Exploring the impact of quality of life and dialysis duration on sleep quality among patients undergoing hemodialysis in Taiwan: A cross-sectional study

Abstract Background: As the population ages, the prevalence of chronic disease—and consequently, end-stage renal disease (ESRD)—has increased. Sleep quality is crucial for maintaining kidney function. While previous research has primarily examined the impact of poor sleep on quality of life, fewer studies have explored how reduced quality of life may lead to poor sleep, particularly among patients undergoing hemodialysis. Dialysis duration and clinical factors may further influence this association. Objectives: This study examined the relationship between health-related quality of life and sleep quality in patients undergoing hemodialysis, and whether dialysis duration modifies this association. Methods: This cross-sectional, multicenter study included 239 patients with ESRD who had been undergoing hemodialysis for at least three months. Data were collected using a structured questionnaire. Quality of life was assessed using the Taiwanese version of the World Health Organization Quality of Life questionnaire. Sleep quality was measured using the Chinese version of the Pittsburgh Sleep Quality Index. Results: Among the 239 participants analyzed, better physical health was significantly associated with a lower risk of poor sleep quality, after adjusting for sex, age, dialysis duration, monthly household income, and self-perceived health status (adjusted odds ratios [ORs] = 0.521; 95% confidence interval [CI]: 0.420–0.647; P < 0.001). Psychological health also showed a significant inverse association (adjusted OR = 0.692; 95% CI: 0.597–0.802; P < 0.001). Social relationships and the environmental domain showed a similar association. In stratified analyses by dialysis duration (≤5 years vs. >5 years), better physical health, psychological health, and environmental conditions remained inversely associated with poor sleep quality. However, social relationships were significantly associated with sleep quality only among patients undergoing dialysis for ≤5 years. Conclusion: Health-related quality of life is significantly associated with sleep quality in patients undergoing hemodialysis. Early psychosocial and environmental interventions may improve sleep and overall well-being.