Abstract
Study Objectives: Smoking and sleep are modifiable factors associated with the chronic kidney diseases. However, the interaction of smoking and sleep on the renal function are still unclear. Therefore, we aimed to evaluate the interactive impacts of smoking and sleep on the renal function.Methods: Data were obtained from the National Health and Nutrition Examination Survey. The study population were categorized into nine subgroups by smoking (smoking every day, sometimes, and non-smokers recently) and sleep duration (short duration ≤ 6 h, normal duration 6–9 h, and longer duration ≥ 9 h on the weekdays).Results: The study group with a short sleep duration had significantly higher serum cotinine and hydrocotinine levels compared with the other two sleep groups. After adjusting the demographic characteristics (age, race, body mass index, and marital status), sleep quality (snoring or breathing cessation), and comorbidities (diabetes mellitus, hypertension, high cholesterol, anemia, congestive heart failure, coronary heart disease, and stroke), non-smokers with short or long sleep duration had significant lower estimated glomerular filtration rate (eGFR) levels than the study group who smoked every day and slept ≤ 6 h. The effects of sleep duration on eGFR levels varied with smoking status. For the study group smoking every day, eGFR levels increased as sleep duration decreased, whereas for the study group smoking sometimes, eGFR levels increased as sleep duration increased. The U-shaped effects of eGFR levels were observed among non-smokers whose normal sleep duration was associated with better eGFR levels. Normal sleep duration was an important protective factor of the renal function for non-smokers than smokers.Conclusions: The effects of sleep duration on eGFR levels varied with smoking status. Normal sleep duration was a protective factor and more crucial for non-smokers than for smokers.
Highlights
Chronic kidney diseases (CKDs) represent a heavy burden on the healthcare system because of the increasing number of patients, high risk of progression to end-stage renal disease, and poor prognosis with respect to morbidity and mortality [1]
The CKD-EPI equation is expressed as a single equation as follows: GFR = 141 × min (SCr/κ, 1)α × max (SCr/κ, 1)−1.209 × 0.993 age × 1.018 [if female] × 1.159 [if black], where SCr is the standardized serum creatinine in mg/dl, κ is 0.7 for women and 0.9 for men, a is −0.329 for women and −0.411 for men, min indicates the minimum of SCr/κ or 1, and max indicates the maximum of SCr/κ or 1 [15]. estimated glomerular filtration rate (eGFR) values are presented in ml/min/1.73 m2
We found that the serum blood urea nitrogen and creatinine were higher and that eGFR levels were lower in the group of noSmoking than in the group of edSmoking and stSmoking after adjusting for age, race, body mass index (BMI), marital status, and comorbidities (DM, hypertension, high cholesterol level, congestive heart failure, coronary heart disease, angina/angina pectoris, heart attack, stroke, emphysema, chronic bronchitis, and anemia)
Summary
Chronic kidney diseases (CKDs) represent a heavy burden on the healthcare system because of the increasing number of patients, high risk of progression to end-stage renal disease, and poor prognosis with respect to morbidity and mortality [1]. Sleep and smoking are two main modifiable factors of CKDs [2]. Sleep plays an important role in every aspect of physiology. A populationbased study showed that 22.3% of men and 28.9% of women aged ≥ 16 years told their doctors that they had trouble sleeping [3]. Short sleep and long sleep duration [4] as well as poor objective sleep quality have been shown to be associated with the lower estimated glomerular filtration rate (eGFR) and CKD development [5,6,7]
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