Sleep quality, autonomic dysfunction and renal function in diabetic patients with pre-CKD phase

Area of Science:

• Nephrology
• Sleep Medicine
• Cardiology

Background:

• Diabetes is a major risk factor for chronic kidney disease (CKD).
• Sleep apnea, poor sleep quality (PSQ), and autonomic imbalance are potential renal function decline risk factors.
• The integrated predictive value of these sleep and autonomic factors in non-CKD patients, particularly those with diabetes, remains unexamined.

Purpose of the Study:

• To investigate the combined predictive value of sleep apnea, PSQ, and heart rate variability (HRV) on renal function decline.
• To assess these factors in both diabetic and non-diabetic individuals without pre-existing CKD.

Main Methods:

• A cohort of 754 patients without CKD (231 diabetic, 523 non-diabetic) from the Hyogo Sleep Cardio-Autonomic Atherosclerosis (HSCAA) study.
• Assessment of respiratory event index, objective sleep quality via actigraphy, and HRV.
• Renal outcome defined as estimated glomerular filtration rate <60 ml/min/1.73 m² for >3 months.

Main Results:

• Diabetic patients with PSQ or low HRV showed a significantly increased risk for renal outcome; sleep apnea alone did not.
• PSQ was a significant independent predictor of renal outcome in diabetic patients (HR: 2.57; 95% CI: 1.01-6.53, p=0.045).
• PSQ also independently predicted renal outcome in non-diabetic patients; sleep apnea and low HRV did not.

Conclusions:

• Poor sleep quality is a significant independent predictor of renal function decline in both diabetic and non-diabetic individuals without CKD.
• Low heart rate variability may also contribute to renal decline risk in diabetic patients.
• Sleep quality and autonomic function are crucial factors for maintaining renal health, especially in diabetic populations.