# Determinants of poor sleep quality in hemodialysis patients: a multicenter cross sectional study in Sri Lanka

## TL;DR

This study finds that most hemodialysis patients in Sri Lanka have poor sleep quality, linked to dialysis frequency, side effects, and blood levels.

## Contribution

The study identifies specific clinical and dialysis-related factors as significant predictors of poor sleep quality in hemodialysis patients.

## Key findings

- 83.3% of hemodialysis patients had poor sleep quality, primarily due to sleep latency and duration issues.
- Dialysis center, side effects, and post-dialysis urea levels were significant predictors of poor sleep quality.
- Dialysis adequacy and hemoglobin levels showed a negative correlation with poor sleep quality.

## Abstract

Sleep quality is a common and often overlooked clinical issue among hemodialysis patients, which can affect physical and psychological quality of Life. This study intended to evaluate sleep quality and its determinants among patients receiving hemodialysis.

A cross-sectional study was conducted at three hemodialysis centers in Anuradhapura and Polonnaruwa districts of Sri Lanka, including a random sample of 310 maintenance hemodialysis patients. The Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep quality of the patients. Socio-demographic information, dialysis and medical data, dietary and lifestyle information were also recorded. Several laboratory investigations were conducted before and after dialysis. Dialysis adequacy was calculated using single pool Kt/V. Multiple linear regression was performed to identify significant predictors of poor sleep quality.

A significant majority (83.3%) of the population exhibited poor sleep quality. According to the PSQI, poor sleep latency and low sleep duration were key contributing factors. A significant association was observed between the sleep quality of patients and the number of dialysis sessions per week (p = 0.001), serum phosphorus level (p = 0.016) and several dialysis side effects. Total number of dialysis side effects and complications (p < 0.01), recovery time (p < 0.01) and post dialysis urea concentration (p = 0.027) depicted a significant positive correlation, while dialysis adequacy (p = 0.001), post dialysis sodium level (p = 0.006) and hemoglobin level (p = 0.005) had a notable negative correlation with global PSQI score of patients. A significant difference in overall sleep quality was observed among the categories of patients’ dialysis vintage (p = 0.032), appetite (p < 0.01) and dialysis center (p < 0.01). Dialysis vascular access depicted a marginal significance.

The study revealed a striking prevalence of poor sleep quality in the population. According to the multiple linear regression model, dialysis center, dialysis access, number of dialysis side effects and complications, appetite and post dialysis serum urea level were identified as significant predictors of poor sleep quality in the population. Subsequent research should develop appropriate interventions to address inadequate sleep quality among hemodialysis patients.