhang T
        • et al.
        Prevalence of sleep apnoea in non-dialysis chronic kidney disease patients: a systematic review and meta-analysis.
        NEPHROLOGY. 2019; 24: 1041-1049
        • Artom M
        • Moss-Morris R
        • Caskey F
        • et al.
        Fatigue in advanced kidney disease.
        Kidney Int. 2014; 86: 497-505
        • Zelnick LR
        • Weiss NS
        • Kestenbaum BR
        • et al.
        Diabetes and CKD in United States population.
        Clin J Am Soc Nephrol. 2017; 12 (2009-2014): 1984-1990
        • Xia J
        • Wang L
        • Ma ZH
        • et al.
        Cigarette smoking and chronic kidney disease in the general population: a systematic review and meta-analysis of prospective cohort studies.
        Nephrol Dial Transplant. 2017; 32: 475-487
        • Shi WR
        • Zhou YP
        • Wang HY
        • et al.
        Synergistic interaction of hypertension and hyperhomocysteinemia on chronic kidney disease: findings from the National Health and Nutrition Examination Survey 1999-2006.
        J Clin Hypertens. 2019; 21: 1567-1577
        • Chen J
        • Patel S
        • Redline S
        • et al.
        Weekly sleep trajectories and their association with obesity and hypertension in the Hispanic/Latino population.
        SLEEP. 2018;
        • Khalil M
        • Power N
        • Gramham E
        • et al.
        The associations between sleep and diabetes outcomes – a systematic review.
        Diabetes Res Clin Pract. 2020;
        • Meinshausen N
        • Bauhlmann P.
        High-dimensional graphs and variable selection with the Lasso.
        Ann Stat. 2006; 34: 1436-1462
        • van der Geer S
        • Buhlmann P
        • Ritov Y.
        On asymptoticaly optimal confidence regions and tests for high-dimensional models.
        Ann Stat. 2014; 42: 166-1202
        • Bild DE
        • Bluemke DA
        • Burke GL
        • et al.
        Multi-ethnic study of atherosclerosis: objectives and design.
        Am J Epidemiol. 2002; 156: 871-881
        • Chen X
        • Wang R
        • Zee P
        • et al.
        Racial/ethnic differences in sleep disturbances: the Multi-Ethnic Study of Atherosclerosis (MESA).
        SLEEP. 2015; 38: 877-888
        • Ricardo AC
        • Knutson K
        • Chen J
        • et al.
        The association of sleep duration and quality with CKD progression.
        J Am Soc Nephrol. 2017; 28: 3708-3715
        • Blazek K.
        • Zwieten A
        • Saglimbene V
        • et al.
        A practical guide to multiple imputation of missing data in nephrology.
        Kidney Int. 2021; 99: 68-74
        • Fan J
        • Li Q
        • Wang Y
        Estimation of high-dimensional mean regression in the absence of symmetry and light tail assymptions.
        J R Stat Soc B. 2016; 79: 247-265
        • Friedman J
        • Hastie T
        • Tibshirani R.
        Regularization paths for generalized linear models via coordinate descent.
        J Stat Softw. 2010; 33: 1-22
        • Javaheri S
        • Redline S.
        Sleep, slow-wave sleep and blood pressure.
        Curr Hypertens Rep. 2012; 214: 442-448
        • Johns EJ
        • Kopp UC
        • DiBona GF.
        Neural control of renal function. 2011; 1: 731-767
        • Ro MN
        • Blackwell T
        • Redline S
        • et al.
        Association between sleep architecture and measures of body composition.
        SLEEP. 2009; 32: 483-490
        • Matsumoto T
        • Tabara Y
        • Murase K
        • et al.
        Association between sleep disturbance and nocturnal blood pressure profiles by a linear mixed model analysis: the Nagahama study.
        Sleep Med. 2019; 61 (104): 109
        • Silvani A.
        Sleep disorders, nocturnal blood pressure, and cardiovascular risk: a translational perspective.
        Auton Neurosci. 2019; 218: 31-42
        • Sturrock NDC
        • George E
        • Pound N
        • et al.
        Non-dipping circadian blood pressure and renal impairment are associated with increased mortality in diabetes mellitus.
        Diabet Med. 2000; 17: 360-364
        • Kado H
        • Kusaba T
        • Matoba S
        • et al.
        Normotensive non-dipping blood pressure does not predict the risk of chronic kidney disease progression.
        Hypertens Res. 2019; 42: 354-361
        • Wang C
        • Li Y
        • Zhang J
        • et al.
        Prognostic effect of isolated nocturnal hypertension in Chinese patients with nondialysis chronic kidney disease.
        J Am Heart Assoc. 2016;
        • Wang CS
        • Bangdiwala SI
        • Rangarajan S
        • et al.
        Association of estimated sleep duration and naps with mortality and cardiovascular events: a study of 116 632 people from 21 countries.
        Eur Heart J. 2019; 40: 1620-1629
        • Anderson N
        • Giri A
        • Wei G
        • et al.
        Sedentary behavior in individuals with diabetic chronic kidney disease and maintenance hemodialysis.
        J Ren Nutr. 2015; 25: 364-370
        • Adams RJ
        • Appleton SL
        • Vakulin A
        • et al.
        Chronic kidney disease and sleep apnea association of kidney disease with obstructive apnea in a population study of men.
        SLEEP. 2017; 40: 1-9
        • Canales MT
        • Hagen EW
        • Barnet JH
        • et al.
        Sleep apnea and kidney function trajectory: results from a 20-year longitudinal study of healthy middle-aged adults.
        SLEEP. 2018;
        • Fineburg D
        • Jandeleit-Dahm KAM
        • Cooper ME.
        Diabetic nephropathy: diagnosis and treatment.
        Nat Rev Endocrinol. 2013; 9: 713-723
        • Tamura A
        • Kawano Y
        • Watanabe T
        • et al.
        Obstructive sleep apnea increases hemoglobin A1c levels regardless of glucose tolerance status.
        Sleep Med. 2012; 13: 1050-1055
        • Zhang XB
        • Jiang XT
        • Cai FR
        • et al.
        Vascular endothelial growth factor levels in patients with obstructive sleep apnea: a meta-analysis.
        Eur Arch Otorhinolaryngol. 2017; 274: 661-670
        • Gilmour H
        • Stranges S
        • Kaplan M
        • et al.
        Longitudinal trajectories of sleep duration in the general population.
        Health Rep. 2013; 24: 14-20