Association of insomnia and short sleep duration, alone or with comorbid obstructive sleep apnea, and the risk of chronic kidney disease.

STUDY OBJECTIVES: Obstructive sleep apnea (OSA), sleep fragmentation, and short sleep duration (SD) have been associated with chronic kidney disease (CKD). However, these potential mechanisms for CKD have not been compared in the same cohort. This study investigated the independent and combined impact of OSA and insomnia with short sleep duration on the risk of CKD progression in a sleep clinic population. METHODS: In a cross-sectional study design, adults with suspected OSA completed an overnight sleep study and a questionnaire that included the Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI). They also provided blood and urine samples for measurement of the glomerular filtration rate and urine albumin:creatinine ratio, from which the risk of CKD progression was determined. RESULTS: Participants (n = 732, 41% female, 55 ± 13 years) were categorized into four groups: no/mild OSA without insomnia (NM-OSA, n = 203), insomnia with SD without OSA (Insomnia-SD, n = 104), moderate-to-severe OSA without insomnia (MS-OSA, n = 242), and comorbid insomnia and OSA with SD (COMISA-SD, n = 183). After stratification, 12.8% of NM-OSA, 15.4% of Insomnia-SD, 28.9% of MS-OSA, and 31.7% of the COMISA-SD participants had an increased risk of CKD progression. Compared to NM-OSA, the odds ratio (OR) for an increased risk of CKD progression was not increased in Insomnia-SD (OR 0.95, confidence interval [CI]: 0.45-1.99) and was increased to the same degree in MS-OSA (OR 2.79, CI: 1.60-4.85) and COMISA-SD (OR 3.04, CI: 1.69-5.47). However, the ORs were similar between the MS-OSA and COMISA-SD groups across all statistical models (p ≥ .883). CONCLUSIONS: In a sleep clinic population, insomnia with short sleep duration does not increase the risk of CKD progression; nor does it further increase the risk of CKD progression associated with moderate-to-severe OSA.

Body Weight Status and Sleep Disturbances During Pregnancy: Does Adherence to Gestational Weight Gain Guidelines Matter?

BACKGROUND: To determine the effect of preconception body mass index (BMI) and/or gestational weight gain (GWG) on the occurrence of sleep disorders over the whole pregnancy. METHODS: A sample of 2,366 pregnant women, recruited in their 1st trimester (TM), was evaluated until delivery for their sleeping characteristics, using the Pittsburgh Sleep Quality Index (PSQI). Mixed or multinomial logistic modeling was applied, as appropriate. RESULTS: When compared with TM 1, PSQI score was the lowest at TM 2 (ß = -1.03; 95% CI: -1.17 to -0.89) and highest in TM 3 (ß = 0.27; 95% CI: 0.10-0.45). Obese (ß = 0.48; 95% CI: 0.17-0.78) and overweight women (ß = 0.24; 95% CI: 0.00-0.48) exhibited an overall greater PSQI than normal-weight women over the whole pregnancy. When sociodemographic factors were accounted for, the effect size was reduced by 25% among obese women (ß = 0.36; 95% CI: 0.06-0.68), but was no more not significant in overweight women (ß = 0.06; 95% CI: -0.17 to 0.30). Both obese and overweight women still exhibited, although at a lower extend, a greater PSQI than normal-weight women. Further adjustment for GWG had no effect on these observations. Obese women almost had a four-fold increased risk (OR = 3.89; 95% CI: 2.50-6.06) of being snorers in the three TMs. While GWG had only a minor effect (aOR = 3.83; 95% CI: 2.43-6.03), sociodemographic factors increased the odds of being habitual snorer (aOR = 4.04; 95% CI: 2.57-6.35). CONCLUSIONS: High prepregnancy BMI together with sociodemographic correlates appear as the most critical for sleep disturbances across pregnancy. GWG is of marginal importance, especially regarding snoring. These findings confirm the importance of considering the initial body weight status of women in tailoring sleep hygiene advises irrespective of the recommendations for weight gain during pregnancy. The results also underscore the need to providing as early as possible during a pregnancy, supportive tools to ethnic minorities, multiparous, and women from deprived socioeconomic neighborhoods.