Albuminuria severity was significantly associated with poor sleep quality in elderly obese non-diabetic individuals, with an optimal ACR threshold of >778 mg/gCr identified by ROC curve analysis for discriminating poor sleep quality.
Key Findings
Results
The prevalence of poor sleep quality in the study sample of obese, non-diabetic elderly individuals with albuminuria was 51%.
Prevalence was 51% (95% CI: 43%–59%) in the study sample of 160 patients
Participants were obese patients over 60 years with ACR >30 mg/gCr from outpatient clinics of Cairo University hospitals
Sleep disturbances were assessed via Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index questionnaires
The study was an analytical cross-sectional design
Results
Patients with ACR ≥500 mg/gCr had a ninefold higher likelihood of poor sleep quality compared to those with lower ACR levels.
Adjusted odds ratio (AOR) = 9.02, 95% CI: 2.963–27.464
Albuminuria was categorized into four levels: <300, ≥300–500, >500–1000, and >1000 mg/gCr
This association was identified through multivariable logistic regression
ACR interacted significantly with both BMI category and female gender (p=0.036 and p=0.045, respectively)
Results
Female sex was independently associated with nearly three times higher odds of poor sleep quality.
AOR = 2.677, 95% CI: 1.102–6.501
ACR interacted significantly with female gender (p=0.045)
Females had a higher ACR threshold for poor sleep (>878 mg/gCr) compared to males (>600 mg/gCr)
The AUC for females in subgroup ROC analysis was 0.767, representing the highest discriminant power among subgroups along with class II obesity
Results
Class II obesity more than doubled the risk of poor sleep quality compared to class I obesity.
AOR = 2.534, 95% CI: 1.094–5.871
ACR interacted significantly with BMI category (p=0.036)
Subgroup ROC analysis for class II obesity yielded an AUC of 0.787, the highest discriminant power among BMI subgroups
ACR threshold for class II obesity was >778 mg/gCr, compared to >739 mg/gCr for class I obesity
Results
The optimal overall ACR threshold for discriminating poor sleep quality was >778 mg/gCr by ROC curve analysis.
Sensitivity was 68.35% and specificity was 71.05% at this threshold
Subgroup thresholds varied: males >600 mg/gCr, females >878 mg/gCr, class I obesity >739 mg/gCr, and class II obesity >778 mg/gCr
The authors noted this threshold is exploratory and requires prospective validation in broader and more diverse patient populations before clinical implementation
ROC curve analysis was performed alongside multivariable logistic regression to identify optimal thresholds
Results
Multiple individual PSQI sleep components were significantly associated with higher ACR levels.
Poorer sleep quality, worse insomnia severity, longer sleep latency, shorter sleep duration, markedly reduced sleep efficiency, and increased sleep disturbance scores were all significantly associated with higher ACR (p<0.05)
Individual PSQI components were analyzed against albuminuria severity
Both PSQI and Insomnia Severity Index questionnaires were used for assessment
Albuminuria was categorized across four levels to examine dose-response relationships with sleep parameters
Methods
The study population consisted of 160 obese, non-diabetic patients over 60 years old with ACR >30 mg/gCr recruited from outpatient clinics.
All participants were from outpatient clinics of Cairo University hospitals
Inclusion required age >60 years, obesity, ACR >30 mg/gCr, and absence of diabetes
The cross-sectional design precluded causal inference
The authors noted limitations requiring prospective validation in broader and more diverse populations
What This Means
This research suggests that in obese older adults without diabetes, higher levels of albumin in the urine (a marker of kidney stress called albuminuria) are strongly linked to worse sleep quality. Among 160 patients aged over 60 recruited from Egyptian hospital outpatient clinics, about half reported poor sleep. Those with urine albumin-to-creatinine ratios (ACR) at or above 500 mg/gCr were nine times more likely to have poor sleep than those with lower levels. The study also found that being female or having more severe obesity (class II) further increased the likelihood of poor sleep. Using a statistical technique called ROC curve analysis, the researchers identified a specific ACR value of greater than 778 mg/gCr as the best cutoff point for identifying individuals at risk of poor sleep, though different thresholds applied to subgroups defined by sex and obesity class.
The study found that not just overall sleep quality but multiple specific aspects of sleep — including how long it takes to fall asleep, total sleep duration, sleep efficiency, and insomnia severity — were all significantly worse as albumin levels in the urine increased. This suggests a broad relationship between kidney stress (as reflected by albuminuria) and disrupted sleep across many dimensions, rather than just one aspect of sleep being affected.
This research suggests that routine sleep assessment could be valuable for older adults with moderate-to-severe albuminuria, particularly women and those with higher degrees of obesity. However, the authors caution that this was a cross-sectional study conducted at a single center in Egypt, meaning it cannot establish cause and effect, and the specific ACR thresholds identified are exploratory. Larger, more diverse, and prospective studies are needed before these thresholds could be used in clinical practice.
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Soliman A, Mohammed A, Rakha N, Abdelgawad E, Attia A, Ahmed R. (2026). Albumin/creatinine ratio thresholds associated with poor sleep quality in elderly obese non-diabetic individuals: a cross-sectional study.. BMC nephrology. https://doi.org/10.1186/s12882-026-04959-1