Self-Reported Sleep Duration, Death-Censored Graft Failure and Health-Related Quality of Life Among Kidney Transplant Recipients: Results From the KNOW-KT Study

Abstract

Aim Sleep duration is associated with cardiovascular events, mortality and rapidly declining kidney function in the general population. Less is known about its impact on transplant outcomes and health-related quality of life (HRQOL) among kidney transplant recipients (KTRs).Methods This prospective multicenter longitudinal cohort study included 986 incident KTRs and investigated self-reported sleep duration at the time of kidney transplantation. Analyses were performed to examine associations between sleep duration and biopsy-proven acute rejection, death-censored graft failure, major cardiovascular events, all-cause mortality and HRQOL.Results During a median follow-up period of 8 years, the death-censored graft failure rate was significantly higher among patients with sleep durations of <= 5 h (adjusted hazard ratio [aHR], 3.69; 95% confidence interval [CI], 1.42-9.57; p = 0.007), 6 h (aHR, 3.25; 95% CI, 1.34-7.87; p = 0.009), 8 h (aHR, 2.93; 95% CI, 1.22-7.01; p = 0.016) and >= 9 h (aHR, 3.58; 95% CI, 1.29-9.93; p = 0.014), compared to patients with a 7-h sleep duration. Sleep duration was not significantly associated with biopsy-proven acute rejection, major cardiovascular events or all-cause mortality. Multivariable linear regression demonstrated that shorter sleep duration (<= 5 h) was associated with lower HRQOL, indicated by decreases in the physical component summary score (beta, -4.51; 95% CI, -8.75 to -0.26; p = 0.038) and mental component summary score (beta, -5.47; 95% CI, -10.29 to -0.65; p = 0.026), relative to patients with a 7-h sleep duration.Conclusion Compared to a 7-h sleep duration, both shorter and longer sleep durations were associated with a significantly higher risk of death-censored graft failure among incident KTRs. Additionally, short sleep duration was significantly correlated with impaired HRQOL.