Sleep debt and prevalence of proteinuria in subjects with short sleep duration on weekdays: a cross-sectional study

  • Katsunori Aoki
  • Ryohei YamamotoEmail author
  • Maki Shinzawa
  • Yoshiki Kimura
  • Hiroyoshi Adachi
  • Yoshiyuki Fujii
  • Ryohei Tomi
  • Kaori Nakanishi
  • Manabu Taneike
  • Makoto Nishida
  • Takashi Kudo
  • Keiko Yamauchi-Takihara
  • Yoshitaka Isaka
  • Toshiki Moriyama
Original article


Study objective

Short sleep duration is a risk factor of chronic kidney disease, along with cardiovascular diseases and all-cause mortality. Several studies reported that many people sleep longer on weekends than on weekdays, suggesting that they should be compensated for their sleep debt on weekdays on the weekends. Few studies have reported the clinical impact of sleep debt on the kidney.


This cross-sectional study included 5799 employees of Osaka University who visited its Health Care Center for their annual health examinations and answered ≤ 6 h of sleep duration on weekdays. The independent variable was the sleep debt index defined as a gap in self-reported sleep duration (≤ 5, 5–6, 6–7, 7–8, 8–9, and ≥ 9 h) between weekdays and weekends, which was categorized into ≤ 0, + 1, + 2, + 3 and ≥+4. An association between the sleep debt index and a prevalence of proteinuria defined as dipstick proteinuria of ≥ 1 + was assessed using logistic regression models adjusting for clinically relevant factors.


More than four-fifths of the subjects had a positive sleep debt index (≤ 0, + 1, + 2, + 3, and ≥+4 recorded for 19%, 36%, 28%, 11%, and 6%, respectively). The multivariable-adjusted logistic regression models showed the sleep debt index ≥ 3 + was significantly associated with the prevalence of proteinuria (sleep debt index ≤ 0, adjusted odds ratio 1.13 [0.77, 1.65]; + 1, 1.00 [reference]; + 2, 1.29 [0.93, 1.79]; + 3, 1.54 [1.02, 2.33]; ≥ + 4, 1.87 [1.15, 3.05]).


Sleep debt was associated with the prevalence of proteinuria in a dose-dependent manner.


Sleep deprivation Sleep debt Sleep duration Proteinuria Health checkup 



We thank all the staff members of Health and Counseling Center, Osaka University for their contributions to the database of the present cohort.

Compliance with ethical standards

Conflict of interest

All the authors have declared no competing interest.

Ethical approval

The study protocol was approved by the ethics committees of Osaka University Health and Counseling Center (No. 2016-1) and Osaka University Hospital (No. 17009-2).

Informed consent

Informed consent was not obtained from participants, according to Japanese Ethical Guidelines for Medical and Health Research Involving Human Subjects.


  1. 1.
    Wu Y, Zhai L, Zhang D. Sleep duration and obesity among adults: a meta-analysis of prospective studies. Sleep Med. 2014;15:1456–62.PubMedCrossRefGoogle Scholar
  2. 2.
    Itani O, Jike M, Watanabe N, Kaneita Y. Short sleep duration and health outcomes: a systematic review, meta-analysis, and meta-regression. Sleep Med. 2017;32:246–56.PubMedCrossRefGoogle Scholar
  3. 3.
    Wang Y, Mei H, Jiang Y-R, Sun W-Q, Song Y-J, Liu S-J, et al. Relationship between duration of sleep and hypertension in adults: a meta-analysis. J Clin Sleep Med. 2015;11:1047–56.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Shan Z, Ma H, Xie M, Yan P, Guo Y, Bao W, et al. Sleep duration and risk of type 2 diabetes: a meta-analysis of prospective studies. Diabetes Care. 2015;38:529–37.PubMedCrossRefGoogle Scholar
  5. 5.
    Cappuccio FP, D’Elia L, Strazzullo P, Miller MA. Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Sleep. 2010;33:585–92.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Bin YS, Marshall NS, Glozier N. Secular trends in adult sleep duration: a systematic review. Sleep Med Rev. 2012;16:223–30.PubMedCrossRefGoogle Scholar
  7. 7.
    Bonnet MH, Arand DL. We are chronically sleep deprived. Sleep. 1995;18:908–11.PubMedCrossRefGoogle Scholar
  8. 8.
    Van Cauter E, Spiegel K, Tasali E, Leproult R. Metabolic consequences of sleep and sleep loss. Sleep Med. 2008;9:23–8.CrossRefGoogle Scholar
  9. 9.
    Spiegel K, Leproult R, Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet. 1999;354:1435–9.CrossRefGoogle Scholar
  10. 10.
    Kitamura S, Katayose Y, Nakazaki K, Motomura Y, Oba K, Katsunuma R, et al. Estimating individual optimal sleep duration and potential sleep debt. Sci Rep. 2016;6:35812.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Basner M, Fomberstein KM, Razavi FM, Banks S, William JH, Rosa RR, et al. American time use survey: sleep time and its relationship to waking activities. Sleep. 2007;30:1085–95.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Yang H, Haack M, Gautam S, Meier-Ewert HK, Mullington JM. Repetitive exposure to shortened sleep leads to blunted sleep-associated blood pressure dipping. J Hypertens. 2017;35:1187–94.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Arora T, Chen MZ, Cooper AR, Andrews RC, Taheri S. The impact of sleep debt on excess adiposity and insulin sensitivity in patients with early type 2 diabetes mellitus. J Clin Sleep Med. 2016;12:673–80.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Hu L, Zhang B, Zhou W, Huang X, You C, Li J, et al. Sleep duration on workdays or non-workdays and cardiac–cerebral vascular diseases in Southern China. Sleep Med. 2018;47:36–43.PubMedCrossRefGoogle Scholar
  15. 15.
    Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, et al. Chronic kidney disease: global dimension and perspectives. Lancet. 2013;382:260–72.PubMedCrossRefGoogle Scholar
  16. 16.
    Couser WG, Remuzzi G, Mendis S, Tonelli M. The contribution of chronic kidney disease to the global burden of major noncommunicable diseases. Kidney Int. 2011;80:1258–70.PubMedCrossRefGoogle Scholar
  17. 17.
    Iseki K, Asahi K, Yamagata K, Fujimoto S, Tsuruya K, Narita I, et al. Mortality risk among screened subjects of the specific health check and guidance program in Japan 2008–2012. Clin Exp Nephrol. 2017;21:978–85.PubMedCrossRefGoogle Scholar
  18. 18.
    Tonelli M, Muntner P, Lloyd A, Manns BJ, Klarenbach S, Pannu N, et al. Risk of coronary events in people with chronic kidney disease compared with those with diabetes: a population-level cohort study. Lancet. 2012;380:807–14.PubMedCrossRefGoogle Scholar
  19. 19.
    Kon S, Konta T, Ichikawa K, Asahi K, Yamagata K, Fujimoto S, et al. Association between renal function and cardiovascular and all-cause mortality in the community-based elderly population: results from the Specific Health Check and Guidance Program in Japan. Clin Exp Nephrol. 2018;22:346–52.PubMedCrossRefGoogle Scholar
  20. 20.
    Matsushita K, van der Velde M, Astor BC, Woodward M, Levey AS, Chronic Kidney Disease Prognosis Consortium, et al. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet. 2010;375:2073–81.PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation. 2003;108:2154–69.PubMedCrossRefGoogle Scholar
  22. 22.
    Keith DS, Nichols GA, Gullion CM, Brown JB, Smith DH. Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Intern Med. 2004;164:659–63.PubMedCrossRefGoogle Scholar
  23. 23.
    Iseki K, Ikemiya Y, Iseki C, Takishita S. Proteinuria and the risk of developing end-stage renal disease. Kidney Int. 2003;63:1468–74.PubMedCrossRefGoogle Scholar
  24. 24.
    Inaguma D, Imai E, Takeuchi A, Ohashi Y, Watanabe T, Nitta K, et al. Risk factors for CKD progression in Japanese patients: findings from the Chronic Kidney Disease Japan Cohort (CKD-JAC) study. Clin Exp Nephrol. 2017;21:446–56.PubMedCrossRefGoogle Scholar
  25. 25.
    Halbesma N, Kuiken DS, Brantsma AH, Bakker SJL, Wetzels JFM, De Zeeuw D, et al. Macroalbuminuria is a better risk marker than low estimated GFR to identify individuals at risk for accelerated GFR loss in population screening. J Am Soc Nephrol. 2006;17:2582–90.PubMedCrossRefGoogle Scholar
  26. 26.
    Damsgaard EM, Froland A, Jorgensen OD, Mogensen CE. Microalbuminuria as predictor of increased mortality in elderly people. Br Med J. 1990;300:297–300.CrossRefGoogle Scholar
  27. 27.
    Kannel WB, Stampfer MJ, Castelli WP, Verter J. The prognostic significance of proteinuria: the Framingham study. Am Heart J. 1984;108:1347–52.PubMedCrossRefGoogle Scholar
  28. 28.
    Iseki K, Konta T, Asahi K, Yamagata K, Fujimoto S, Tsuruya K, et al. Dipstick proteinuria and all-cause mortality among the general population. Clin Exp Nephrol. 2018;22:1331–40.PubMedCrossRefGoogle Scholar
  29. 29.
    Cheungpasitporn W, Thongprayoon C, Gonzalez-Suarez ML, Srivali N, Ungprasert P, Kittanamongkolchai W, et al. The effects of short sleep duration on proteinuria and chronic kidney disease: a systematic review and meta-analysis. Nephrol Dial Transpl. 2017;32:991–6.Google Scholar
  30. 30.
    McMullan CJ, Curhan GC, Forman JP. Association of short sleep duration and rapid decline in renal function. Kidney Int. 2016;89:1324–30.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Yamamoto R, Shinzawa M, Isaka Y, Yamakoshi E, Imai E, Ohashi Y, et al. Sleep quality and sleep duration with CKD are associated with progression to ESKD. Clin J Am Soc Nephrol. 2018;13:1825–32.PubMedCrossRefGoogle Scholar
  32. 32.
    Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53:982–92.PubMedCrossRefGoogle Scholar
  33. 33.
    Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transpl. 2013;48:452–8.CrossRefGoogle Scholar
  34. 34.
    Yamamoto R, Nagasawa Y, Iwatani H, Shinzawa M, Obi Y, Teranishi J, et al. Self-reported sleep duration and prediction of proteinuria: a retrospective cohort study. Am J Kidney Dis. 2012;59:343–55.PubMedCrossRefGoogle Scholar
  35. 35.
    Andrews R, Cooper AR, Montgomery AA, Norcross AJ, Peters TJ, Sharp DJ, et al. Diet or diet plus physical activity versus usual care in patients with newly diagnosed type 2 diabetes: the Early ACTID randomised controlled trial. Lancet. 2011;378:129–39.PubMedCrossRefGoogle Scholar
  36. 36.
    Meier-Ewert HK, Ridker PM, Rifai N, Regan MM, Price NJ, Dinges DF, et al. Effect of sleep loss on C-Reactive protein, an inflammatory marker of cardiovascular risk. J Am Coll Cardiol. 2004;43:678–83.PubMedCrossRefGoogle Scholar
  37. 37.
    Yang S, Liu J, Yi B, Mao J, Zhang X, Liu Y, et al. Elevated high sensitivity c-reactive protein increases the risk of microalbuminuria in subjects with cardiovascular disease risk factors. Ther Apher Dial. 2017;21:387–94.PubMedCrossRefGoogle Scholar
  38. 38.
    Taheri S, Lin L, Austin D, Young T, Mignot E. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med. 2004;1:e62.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Lockley SW, Skene DJ, Arendt J. Comparison between subjective and actigraphic measurement of sleep and sleep rhythms. J Sleep Res. 1999;8:175–83.PubMedCrossRefGoogle Scholar
  40. 40.
    Regestein Q, Natarajan V, Pavlova M, Kawasaki S, Gleason R, Koff E. Sleep debt and depression in female college students. Psychiatry Res. 2010;176:34–9.PubMedCrossRefGoogle Scholar
  41. 41.
    Martens RJH, Kooman JP, Stehouwer CDA, Dagnelie PC, Van Der Kallen CJH, Kroon AA, et al. Albuminuria is associated with a higher prevalence of depression in a population-based cohort study: the Maastricht Study. Nephrol Dial Transpl. 2018;33:128–38.Google Scholar
  42. 42.
    Silva CM, Mota MC, Miranda MT, Paim SL, Waterhouse J, Crispim CA. Chronotype, social jetlag and sleep debt are associated with dietary intake among Brazilian undergraduate students. Chronobiol Int. 2016;33:740–8.PubMedCrossRefGoogle Scholar
  43. 43.
    Kimura Y, Yamamoto R, Shinzawa M, Isaka Y, Iseki K, Yamagata K, et al. Alcohol consumption and incidence of proteinuria: a retrospective cohort study. Clin Exp Nephrol. 2018;22:1133–42.PubMedCrossRefGoogle Scholar
  44. 44.
    Sato KK, Hayashi T, Uehara S, Kinuhata S, Oue K, Endo G, et al. Drinking pattern and risk of chronic kidney disease: the Kansai Healthcare Study. Am J Nephrol. 2014;40:516–22.PubMedCrossRefGoogle Scholar
  45. 45.
    Shoham DA, Durazo-Arvizu R, Kramer H, Luke A, Vupputuri S, Kshirsagar A, et al. Sugary soda consumption and albuminuria: results from the national health and nutrition examination survey, 1999-2004. PLoS One. 2008;3:1999–2004.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Nephrology 2019

Authors and Affiliations

  • Katsunori Aoki
    • 1
  • Ryohei Yamamoto
    • 1
    • 2
    Email author
  • Maki Shinzawa
    • 1
  • Yoshiki Kimura
    • 1
  • Hiroyoshi Adachi
    • 2
  • Yoshiyuki Fujii
    • 1
  • Ryohei Tomi
    • 1
  • Kaori Nakanishi
    • 2
  • Manabu Taneike
    • 2
  • Makoto Nishida
    • 2
  • Takashi Kudo
    • 2
  • Keiko Yamauchi-Takihara
    • 2
  • Yoshitaka Isaka
    • 1
  • Toshiki Moriyama
    • 1
    • 2
  1. 1.Department of NephrologyOsaka University Graduate School of MedicineSuitaJapan
  2. 2.Health Care Division, Health and Counseling CenterOsaka UniversityToyonakaJapan

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