Hemodialysis patients face high burden of sleep disorders, review finds

A systematic review and meta-analysis of 86 observational studies involving 21,119 patients undergoing hemodialysis found that poor sleep quality affected an estimated 60.6% of participants, while 42.7% had insomnia and 47.8% had sleep apnea. Restless legs syndrome was reported less often, with a pooled prevalence of 23.1%. The findings, based on studies published through May 2026, indicate a substantial burden of sleep-related conditions among people receiving hemodialysis, although the researchers rated the certainty of the evidence as very low.

Yu Shenao, Zhou Xinling and Wang Yanru pooled the results using random-effects meta-analyses, with prevalence summarized as a secondary outcome. The analysis estimated the proportion of hemodialysis patients with each condition and examined multivariable-adjusted associations with demographic, clinical, psychological and biochemical factors. Study quality was assessed with the Agency for Healthcare Research and Quality checklist and the Newcastle-Ottawa Scale, while the GRADE approach was used to evaluate certainty. The review protocol was registered with PROSPERO under the identifier CRD420251241385.

Sleep problems were common, but their measured prevalence varied considerably across studies. The pooled estimate for poor sleep quality was 60.6%, with a 95% confidence interval of 56.2% to 64.9% and a 95% prediction interval of 29.2% to 87.7%. For insomnia, the estimate was 42.7%, with a 95% confidence interval of 39.8% to 45.7% and a prediction interval of 34.7% to 51.0%. Restless legs syndrome had a pooled estimate of 23.1%, with a 95% confidence interval of 18.3% to 28.4% and a prediction interval of 4.1% to 51.8%. Sleep apnea was estimated at 47.8%, with a 95% confidence interval of 33.1% to 62.8% and a 95% prediction interval of 1.3% to 97.6%. These wide prediction intervals, particularly for sleep apnea, show that prevalence estimates across individual study settings may differ substantially from the pooled averages.

Several factors were associated with poor sleep quality after the researchers considered other variables. Older age, female sex, lower education, diabetes and depression were each linked to higher odds of poor sleep quality, whereas higher serum albumin was inversely associated with the outcome. Anxiety showed a borderline association that did not reach statistical significance. Among participants whose poor sleep quality was expressed as a continuous PSQI score, older age was associated with greater sleep-disturbance severity, while hemoglobin showed an inverse association. These results describe statistical associations in observational studies; they do not establish that the identified factors cause poor sleep or that changing them would improve sleep.

The review found weaker evidence for restless legs syndrome. Higher serum phosphorus, longer dialysis vintage, a higher intact parathyroid hormone concentration and more frequent exercise each showed borderline associations that were not statistically significant. For insomnia, age was not significantly associated with the condition. Age, sex and hypertension were likewise not significantly associated with sleep apnea. No significant associations were identified for these three conditions in the meta-analysis. Because the evidence for all four sleep outcomes was rated very low in certainty, the findings should be interpreted cautiously. The authors concluded that multiple demographic, clinical, psychological and biochemical factors were associated with poor sleep quality, while several proposed links with restless legs syndrome remained uncertain. The secondary prevalence estimates nevertheless point to sleep disorders as a widespread feature of hemodialysis care, with further research needed to clarify why rates and associated factors vary so widely among patient populations.

Subject of Research: Prevalence and associated factors of sleep disorders among hemodialysis patients

Article Title: Prevalence and associated factors of poor sleep quality, restless legs syndrome, insomnia, and sleep apnea in hemodialysis patients: a systematic review and meta-analysis

Article References: Yu, S., Zhou, X., & Wang, Y. (2026). Prevalence and associated factors of poor sleep quality, restless legs syndrome, insomnia, and sleep apnea in hemodialysis patients: a systematic review and meta-analysis. BMC Public Health. https://doi.org/10.1186/s12889-026-29810-y

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29810-y

Keywords: hemodialysis, poor sleep quality, insomnia, sleep apnea, restless legs syndrome, systematic review, meta-analysis, observational studies, sleep health, Prevalence, associated, factors