# Global prevalence of poor sleep quality in hemodialysis patients: a systematic review and meta-analysis

## TL;DR

This study finds that about 64% of hemodialysis patients globally experience poor sleep quality, highlighting the need for better screening and interventions.

## Contribution

The study provides the first global pooled prevalence estimate of poor sleep quality in hemodialysis patients.

## Key findings

- The global prevalence of poor sleep quality among hemodialysis patients is 64.2%.
- Subgroup analysis showed significant variation in prevalence based on cut-off values.
- Meta-regression found no significant association between sleep quality prevalence and factors like age or dialysis duration.

## Abstract

Poor sleep quality is associated with various adverse outcomes among hemodialysis (HD) patients. Although poor sleep quality is a widely recognized health issue in HD patients, the reported prevalence in the current literature are remarkably inconsistent. This study aimed to determine the global prevalence of poor sleep quality in HD patients.

A comprehensive literature search was conducted across seven electronic databases (PubMed, Web of Science, Scopus, Embase, Cochrane Library, CINAHL, PsycINFO) from their inception to October 20, 2025. Data extraction was performed using a standardized form, and the methodological quality of included studies was evaluated with the Joanna Briggs Institute (JBI) critical appraisal checklist for prevalence studies. A random-effects model was applied to calculate the pooled prevalence of poor sleep quality, and the heterogeneity was quantified using the I2 statistic. Subgroup analyses and meta-regression were conducted to explore potential sources of heterogeneity.

A total of 69 studies involving 14,998 HD patients were included in the meta-analysis. The pooled global prevalence of poor sleep quality was 64.2% (95% CI: 60.5–67.8%). Based on the JBI critical appraisal tool, 55 studies were rated as having a low risk of bias, while 14 were considered to have a moderate risk of bias. Subgroup analysis revealed that the pooled prevalence varied significantly by the cut-off values. Meta-regression results indicated that prevalence was not significantly associated with sample size, mean age, dialysis duration, and proportion of females.

Our findings demonstrate a high prevalence of poor sleep quality among HD patients. To mitigate the adverse effects of poor sleep quality on HD patients, healthcare providers should routinely conduct screenings and deliver evidence-based interventions.