Association between sleep duration and urinary albumin excretion in patients with type 2 diabetes: the Fukuoka diabetes registry.

OBJECTIVE: Few studies have so far investigated the impact of sleep duration on chronic kidney disease in diabetic patients. The objective of the present study was to examine the relationship between sleep duration and albuminuria in type 2 diabetic patients. RESEARCH DESIGN AND METHODS: A total of 4,870 Japanese type 2 diabetic patients ≥20 years of age were divided into six groups according to self-reported sleep duration: less than 4.5 hours, 4.5-5.4 hours, 5.5-6.4 hours, 6.5-7.4 hours, 7.5-8.4 hours and more than 8.5 hours. The association between sleep duration and urinary albumin-creatinine ratio (UACR) was examined cross-sectionally. RESULTS: Both short and long sleep durations were significantly associated with higher UACR levels and higher proportions of patients with albuminuria (≥30 mg/g) and macroalbuminuria (≥300 mg/g) compared with a sleep duration of 6.5-7.4 hours (P for quadratic trend <0.001). A U-shaped association between sleep duration and UACR remained significant even after adjustment for potential confounders, including age, sex, duration of diabetes, current smoking habits, former smoking habits, current drinking habits, regular exercise habits, total energy intake, total protein intake, hypnotic use and estimated glomerular filtration rate. Furthermore, the association remained substantially unchanged after additional adjustment for body mass index, hemoglobin A1c, systolic blood pressure, renin-angiotensin system inhibitor use and depressive symptoms. CONCLUSIONS: Our findings suggest that sleep duration has a U-shaped association with the UACR levels in type 2 diabetic patients, independent of potential confounders

The percentile plot of the urinary albumin-creatinine ratio (UACR) levels according to sleep duration in Japanese type 2 diabetic patients.

<p>The bottom and top of the box are the 25th and 75th percentile, respectively, and the band in the box is the median. *p<0.05, **p<0.01 vs. sleep duration of 6.5–7.4 hours per day.</p

Clinical characteristics of the study subjects according to sleep duration.

<p>The values are expressed as the mean ± SD or the percentage.</p><p>Abbreviations: BMI, body mass index; HbA_1c, hemoglobin A_1c; OHA, oral hypoglycemic agent; RAS, renin-angiotensin system; eGFR, estimated glomerular filtration rate.</p><p>Obesity was defined as BMI ≥30 kg/m². Hypertension was defined as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg or the current use of antihypertensive agents.</p

Adjusted partial regression coefficients (95% CIs) of log-transformed UACR according to sleep duration.

<p>The numbers in parentheses represent the 95% CIs.</p><p>Abbreviations: UACR, urinary albumin-creatinine ratio; BMI, body mass index; HbA_1c, hemoglobin A_1c; SBP, systolic blood pressure; RASI, renin-angiotensin system inhibitor.</p><p>Multivariate adjustment was made for age, sex, duration of diabetes, current smoking habits, former smoking habits, current drinking habits, regular exercise habits, total energy intake, total protein intake, hypnotic use and estimated glomerular filtration rate.</p