Sleep

The Association Between Lifestyle Factors and Sleep Quality in Haemodialysis Patients.

Zhang L, Zhang S, Tang X • Nursing open • 2026

TL;DR

Depression and self-management were the key factors associated with sleep quality in patients undergoing maintenance haemodialysis, with 73.4% of patients exhibiting poor sleep quality.

Key Findings

Results

The majority of haemodialysis patients in this study experienced poor sleep quality.

73.4% of the 286 haemodialysis patients had poor sleep quality
The mean Pittsburgh Sleep Quality Index (PSQI) score was 7.89 ± 4.68
PSQI scores above 5 are generally considered indicative of poor sleep quality
Participants were drawn from two hospitals using a cross-sectional study design

Results

Depression was identified as a major factor associated with poor sleep quality in haemodialysis patients.

Depression was identified as a psychological factor significantly associated with sleep quality in multivariate logistic regression analyses
Depression was classified as a psychological factor domain in the analysis
The finding supports integrating depression screening into routine dialysis care for early identification of at-risk patients

Results

Self-management was identified as a major lifestyle-related factor associated with sleep quality in haemodialysis patients.

Self-management was categorized as a behavioural lifestyle domain in the analysis
Self-management behaviours included dietary adherence, fluid restriction, and medication compliance
Self-management was identified as a significant factor in multivariate logistic regression analyses
Active participation in treatment plans was suggested to potentially improve sleep quality

Results

Age and maintenance haemodialysis duration were also identified as major factors associated with sleep quality.

Age and maintenance haemodialysis duration were identified alongside depression and self-management in multivariate logistic analyses
These factors were among the variables examined for association with sleep quality in 286 haemodialysis patients
The cross-sectional design limits the ability to establish causal directionality for these associations

Conclusions

The study recommended integrating sleep and depression screening into routine haemodialysis nursing care.

Nurses were advised to integrate brief sleep-quality screening and depression screening into routine dialysis care
Nursing interventions were recommended to strengthen patients' self-management skills including dietary adherence, fluid restriction, and medication compliance
A holistic approach addressing both psychological well-being and behavioural self-management was recommended
Individualized lifestyle counselling tailored to each patient's dietary and fluid needs was recommended

What This Means

This research examined sleep quality among 286 patients receiving maintenance haemodialysis (a kidney replacement therapy) at two hospitals. Using the Pittsburgh Sleep Quality Index, the study found that nearly three-quarters of patients (73.4%) were sleeping poorly, with an average score of 7.89 out of a possible 21, where higher scores indicate worse sleep. Using statistical analysis, the researchers identified four key factors linked to poor sleep: older age, longer time on haemodialysis, depression, and poorer self-management of health behaviours like diet, fluid intake, and medication. Two factors stood out as particularly important and modifiable: depression and self-management. Patients who were more depressed tended to have worse sleep, and patients who were better at managing their own health behaviours tended to sleep better. These findings suggest that addressing mental health and empowering patients to take an active role in their care could be meaningful targets for improving sleep in this population. This research suggests that dialysis care teams should routinely screen patients for both poor sleep and depression, and should provide education and support to help patients better manage their dietary restrictions and medication regimens. Rather than treating sleep problems in isolation, a combined approach that addresses psychological well-being alongside practical health behaviours may offer the most benefit to haemodialysis patients struggling with sleep.

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Citation

Zhang L, Zhang S, Tang X. (2026). The Association Between Lifestyle Factors and Sleep Quality in Haemodialysis Patients.. Nursing open. https://doi.org/10.1002/nop2.70768

Key Findings

What This Means

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