Sleep Disturbance as a Nontraditional Risk Factor in CKD

描述(由申请人提供)： 流行病学和实验室研究都有越来越多的证据表明，睡眠时间和/或质量与包括糖尿病和心血管疾病在内的重大慢性病的患病率和/或严重性之间存在关联。睡眠障碍，特别是睡眠呼吸紊乱(SDB)和周期性腿部运动(PLM)，在慢性肾脏疾病(CKD)患者中比普通人群更常见。由于参与控制肾功能的激素明显受到睡眠的调节，因此睡眠障碍可能会对肾功能产生不利影响。因此，本提案旨在探讨睡眠时间和/或质量减少作为慢性肾功能不全进展和慢性肾脏病心血管疾病发展的危险因素的作用。这项研究有两个重要的假设：1.睡眠质量将是CKD进展的预测因子，2.睡眠质量将是CKD心血管疾病的预测因子。该项目将是正在进行的纵向队列研究慢性肾功能不全研究(CRIC)的辅助研究。具体目标1将涉及(通过手腕和腿部活动监测、日志和问卷)评估习惯的在家睡眠时间和质量，以预测CRIC受试者在研究期间肾脏和心血管指标的变化。具体目标2将检查多导睡眠监测变量的变化，包括SDB和PLM的测量，以预测CRIC受试者在研究期间肾脏和心血管测量的变化。具体目标3将描述控制体液平衡、心血管功能和睡眠的激素与轻、中度CKD患者与正常对照组之间的关系，以确定可能的病理生理机制。总体而言，拟议的研究将确定睡眠质量差是否会加速CKD的发展或增加CKD和心血管疾病的严重程度，以及改善睡眠质量的策略是否会对CKD产生有益影响。

DESCRIPTION (provided by applicant): There is increasing evidence from both epidemiologic and laboratory studies for an association between sleep duration and/or quality and the prevalence and/or severity of major chronic diseases, including diabetes and cardiovascular disease. Sleep disturbances, particularly sleep disordered breathing (SDB) and periodic leg movements (PLM), are more prevalent in patients with chronic kidney disease (CKD) than in the general population. Because the hormones involved in the control of kidney function are markedly modulated by sleep, it is possible that sleep disturbances have an adverse effect on kidney function. The present proposal therefore seeks to explore the role of decreased sleep duration and/or quality as a risk factor for the progression of chronic renal insufficiency and the development of cardiovascular disease in CKD. This study has two over-arching hypotheses: 1. Sleep quality will be a predictor of the progression of CKD, and 2. Sleep quality will be a predictor of cardiovascular disease in CKD. This project will be an ancillary study to an ongoing longitudinal cohort study, the Chronic Renal Insufficiency Study (CRIC). Specific Aim 1 will involve assessment of habitual at-home sleep duration and quality (by wrist and leg activity monitoring, logs and questionnaires) to predict changes in renal and cardiovascular measures over study period in CRIC subjects. Specific Aim 2 will examine changes in polysomnographic variables, including measures of SDB and PLM, to predict changes in renal and cardiovascular measures over study period in CRIC subjects. Specific Aim 3 will delineate the relationship between hormones controlling body fluid balance, cardiovascular function and sleep in mild to moderate CKD patients as compared to normal controls to identify possible pathophysiological mechanisms. Overall, the proposed studies will determine if poor sleep quality accelerates the development or increases the severity of CKD and of cardiovascular disease in CKD and if strategies to improve sleep quality may have beneficial effects on CKD.