Association of sleep duration with chronic kidney disease and proteinuria in adults: a systematic review and dose-response meta-analysis

Background and objectives Previous studies have found that sleep duration may be associated with chronic kidney disease (CKD) and proteinuria in adults. However, the correlation remains controversial. In this study, we aimed to assess the effects of sleep duration on CKD and proteinuria. Methods PubMed, EMBASE, and Cochrane Library were searched from their inception up to April 5, 2019 for observational study. The outcomes were CKD and/or proteinuria and the exposure was sleep duration assessed by self-reported questionnaire or interview. Studies were included if they provided risk estimates of effects of sleep duration on patients with CKD or proteinuria. The overall effects were measured by odds ratios (OR) and 95% confidence intervals (CI). Heterogeneity was quantified using Q statistics and the I-2 statistics. The potential causes of heterogeneity were investigated using sensitivity analysis. Results Eleven observational studies with 521,242 individuals were included. The adjusted ORs of CKD in individuals who slept <= 6 h/night and >= 8 h/night were 1.13 (95% CI, 1.02-1.25; I-2 = 29%) and 1.14 (95% CI, 1.07-1.22; I-2= 0%), respectively. Meanwhile, the adjusted ORs of proteinuria in those who slept <= 6 h/night and >= 8 h/night were 1.24 (95% CI, 1.06-1.44; I-2 = 61%) and 1.15 (95% CI, 1.04-1.29; I-2 = 0%), respectively. Furthermore, a U-shaped relationship was observed between sleep duration and CKD or proteinuria, with the lowest risk at 7 h/night of sleep. Conclusions Both short and long sleep durations are significantly associated with CKD and proteinuria. Our findings suggest curvilinear dose-response associations of sleep duration with CKD and proteinuria.