TY - JOUR
T1 - Evaluation of Allostatic Load as a Mediator of Sleep and Kidney Outcomes in Black Americans
AU - Lunyera, Joseph
AU - Davenport, Clemontina A.
AU - Jackson, Chandra L.
AU - Johnson, Dayna A.
AU - Bhavsar, Nrupen A.
AU - Sims, Mario
AU - Scialla, Julia J.
AU - Stanifer, John W.
AU - Pendergast, Jane
AU - McMullan, Ciaran J.
AU - Ricardo, Ana C.
AU - Boulware, L. Ebony
AU - Diamantidis, Clarissa J.
N1 - Funding Information:
The Jackson Heart Study is supported and conducted in collaboration with Jackson State University ( HHSN268201300049C and HHSN268201300050C ), Tougaloo College ( HHSN268201300048C ), and the University of Mississippi Medical Center ( HHSN268201300046C and HHSN268201300047C ) contracts from the National Heart, Lung, and Blood Institute and the National Institute for Minority Health and Health Disparities. This work, in part, was funded by the Intramural Program at the National Institutes of Health , National Institute of Environmental Health Sciences ( Z1AES103325-01 ). The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute, the National Institutes of Health, or the US Department of Health and Human Services.
Funding Information:
The Jackson Heart Study is supported and conducted in collaboration with Jackson State University (HHSN268201300049C and HHSN268201300050C), Tougaloo College (HHSN268201300048C), and the University of Mississippi Medical Center (HHSN268201300046C and HHSN268201300047C) contracts from the National Heart, Lung, and Blood Institute and the National Institute for Minority Health and Health Disparities. This work, in part, was funded by the Intramural Program at the National Institutes of Health, National Institute of Environmental Health Sciences (Z1AES103325-01). The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute, the National Institutes of Health, or the US Department of Health and Human Services.
Publisher Copyright:
© 2018 International Society of Nephrology
PY - 2019/3
Y1 - 2019/3
N2 - Introduction: Poor sleep associates with adverse chronic kidney disease (CKD) outcomes yet the biological mechanisms underlying this relation remain unclear. One proposed mechanism is via allostatic load, a cumulative biologic measure of stress. Methods: Using data from 5177 Jackson Heart Study participants with sleep measures available, we examined the association of self-reported sleep duration: very short, short, recommended, and long (≤5, 6, 7–8, or ≥9 hours per 24 hours, respectively) and sleep quality (high, moderate, low) with prevalent baseline CKD, and estimated glomerular filtration rate (eGFR) decline and incident CKD at follow-up. CKD was defined as eGFR <60 ml/min per 1.73 m 2 or urine albumin-to-creatinine ratio ≥30 mg/g. Models were adjusted for demographics, comorbidities, and kidney function. We further evaluated allostatic load (quantified at baseline using 11 biomarkers from neuroendocrine, metabolic, autonomic, and immune domains) as a mediator of these relations using a process analysis approach. Results: Participants with very short sleep duration (vs. 7–8 hours) had greater odds of prevalent CKD (odds ratio [OR] 1.31, 95% confidence interval [CI] 1.03–1.66). Very short, short, or long sleep duration (vs. 7–8 hours) was not associated with kidney outcomes over a median follow-up of 8 years. Low sleep quality (vs. high) associated with greater odds of prevalent CKD (OR 1.26, 95% CI 1.00–1.60) and 0.18 ml/min per 1.73 m 2 (95% CI 0.00–0.36) faster eGFR decline per year. Allostatic load did not mediate the associations of sleep duration or sleep quality with kidney outcomes. Conclusions: Very short sleep duration and low sleep quality were associated with adverse kidney outcomes in this all-black cohort, but allostatic load did not appear to mediate these associations.
AB - Introduction: Poor sleep associates with adverse chronic kidney disease (CKD) outcomes yet the biological mechanisms underlying this relation remain unclear. One proposed mechanism is via allostatic load, a cumulative biologic measure of stress. Methods: Using data from 5177 Jackson Heart Study participants with sleep measures available, we examined the association of self-reported sleep duration: very short, short, recommended, and long (≤5, 6, 7–8, or ≥9 hours per 24 hours, respectively) and sleep quality (high, moderate, low) with prevalent baseline CKD, and estimated glomerular filtration rate (eGFR) decline and incident CKD at follow-up. CKD was defined as eGFR <60 ml/min per 1.73 m 2 or urine albumin-to-creatinine ratio ≥30 mg/g. Models were adjusted for demographics, comorbidities, and kidney function. We further evaluated allostatic load (quantified at baseline using 11 biomarkers from neuroendocrine, metabolic, autonomic, and immune domains) as a mediator of these relations using a process analysis approach. Results: Participants with very short sleep duration (vs. 7–8 hours) had greater odds of prevalent CKD (odds ratio [OR] 1.31, 95% confidence interval [CI] 1.03–1.66). Very short, short, or long sleep duration (vs. 7–8 hours) was not associated with kidney outcomes over a median follow-up of 8 years. Low sleep quality (vs. high) associated with greater odds of prevalent CKD (OR 1.26, 95% CI 1.00–1.60) and 0.18 ml/min per 1.73 m 2 (95% CI 0.00–0.36) faster eGFR decline per year. Allostatic load did not mediate the associations of sleep duration or sleep quality with kidney outcomes. Conclusions: Very short sleep duration and low sleep quality were associated with adverse kidney outcomes in this all-black cohort, but allostatic load did not appear to mediate these associations.
KW - African Americans
KW - kidney diseases
KW - sleep
KW - sleep deprivation
UR - http://www.scopus.com/inward/record.url?scp=85061981083&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85061981083&partnerID=8YFLogxK
U2 - 10.1016/j.ekir.2018.12.005
DO - 10.1016/j.ekir.2018.12.005
M3 - Article
C2 - 30899870
AN - SCOPUS:85061981083
SN - 2468-0249
VL - 4
SP - 425
EP - 433
JO - Kidney International Reports
JF - Kidney International Reports
IS - 3
ER -