Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
Department of Genetic Epidemiology, University Regensburg, Regensburg, Germany.
Sleep Med. 2019 Feb;54:205-212. doi: 10.1016/j.sleep.2018.10.034. Epub 2018 Nov 25.
Diabetes-associated Kidney Disease (DKD) is a common comorbidity in patients with type 2 diabetes. The present study investigates whether daytime sleeping duration in patients, ill with type 2 diabetes, is associated with DKD.
A total of 733 outpatients of the cross-sectional baseline survey of the DIACORE study were analyzed with respect to their self-reported daytime sleeping duration, assessed by a standardized questionnaire. DKD was defined as eGFR <60 ml/min/1.73 m and/or urinary albumin-to-creatinine-ratio (UACR) > 30 mg/g.
Mean daytime sleeping duration was 17 ± 27 min. With increasing daytime sleeping duration a statistically significant decrease in eGFR (p = 0.002) and increase in UACR (p < 0.001) were found, respectively. Prevalence of DKD was significantly higher in patients with longer daytime sleeping duration (31% in patients not napping, 40% in patients napping less than 30 min, 47% in patients napping 30-60 min, 56% in patients napping 60 min or more; p = 0.001). After accounting for known modulators (Age, sex, BMI, waist-hip-ratio, systolic and diastolic blood pressure, physical activity, diabetes duration, HbA1c, homeostasis model assessment (HOMA-Index), nighttime sleeping duration, apnea-hypopnea-index (AHI), Epworth Sleepiness Scale (ESS)), longer daytime sleeping duration was significantly associated with impaired eGFR [B (95% CI) = -0.05 (-0.09; 0.00), p = 0.044] and increased UACR [B (95% CI) = 0.01 (0.01; 0.02), p < 0.001], respectively.
Increased daytime sleeping duration is significantly associated with reduced eGFR and higher UACR, independent of known modulators of DKD. The direction of this relationship remains unclear.
糖尿病相关肾脏疾病（DKD）是 2 型糖尿病患者的常见合并症。本研究旨在探讨 2 型糖尿病患者日间睡眠时间与 DKD 的关系。
本研究共纳入了 DIACORE 研究横断面基线调查的 733 例门诊患者，通过标准化问卷评估其日间睡眠时间。DKD 的定义为 eGFR <60 ml/min/1.73 m 和/或尿白蛋白与肌酐比值（UACR）>30 mg/g。
平均日间睡眠时间为 17±27 分钟。随着日间睡眠时间的增加，eGFR 呈显著下降趋势（p=0.002），UACR 呈显著上升趋势（p<0.001）。睡眠时间较长的患者 DKD 患病率显著升高（无午睡患者为 31%，午睡时间少于 30 分钟的患者为 40%，午睡时间 30-60 分钟的患者为 47%，午睡时间 60 分钟或以上的患者为 56%；p=0.001）。在校正已知调节因素（年龄、性别、BMI、腰臀比、收缩压和舒张压、体力活动、糖尿病病程、HbA1c、稳态模型评估（HOMA-Index）、夜间睡眠时间、呼吸暂停低通气指数（AHI）、Epworth 嗜睡量表（ESS））后，较长的日间睡眠时间与 eGFR 受损显著相关[B（95%CI）=-0.05（-0.09；0.00），p=0.044]和 UACR 升高显著相关[B（95%CI）=0.01（0.01；0.02），p<0.001]。
日间睡眠时间的增加与 eGFR 降低和 UACR 升高显著相关，独立于 DKD 的已知调节因素。这种关系的方向尚不清楚。
