Association of sleep quality and functional dependence in maintenance hemodialysis patients: A cross-sectional study

Abstract Objective Sleep disorders and functional dependence are common in maintenance hemodialysis (MHD) patients but often go unnoticed. Despite their high prevalence, the association between sleep quality and functional dependence in patients undergoing MHD remains underexplored. Methods The cross-sectional study evaluated patients undergoing MHD at the Second Affiliated Hospital of Soochow University from June to December 2023. Physical function was assessed using the Katz and Lawton–Brody scales. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality. Binary logistic regression was conduct to explore the relationship between sleep quality and the risk of functional dependence. The dose–response relationship was observed using restricted cubic splines (RCS). Subgroup analyses and mediation analysis were conducted as sensitivity analyses. Results This study evaluated 103 patients (mean age: 58.7 ± 12.5 years; 63.1% male), the prevalence of functional dependence was 46.6%. Patients who are dependent had significantly higher ages, catheter use, diabetes prevalence, pulse pressure, and PSQI scores, and lower serum albumin ( P < 0.05). A higher PSQI scores was associated with a higher prevalence of functional dependence (odds ratio [OR] = 14.28, 95% confidence interval [CI] 2.45–83.17; P = 0.003). Restricted cubic splines (RCS) analysis indicated a nonlinear relationship between PSQI scores and functional dependence. Subgroup analysis identified a significant interaction between PSQI and age ( P = 0.003), but no significant mediating effects of age or albumin was observed ( P > 0.05). The receiver operating characteristic (ROC) curve demonstrated good predictive accuracy (area under the curve [AUC] = 0.719, 95% CI 0.623–0.815; P < 0.001). Conclusion Poor sleep quality is independently associated with functional dependence in patients undergoing MHD, characterized by a nonlinear dose–response relationship. Age and albumin do not mediate this association.