Diabetes has been established as a strong risk factor for chronic kidney disease (CKD). Sleep apnea, poor sleep quality (PSQ), and autonomic imbalance are also considered to be potential risk factors for decline in renal function, though no known study has examined their integrated predictive value in diabetic and non-diabetic patients without CKD. The present cohort consisted of 754 serial patients (diabetes; n = 231, non-diabetes; n = 523) without CKD registered in the Hyogo Sleep Cardio-Autonomic Atherosclerosis (HSCAA) study. Patients underwent examinations to determine respiratory event index and objective sleep quality using actigraphy, as well as heart rate variability (HRV). Renal outcome was defined as a decline in estimated glomerular filtration rate to less than 60 ml/min/1.73 m² for more than 3 months. Kaplan–Meier analysis showed that diabetic patients with PSQ or low HRV, but not sleep apnea, had a significantly increased risk for renal outcome. Furthermore, Cox proportional hazards analysis revealed that PSQ was significantly associated with elevated risk of renal outcome (HR: 2.57; 95% CI: 1.01–6.53, p = 0.045) independent of sleep apnea and classical risk factors. Low HRV tended to be, but not significantly (p = 0.065), associated with the outcome. In non-diabetic patients, PSQ was also significantly and independently associated with renal outcome, whereas sleep apnea and low HRV were not. In conclusion, PSQ and low HRV appear to be important predictors of decline in renal function in diabetic patients without CKD.

糖尿病已被确定为慢性肾病 (CKD) 的重要危险因素。睡眠呼吸暂停、睡眠质量差 (PSQ) 和自主神经失衡也被认为是肾功能下降的潜在危险因素，尽管没有已知的研究检查它们在没有 CKD 的糖尿病和非糖尿病患者中的综合预测价值。本队列由 754 名连续患者（糖尿病；n = 231，非糖尿病；n = 523）组成，没有在兵库睡眠心脏自主动脉粥样硬化 (HSCAA) 研究中登记的 CKD。患者接受检查以确定呼吸事件指数和客观睡眠质量，使用活动记录仪，以及心率变异性 (HRV)。肾脏结局定义为估计肾小球滤过率下降至低于 60 ml/min/1.73 m ²超过 3 个月。Kaplan-Meier 分析显示，患有 PSQ 或低 HRV 而非睡眠呼吸暂停的糖尿病患者的肾脏结局风险显着增加。此外，Cox 比例风险分析显示，PSQ 与肾结局风险升高显着相关（HR：2.57；95% CI：1.01-6.53，p  = 0.045），与睡眠呼吸暂停和经典危险因素无关。低 HRV 往往 与结果相关，但不显着（p = 0.065）。在非糖尿病患者中，PSQ 也与肾脏结局显着且独立相关，而睡眠呼吸暂停和低 HRV 则不然。总之，PSQ 和低 HRV 似乎是非 CKD 糖尿病患者肾功能下降的重要预测因素。