Sleep Disturbance as a Nontraditional Risk Factor in CKD

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/或质量以及主要慢性病的患病率和/或严重程度，包括 糖尿病和心血管疾病。睡眠障碍，特别是睡眠呼吸障碍(SDB) 和周期性腿部运动(PLM)，在慢性肾脏疾病(CKD)患者中比 在普通人群中。因为参与控制肾功能的激素明显 在睡眠的调节下，睡眠障碍可能会对肾脏功能产生不利影响。这个 因此，本提案试图探讨睡眠时间和/或质量下降作为一种风险所起的作用 慢性肾功能不全进展和心血管疾病发展的因素 CKD。这项研究有两个最重要的假设：1.睡眠质量将是进步的预测因素 睡眠质量将是CKD患者心血管疾病的预测因子。这个项目将是一个 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将包括评估习惯在家睡眠的持续时间和质量(通过手腕和腿部 活动监测、日志和问卷)来预测肾脏和心血管测量的变化 在审评委科目中的学习时间。特定目标2将检查多导睡眠图变量的变化， 包括SDB和PLM的测量，以预测研究期间肾脏和心血管测量的变化 审评委受试者中的句号。具体目标3将描绘激素控制身体之间的关系 轻、中度CKD患者与正常对照的体液平衡、心血管功能和睡眠 对照以确定可能的病理生理机制。总的来说，拟议的研究将确定 睡眠质量差会加速CKD和心血管疾病的发展或加重其严重程度 CKD中的疾病和改善睡眠质量的IF策略可能对CKD有有益的影响。

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.