Main Article Content
Abstract
Background: Kidney failure is a condition in which one or both of the kidneys can no longer work on their own. Sometimes, kidney failure is temporary and comes on quickly. Other times, it is a chronic condition that can get worse slowly over a long time.
Objectives: The aims of the existing study were to identify sleep patterns for patients undergoing hemodialysis and to find out the association between sleep patterns for patients undergoing hemodialysis and their socio demographic variables.
Methodology: A descriptive cross-sectional study was conducted in in Al-Diwaniyah Teaching Hospital. Data were collected from (15 January to 15 February 2024) through the self-report questionnaire and analyzed through the descriptive and inferential statistical (SPSS) method.
Results: The study revealed that hemodialysis patients are predominantly middle-aged males, with many reporting poor sleep qualities, including daytime dysfunction, insufficient restoration after sleep, and difficulties falling or staying asleep. Despite these challenges, most patients expressed general satisfaction with their sleep pattern but experienced disruptions, such as noise and waking during sleep. The findings highlight the need for targeted interventions to improve sleep quality and overall health in this population.
Conclusions: 60% of participants were classified as having low overall sleep quality. This underscores the widespread nature of sleep disturbances within the hemodialysis population and highlights the critical need for targeted interventions to improve sleep quality, which may in turn enhance patients' overall health and well-being.
Recommendations: Given the widespread impact of poor sleep on daily functioning, further clinical attention should be given to improving sleep hygiene, minimizing nocturnal disruptions, and addressing underlying health issues that contribute to poor sleep quality in hemodialysis patients.
Keywords
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Copyright (c) 2026 Ismael Mohammed Alsaadi, Haider Abbas Hadi Al-Mhanaa, Widad Abd Aljabbar Mozzan, Fatima Kamil Salman, Saad Mardi Muhammad (Author)

This work is licensed under a Creative Commons Attribution 4.0 International License.
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References
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- Collins AJ, Foley RN, Chavers B, Gilbertson D, Herzog C, Johansen K, et al. US Renal Data System 2013 Annual Data Report. Am J Kidney Dis. 2014;63(1 Suppl):A7. https://doi.org/10.1053/j.ajkd.2013.11.001
- Steenkamp R, Castledine C, Feest T, Fogarty D. UK Renal Registry 13th Annual Report (December 2010): Chapter 2: UK RRT prevalence in 2009: national and centre-specific analyses. Nephron Clin Pract. 2011;119(suppl 2):c27–c52. https://doi.org/10.1159/000331744
- Alsuwaida AO, Farag YM, Al Sayyari AA, Alhejaili F, Alharbi A, Alnour H, et al. Epidemiology of chronic kidney disease in the Kingdom of Saudi Arabia (SEEK-Saudi investigators) a pilot study. Saudi J Kidney Dis Transpl. 2010;21(6):1066–1072.
- Afifi A. Egyptian renal registry 9th Annual Reports. Cairo: Egyptian Society of Nephrology; 2008.
- van der Tol A, Lameire N, Morton RL, Van Biesen W, Vanholder R. An international analysis of dialysis services reimbursement. Clin J Am Soc Nephrol. 2019;14(1):84–93. https://doi.org/10.2215/CJN.08150718
- Levin A, Tonelli M, Bonventre J, Coresh J, Donner JA, Fogo AB, et al. Global kidney health 2017 and beyond: a roadmap for closing gaps in care, research, and policy. Lancet. 2017;390(10105):1888–1917. https://doi.org/10.1016/S0140-6736(17)30788-2
- Vanholder R, Lameire N, Annemans L, Van Biesen W. Cost of renal replacement: how to help as many as possible while keeping expenses reasonable? Nephrol Dial Transplant. 2016;31(8):1251–1261. https://doi.org/10.1093/ndt/gfv233
- Iyanage T, Ninomiya T, Jha V, Neal B, Patrice HM, Okpechi I, et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet. 2015;385(9981):1975–1982. https://doi.org/10.1016/S0140-6736(14)61601-9
- Mollaoğlu M. Sleep in patients with ESRD undergoing hemodialysis. In: Carpi A, editor. Progress in hemodialysis: from emergent biotechnology to clinical practice. Rijeka: InTech; 2011. https://doi.org/10.5772/21597
- Maung SC, El Sara A, Chapman C, Cohen D, Cukor D. Sleep disorders and chronic kidney disease. World J Nephrol. 2016;5(3):224–232. https://doi.org/10.5527/wjn.v5.i3.224
- Knezevic MZ, Djordjevic VV, Jankovic SM, Djordjevic VM. Influence of dialysis modality and membrane flux on insomnia severity in haemodialysis patients. Nephrology (Carlton). 2013;18(11):706–711. https://doi.org/10.1111/nep.12131
- Merlino G, Piani A, Dolso P, Adorati M, Cancelli I, Valente M, et al. Sleep disorders in patients with end-stage renal disease undergoing dialysis therapy. Nephrol Dial Transplant. 2006;21(1):184–190. https://doi.org/10.1093/ndt/gfi144
- Perl J, Unruh ML, Chan CT. Sleep disorders in end-stage renal disease: 'markers of inadequate dialysis'? Kidney Int. 2006;70(10):1687–1693. https://doi.org/10.1038/sj.ki.5001791
- Abuyassin B, Sharma K, Ayas NT, Laher I. Obstructive sleep apnea and kidney disease: a potential bidirectional relationship? J Clin Sleep Med. 2015;11(8):915–924. https://doi.org/10.5664/jcsm.4946
- Kraus MA, Hamburger RJ. Sleep apnea in renal failure. Adv Perit Dial. 1997;13:88–92.
- Fleischmann G, Fillafer G, Matterer H, Skrabal F, Kotanko P. Prevalence of chronic kidney disease in patients with suspected sleep apnoea. Nephrol Dial Transplant. 2010;25(1):181–186. https://doi.org/10.1093/ndt/gfp403
- Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342(19):1378–1384. https://doi.org/10.1056/NEJM200005113421901
- Peker Y, Carlson J, Hedner J. Increased incidence of coronary artery disease in sleep apnoea: a long-term follow-up. Eur Respir J. 2006;28(3):596–602. https://doi.org/10.1183/09031936.06.00107805
- Punjabi NM, Polotsky VY. Disorders of glucose metabolism in sleep apnea. J Appl Physiol. 2005;99(5):1998–2007. https://doi.org/10.1152/japplphysiol.00695.2005
- Ogna A, Forni Ogna V, Mihalache A, Pruijm M, Halabi G, Phan O, et al. Obstructive sleep apnea severity and overnight body fluid shift before and after hemodialysis. Clin J Am Soc Nephrol. 2015;10(6):1002–1010. https://doi.org/10.2215/CJN.08760914
- United States Renal Data System. USRDS Annual Data Report: epidemiology of kidney disease in the United States. Bethesda: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2015. https://doi.org/10.1053/j.ajkd.2015.12.014
- Park JI, Bae E, Kim YL, Kang SW, Yang CW, Oh KH, et al. Glycemic control and mortality in diabetic patients undergoing dialysis focusing on the effects of age and dialysis type: a prospective cohort study in Korea. PLoS One. 2015;10(8):e0136085. https://doi.org/10.1371/journal.pone.0136085
- Yi C, Guo Q, Lin J, Huang X, Mao H, Yu X, et al. Clinical outcomes of remote peritoneal dialysis patients: a retrospective cohort study from a single center in China. Blood Purif. 2016;41(1-3):100–107. https://doi.org/10.1159/000442516
- Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213. https://doi.org/10.1016/0165-1781(89)90047-4
- Asaad T, Kahla A. Sleep problems and diagnosis. Cairo: Dar Eirtak for Printing, Publishing and Distribution; 2009. p. 22–25.
- Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV. Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep. 2004;27(7):1255–1273. https://doi.org/10.1093/sleep/27.7.1255
- Bonnet M, Arand D. EEG Arousal Norms by Age. J Clin Sleep Med. 2007;3(3):271–274. https://doi.org/10.5664/jcsm.26796
- Atlas Task Force. Recording and scoring leg movements. Sleep. 1993;16(8):748–759. https://doi.org/10.1093/sleep/16.8.749
- Peters B. Definition of AHI [Internet]. About.com Sleep Disorders; 2011. Available from: http://sleepdisorders.about.com/od/glossary/g/AHI.htm [Accessed 2011].
- Goyal M, Johnson J. Obstructive Sleep Apnea Diagnosis and Management. Missouri Med. 2017;114(2):120–124.
- American Academy of Sleep Medicine. International Classification of Sleep Disorders: Diagnostic and Coding Manual. 1st ed. Westchester: American Academy of Sleep Medicine; 2005.
- Hanly P. Sleep apnea and daytime sleepiness in end-stage renal disease. Semin Dial. 2004;17(2):109–114. https://doi.org/10.1111/j.0894-0959.2004.17206.x
- Beecroft JM, Pierratos A, Hanly PJ. Clinical presentation of obstructive sleep apnea in patients with end-stage renal disease. J Clin Sleep Med. 2009;5(2):115–121. https://doi.org/10.5664/jcsm.27438
- Ezzat H, Mohab A. Prevalence of sleep disorders among ESRD patients. Ren Fail. 2015;37(6):1013–1019. https://doi.org/10.3109/0886022X.2015.1044403
- Nicholl DD, Ahmed SB, Loewen AH, Hemmelgarn BR, Sola DY, Beecroft JM, et al. Declining kidney function increases the prevalence of sleep apnea and nocturnal hypoxia. Chest. 2012;141(6):1422–1430. https://doi.org/10.1378/chest.11-1809
- Kuhlmann U, Becker HF, Birkhahn M, Peter JH, Von Wichert P, Schutterle S, et al. Sleep-apnea in patients with end-stage renal disease and objective results. Clin Nephrol. 2000;53(6):460–466.
- Beecroft JM, Zaltzman J, Prasad GV, Meliton G, Hanly PJ. Improvement of periodic limb movements following kidney transplantation. Nephron Clin Pract. 2008;109(3):c133–c139. https://doi.org/10.1159/000145456
- Jurado-Gamez B, Martin-Malo A, Alvarez-Lara MA, Munoz L, Cosano A, Aljama P. Sleep disorders are underdiagnosed in patients on maintenance hemodialysis. Nephron Clin Pract. 2006;105(1):c35–c42. https://doi.org/10.1159/000096982
- Hanly PJ, Gabor JY, Chan C, Pierratos A. Daytime sleepiness in patients with CRF: impact of nocturnal hemodialysis. Am J Kidney Dis. 2003;41(2):403–410.
References
Cy H, Lin F, Vittinghoff E, Haan M, Selby JV. Racial differences in the progression from chronic renal insufficiency to end-stage renal disease in the United States. J Am Soc Nephrol. 2003;14(11):2902–2907. https://doi.org/10.1097/01.asn.0000091586.46532.b4
Collins AJ, Foley RN, Chavers B, Gilbertson D, Herzog C, Johansen K, et al. US Renal Data System 2013 Annual Data Report. Am J Kidney Dis. 2014;63(1 Suppl):A7. https://doi.org/10.1053/j.ajkd.2013.11.001
Steenkamp R, Castledine C, Feest T, Fogarty D. UK Renal Registry 13th Annual Report (December 2010): Chapter 2: UK RRT prevalence in 2009: national and centre-specific analyses. Nephron Clin Pract. 2011;119(suppl 2):c27–c52. https://doi.org/10.1159/000331744
Alsuwaida AO, Farag YM, Al Sayyari AA, Alhejaili F, Alharbi A, Alnour H, et al. Epidemiology of chronic kidney disease in the Kingdom of Saudi Arabia (SEEK-Saudi investigators) a pilot study. Saudi J Kidney Dis Transpl. 2010;21(6):1066–1072.
Afifi A. Egyptian renal registry 9th Annual Reports. Cairo: Egyptian Society of Nephrology; 2008.
van der Tol A, Lameire N, Morton RL, Van Biesen W, Vanholder R. An international analysis of dialysis services reimbursement. Clin J Am Soc Nephrol. 2019;14(1):84–93. https://doi.org/10.2215/CJN.08150718
Levin A, Tonelli M, Bonventre J, Coresh J, Donner JA, Fogo AB, et al. Global kidney health 2017 and beyond: a roadmap for closing gaps in care, research, and policy. Lancet. 2017;390(10105):1888–1917. https://doi.org/10.1016/S0140-6736(17)30788-2
Vanholder R, Lameire N, Annemans L, Van Biesen W. Cost of renal replacement: how to help as many as possible while keeping expenses reasonable? Nephrol Dial Transplant. 2016;31(8):1251–1261. https://doi.org/10.1093/ndt/gfv233
Iyanage T, Ninomiya T, Jha V, Neal B, Patrice HM, Okpechi I, et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet. 2015;385(9981):1975–1982. https://doi.org/10.1016/S0140-6736(14)61601-9
Mollaoğlu M. Sleep in patients with ESRD undergoing hemodialysis. In: Carpi A, editor. Progress in hemodialysis: from emergent biotechnology to clinical practice. Rijeka: InTech; 2011. https://doi.org/10.5772/21597
Maung SC, El Sara A, Chapman C, Cohen D, Cukor D. Sleep disorders and chronic kidney disease. World J Nephrol. 2016;5(3):224–232. https://doi.org/10.5527/wjn.v5.i3.224
Knezevic MZ, Djordjevic VV, Jankovic SM, Djordjevic VM. Influence of dialysis modality and membrane flux on insomnia severity in haemodialysis patients. Nephrology (Carlton). 2013;18(11):706–711. https://doi.org/10.1111/nep.12131
Merlino G, Piani A, Dolso P, Adorati M, Cancelli I, Valente M, et al. Sleep disorders in patients with end-stage renal disease undergoing dialysis therapy. Nephrol Dial Transplant. 2006;21(1):184–190. https://doi.org/10.1093/ndt/gfi144
Perl J, Unruh ML, Chan CT. Sleep disorders in end-stage renal disease: 'markers of inadequate dialysis'? Kidney Int. 2006;70(10):1687–1693. https://doi.org/10.1038/sj.ki.5001791
Abuyassin B, Sharma K, Ayas NT, Laher I. Obstructive sleep apnea and kidney disease: a potential bidirectional relationship? J Clin Sleep Med. 2015;11(8):915–924. https://doi.org/10.5664/jcsm.4946
Kraus MA, Hamburger RJ. Sleep apnea in renal failure. Adv Perit Dial. 1997;13:88–92.
Fleischmann G, Fillafer G, Matterer H, Skrabal F, Kotanko P. Prevalence of chronic kidney disease in patients with suspected sleep apnoea. Nephrol Dial Transplant. 2010;25(1):181–186. https://doi.org/10.1093/ndt/gfp403
Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342(19):1378–1384. https://doi.org/10.1056/NEJM200005113421901
Peker Y, Carlson J, Hedner J. Increased incidence of coronary artery disease in sleep apnoea: a long-term follow-up. Eur Respir J. 2006;28(3):596–602. https://doi.org/10.1183/09031936.06.00107805
Punjabi NM, Polotsky VY. Disorders of glucose metabolism in sleep apnea. J Appl Physiol. 2005;99(5):1998–2007. https://doi.org/10.1152/japplphysiol.00695.2005
Ogna A, Forni Ogna V, Mihalache A, Pruijm M, Halabi G, Phan O, et al. Obstructive sleep apnea severity and overnight body fluid shift before and after hemodialysis. Clin J Am Soc Nephrol. 2015;10(6):1002–1010. https://doi.org/10.2215/CJN.08760914
United States Renal Data System. USRDS Annual Data Report: epidemiology of kidney disease in the United States. Bethesda: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2015. https://doi.org/10.1053/j.ajkd.2015.12.014
Park JI, Bae E, Kim YL, Kang SW, Yang CW, Oh KH, et al. Glycemic control and mortality in diabetic patients undergoing dialysis focusing on the effects of age and dialysis type: a prospective cohort study in Korea. PLoS One. 2015;10(8):e0136085. https://doi.org/10.1371/journal.pone.0136085
Yi C, Guo Q, Lin J, Huang X, Mao H, Yu X, et al. Clinical outcomes of remote peritoneal dialysis patients: a retrospective cohort study from a single center in China. Blood Purif. 2016;41(1-3):100–107. https://doi.org/10.1159/000442516
Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213. https://doi.org/10.1016/0165-1781(89)90047-4
Asaad T, Kahla A. Sleep problems and diagnosis. Cairo: Dar Eirtak for Printing, Publishing and Distribution; 2009. p. 22–25.
Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV. Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep. 2004;27(7):1255–1273. https://doi.org/10.1093/sleep/27.7.1255
Bonnet M, Arand D. EEG Arousal Norms by Age. J Clin Sleep Med. 2007;3(3):271–274. https://doi.org/10.5664/jcsm.26796
Atlas Task Force. Recording and scoring leg movements. Sleep. 1993;16(8):748–759. https://doi.org/10.1093/sleep/16.8.749
Peters B. Definition of AHI [Internet]. About.com Sleep Disorders; 2011. Available from: http://sleepdisorders.about.com/od/glossary/g/AHI.htm [Accessed 2011].
Goyal M, Johnson J. Obstructive Sleep Apnea Diagnosis and Management. Missouri Med. 2017;114(2):120–124.
American Academy of Sleep Medicine. International Classification of Sleep Disorders: Diagnostic and Coding Manual. 1st ed. Westchester: American Academy of Sleep Medicine; 2005.
Hanly P. Sleep apnea and daytime sleepiness in end-stage renal disease. Semin Dial. 2004;17(2):109–114. https://doi.org/10.1111/j.0894-0959.2004.17206.x
Beecroft JM, Pierratos A, Hanly PJ. Clinical presentation of obstructive sleep apnea in patients with end-stage renal disease. J Clin Sleep Med. 2009;5(2):115–121. https://doi.org/10.5664/jcsm.27438
Ezzat H, Mohab A. Prevalence of sleep disorders among ESRD patients. Ren Fail. 2015;37(6):1013–1019. https://doi.org/10.3109/0886022X.2015.1044403
Nicholl DD, Ahmed SB, Loewen AH, Hemmelgarn BR, Sola DY, Beecroft JM, et al. Declining kidney function increases the prevalence of sleep apnea and nocturnal hypoxia. Chest. 2012;141(6):1422–1430. https://doi.org/10.1378/chest.11-1809
Kuhlmann U, Becker HF, Birkhahn M, Peter JH, Von Wichert P, Schutterle S, et al. Sleep-apnea in patients with end-stage renal disease and objective results. Clin Nephrol. 2000;53(6):460–466.
Beecroft JM, Zaltzman J, Prasad GV, Meliton G, Hanly PJ. Improvement of periodic limb movements following kidney transplantation. Nephron Clin Pract. 2008;109(3):c133–c139. https://doi.org/10.1159/000145456
Jurado-Gamez B, Martin-Malo A, Alvarez-Lara MA, Munoz L, Cosano A, Aljama P. Sleep disorders are underdiagnosed in patients on maintenance hemodialysis. Nephron Clin Pract. 2006;105(1):c35–c42. https://doi.org/10.1159/000096982
Hanly PJ, Gabor JY, Chan C, Pierratos A. Daytime sleepiness in patients with CRF: impact of nocturnal hemodialysis. Am J Kidney Dis. 2003;41(2):403–410.
