A Modifiable Risk Factor? Exploring the Impact of Sleep on Vascular Health and Quality of Life in Chronic Kidney Disease

INTRODUCTION: Poor sleep quality (SQ) is common among individuals with chronic kidney disease (CKD) and is associated with elevated cardiovascular risk. Poor SQ may contribute to arterial stiffness, impaired endothelial function, and lower quality of life (QoL); however, few studies have examined these relationships in CKD. PURPOSE: To determine whether poorer SQ predicts greater arterial stiffness, impaired endothelial function, and lower QoL in individuals with CKD. HYPOTHESIS: We hypothesized that poor SQ would be associated with increased arterial stiffness, worse endothelial function, and individuals with poor SQ will have lower QoL. METHODS: One hundred and five adults with CKD stages III–IV (male: 61%, Black: 72%, 65±9 years, 30±7 kg/m 2 ) were assessed. Arterial stiffness was determined using carotid-femoral pulse wave velocity (cf-PWV) and endothelial function was assessed using reactive hyperemia index (RHI) via peripheral arterial tonometry. SQ was derived from the Pittsburgh Sleep Quality Index (PSQI), and QoL via the Short Form-36 (SF-36). RESULTS: Hierarchical linear regression models were used to examine whether sleep duration and PSQI global scores predicted PWV after adjusting for age, sex, estimated glomerular filtration rate (eGFR), and mean arterial pressure (MAP). In Step 1, age, sex, eGFR, and MAP significantly predicted PWV (R 2 = 0.11, p = 0.029). In Step 2, sleep duration and PSQI global score were added. This produced a small, nonsignificant increase in explained variance (R 2 Δ = 0.03, p = 0.20), although the overall model remained significant (R 2 = 0.14, p = 0.030). In the final model, higher MAP was significantly associated with greater PWV (B = 0.043, SE = 0.018, β = 0.25, p = 0.020), and eGFR showed a trend-level association with PWV (B = 0.026, SE = 0.014, β = 0.20, p = 0.056). Age and sex were not significant predictors (both p > 0.09). Neither self-reported sleep duration (B = 0.133, SE = 0.141, β = 0.13, p = 0.350) nor PSQI global score (B = 0.087, SE = 0.050, β = 0.24, p = 0.083) was significantly associated with PWV in the fully adjusted model. Hierarchical linear regression models were also used to examine whether SQ measures predicted RHI. Covariates (age, sex, eGFR, MAP) did not significantly predict RHI (R 2 = 0.09, p = 0.086). Adding sleep duration and PSQI global score did not significantly improve model fit (R 2 Δ = 0.03, p = 0.22), and the overall model was not significant (R 2 = 0.12, p = 0.08). In the final model, neither sleep duration nor global SQ showed a significant association with RHI (all p > 0.08). QoL scores were significantly lower across all SF-36 domains in participants with poor SQ compared with those with good SQ (all p < 0.05). DISCUSSION: In adults with CKD, subjective SQ and sleep duration did not predict arterial stiffness or endothelial function after adjustment for covariates. However, poor SQ was consistently associated with lower QoL across all domains, highlighting the substantial symptom burden of poor sleep in this population. Funded by: NIH grants R01HL135183, R33AT010457 and R61AT10457. This project received financial support by the Atlanta Network for Training In KUH Scientific Research (ATLANTIS) grant from the National Institute of Diabetes, Digestive, and Kidney Diseases (TL1DK136047 and U2CDK129501). This abstract was presented at the American Physiology Summit 2026 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.