PwH exhibit poorer sleep quality and feeling of restoration after sleep compared to healthy controls, with pain over four weeks and diminished quality of life being key factors contributing to impaired sleep quality.
Key Findings
Results
Persons with haemophilia had significantly worse sleep quality compared to healthy controls after age adjustment.
100 persons with haemophilia A or B (PwH) and 100 healthy controls (Con) participated in the study.
Age-adjusted comparisons revealed significantly worse sleep quality (SQual) in PwH compared to Con (p < 0.001).
Sleep metrics were assessed using the German sleep questionnaire (Schlaffragebogen B revised).
The comparison specifically measured sleep quality, trouble falling asleep, trouble staying asleep, feeling of being restored after sleep, and sleep quantity.
Results
Persons with haemophilia reported significantly worse feeling of being restored after sleep compared to healthy controls.
Age-adjusted comparison revealed significantly worse restoration after sleep (RAS) in PwH compared to Con (p = 0.037).
This was one of two sleep metrics that differed significantly between groups.
The difference in RAS was less statistically pronounced than the difference in overall sleep quality (p = 0.037 vs. p < 0.001).
Results
Trouble falling asleep, trouble staying asleep, and sleep quantity did not differ significantly between persons with haemophilia and healthy controls.
No significant differences were found between PwH and Con in trouble falling asleep (TFA), trouble staying asleep (TSA), or sleep quantity (SQuan).
These three sleep indices were described as 'unaltered' compared to controls.
This suggests the sleep impairment in PwH is specific to sleep quality and restorative function rather than quantitative aspects of sleep.
Results
Pain over four weeks and quality of life were the only significant predictors of worse sleep quality in persons with haemophilia.
A multiple regression model identified NRS-4w (pain over four weeks) as a significant predictor of worse sleep quality (p = 0.012).
Quality of life (QoL) was also a significant predictor of worse sleep quality (p = 0.008).
The overall regression model explained 17% of the variance in sleep quality (R² = 0.17).
Variables included in the regression model were age, BMI, current pain (NRSnow), pain over four weeks (NRS-4w), joint health (Haemophilia Joint Health Score, HJHS), and quality of life (QoL).
Results
Age, BMI, and joint health score had no significant effect on sleep quality in persons with haemophilia.
Despite being included in the multiple regression model, age, BMI, and Haemophilia Joint Health Score (HJHS) were not significant predictors of sleep quality.
Current pain (NRSnow) was also not a significant predictor, whereas pain measured over four weeks (NRS-4w) was significant.
This suggests that sustained or chronic pain rather than acute pain is more relevant to sleep quality impairment in PwH.
What This Means
This research suggests that people living with haemophilia (a bleeding disorder) experience meaningfully worse sleep quality and feel less refreshed after sleeping compared to people without the condition, even when accounting for age differences. The study compared 100 people with haemophilia to 100 healthy individuals using a validated sleep questionnaire and found that while total sleep time and difficulties falling or staying asleep were similar between groups, the overall quality and restorative value of sleep were significantly poorer in the haemophilia group.
When researchers looked at what factors were driving poor sleep quality among people with haemophilia, they found that pain experienced over the past four weeks and reduced quality of life were the most important contributors. Interestingly, current pain at the time of the assessment, age, body weight, and the severity of joint damage — which is a common complication of haemophilia — were not significant predictors. This points to the role of ongoing, persistent pain rather than immediate pain in disrupting sleep quality.
This research suggests that sleep problems are a real but potentially underrecognized issue for people with haemophilia, and that managing chronic pain and improving quality of life may help address sleep difficulties in this population. The authors recommend that sleep assessment be incorporated into routine clinical care for people with haemophilia, as poor sleep can have wide-ranging negative effects on both physical and mental health.
Schmidt A, Brühl M, Möllers P, Hmida J, Tomschi F, Wiese J, et al.. (2026). Sleep and Haemophilia-A Case-Control Analysis of Associated Factors.. Haemophilia : the official journal of the World Federation of Hemophilia. https://doi.org/10.1111/hae.70217