1026 GENDER DIFFERENCES IN THE ASSOCIATION BETWEEN SERUM ASYMMETRIC DIMETHYLARGININE, CHRONIC KIDNEY DISEASE, AND QUALITY OF OBJECTIVE/SUBJECTIVE SLEEP: THE HEIJO-KYO COHORT

Abstract

Introduction: Sleep problems are common in individuals with chronic kidney disease (CKD), although the underlying mechanisms are largely unknown. Nitric oxide (NO) plays an important role in regulating physiological process in sleep/wake states; however, the association between serum asymmetric dimethylarginine (ADMA) level, an endogenous competitive inhibitor of NO synthesis, and sleep quality has not been studied yet. Method(s): We measured serum ADMA level along with actigraphic and subjective sleep quality among 1115 elderly individuals with and without CKD (mean age, 71.9 years). Result(s): Multivariable analysis adjusted for age, BMI, hypertension, diabetes, and physical activity revealed that, in females, compared with the low-ADMA/non-CKD groups (n = 312), sleep efficiency (SE) was significantly lower in the high-ADMA/CKD (n = 52) by 3.5% for objective (95% CI, 1.1-5.9; P = 0.005) and 4.2% (95% CI, 0.3-8.0; P = 0.034) for subjective but not in the low-ADMA/non-CKD group (n = 179) and the high-ADMA/CKD group (n = 36). In males, no significant associations between ADMA and sleep quality were observed. Consistently, the high-ADMA/CKD group exhibited significantly longer wake after sleep onset by 11.3 min (95% CI, 3.0-19.6; P = 0.008) for objective and 25.9 min (95% CI, 4.9-46.9; P = 0.016) for subjective than that in low-ADMA/non-CKD group in females but not in males. No significant association of ADMA and sleep onset latency was observed in both genders. Conclusion(s): Elderly individuals with high ADMA and CKD exhibited poor sleep quality measured objectively and subjectively than those with low ADMA and without CKD. In addition, potential gender differences in the associations were detected in this study. Increased ADMA levels in CKD may be a possible mechanism underlying high prevalence of sleep problems in CKD patients.