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

초록

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 (β, −4.51; 95% CI, −8.75 to −0.26; p = 0.038) and mental component summary score (β, −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. Trial Registration: NCT02042963; clinicaltrials.gov identifier. © 2026 The Author(s). Nephrology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Nephrology.

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