Sleep Quality and Its Association with Quality of Life and Mortality in Hemodialysis Patients

Sleep disturbances are highly prevalent in hemodialysis (HD) patients and are associated with impaired quality of life (QOL) and poor outcomes. However, the independent impact of sleep quality on QOL and mortality in this population remains unclear. Methods: In this multicenter observational study, 346 HD patients completed the Kidney Disease Quality of Life-Short Form (KDQOL-SF). A composite sleep score was derived from sleep-related items, and patients were stratified into tertiles (Q1-Q3). Clinical characteristics, QOL outcomes, and survival were compared across tertiles. Associations between sleep quality and QOL domains were assessed using linear regression, while Cox proportional hazards models were applied to evaluate mortality risk. Results: Patients in the lowest tertile (Q1) consistently demonstrated significantly lower scores across multiple SF-36 and kidney-disease-specific QOL domains compared with Q2 and Q3 (all p < 0.001). Kaplan-Meier analysis showed lower cumulative survival in Q1 (log-rank p = 0.012). In Cox models, Q1 was associated with higher mortality compared to Q3 in both unadjusted (HR, 2.58; 95% CI, 1.46-4.54; p = 0.001) and adjusted models (Model 3: HR, 2.04; 95% CI, 1.11-3.77; p = 0.023). The associations between Q1 and Q2 were attenuated after full adjustment (HR, 1.88; 95% CI, 0.98-3.60; p = 0.058). Conclusions: Poor sleep quality was independently associated with impaired QOL and increased all-cause mortality in HD patients. These associations remained significant even after adjustment for inflammation and dialysis adequacy, suggesting that sleep quality reflects a distinct pathophysiological condition and may serve as an important, potentially modifiable indicator of patient well-being and prognosis.