Albumin/creatinine ratio thresholds associated with poor sleep quality in elderly obese non-diabetic individuals: a cross-sectional study

Abstract

Abstract Background Obesity, albuminuria, and sleep disturbances commonly affect older adults and increase cardiovascular and chronic kidney disease progression, yet their interrelationships and clinically useful thresholds remain uncertain. This study aimed to identify albumin-to-creatinine ratio (ACR) thresholds associated with poor sleep quality in obese, non-diabetic elderly individuals. Methods This analytical cross-sectional study examined 160 obese patients over 60 years with (ACR) > 30 mg/gCr from outpatient clinic of Cairo University hospitals. Sleep disturbances were assessed via Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index questionnaires with individual PSQI components analyzed against albuminuria severity. Albuminuria was categorized into four levels (< 300, ≥ 300–500, > 500–1000,>1000 mg/gCr). ROC curve analysis and multivariable logistic regression were performed to identify optimal ACR thresholds and independent predictors of poor sleep quality. Results Prevalence of poor sleep is 51% (95th C.I. 43%-59%) in the study sample. Patients with ACR ≥ 500 mg/gCr had ninefold higher likelihood of poor sleep (AOR = 9.02, 95% CI: 2.963–27.464). females had nearly three times higher odds (AOR = 2.677, 95% CI: 1.102–6.501). and class II obesity more than doubled the risk compared to class I (AOR = 2.534, 95% CI: 1.094–5.871). ACR interacted significantly with both BMI category and female gender (p = 0.036 and p = 0.045, respectively). The optimal ACR threshold by ROC curve analysis is > 778 mg/gCr with 68.35% sensitivity and 71.05% specificity. Subgroup analysis revealed varying thresholds: males > 600 mg/gCr, females > 878 mg/gCr, class I obesity > 739 mg/gCr, and class II obesity > 778 mg/gCr with the highest discriminant power for females and obesity class II (AUC 0.767 & 0.787, respectively). Poorer sleep quality, worse insomnia severity, longer sleep latency, shorter sleep duration, and markedly reduced sleep efficiency, increased sleep disturbances scores were significantly associated with higher ACR, p < 0.05. Conclusions Albuminuria severity was significantly associated with poor sleep quality in elderly obese non-diabetic individuals. The ACR threshold of > 778 mg/gCr identified in this study is exploratory and require prospective validation in broader and more diverse patient populations before clinical implementation. Sleep assessment should be considered in the routine care of older adults with moderate-to-severe albuminuria, pending confirmatory studies. Clinical trial number Not applicable.