{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T22:29:49Z","timestamp":1790116189352,"version":"4.0.1"},"reference-count":27,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T00:00:00Z","timestamp":1765324800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Sleep disturbances are highly prevalent in hemodialysis (HD) patients and are associated with impaired quality of life (QOL) and poor outcomes. However, the independent impact of sleep quality on QOL and mortality in this population remains unclear. Methods: In this multicenter observational study, 346 HD patients completed the Kidney Disease Quality of Life\u2013Short Form (KDQOL-SF). A composite sleep score was derived from sleep-related items, and patients were stratified into tertiles (Q1\u2013Q3). Clinical characteristics, QOL outcomes, and survival were compared across tertiles. Associations between sleep quality and QOL domains were assessed using linear regression, while Cox proportional hazards models were applied to evaluate mortality risk. Results: Patients in the lowest tertile (Q1) consistently demonstrated significantly lower scores across multiple SF-36 and kidney-disease-specific QOL domains compared with Q2 and Q3 (all p &lt; 0.001). Kaplan\u2013Meier analysis showed lower cumulative survival in Q1 (log-rank p = 0.012). In Cox models, Q1 was associated with higher mortality compared to Q3 in both unadjusted (HR, 2.58; 95% CI, 1.46\u20134.54; p = 0.001) and adjusted models (Model 3: HR, 2.04; 95% CI, 1.11\u20133.77; p = 0.023). The associations between Q1 and Q2 were attenuated after full adjustment (HR, 1.88; 95% CI, 0.98\u20133.60; p = 0.058). Conclusions: Poor sleep quality was independently associated with impaired QOL and increased all-cause mortality in HD patients. These associations remained significant even after adjustment for inflammation and dialysis adequacy, suggesting that sleep quality reflects a distinct pathophysiological condition and may serve as an important, potentially modifiable indicator of patient well-being and prognosis.<\/jats:p>","DOI":"10.3390\/jcm14248729","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T16:11:18Z","timestamp":1765383078000},"page":"8729","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Sleep Quality and Its Association with Quality of Life and Mortality in Hemodialysis Patients"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-6113-6588","authenticated-orcid":false,"given":"Norihito","family":"Yoshida","sequence":"first","affiliation":[{"name":"Department of Nephrology, Toho University Sakura Medical Center, Chiba 285-8741, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuki","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Toho University Sakura Medical Center, Chiba 285-8741, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Toho University Sakura Medical Center, Chiba 285-8741, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0028-1466","authenticated-orcid":false,"given":"Sadamu","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Toho University Sakura Medical Center, Chiba 285-8741, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6851-2858","authenticated-orcid":false,"given":"Mai","family":"Hitaka","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Toho University Sakura Medical Center, Chiba 285-8741, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shingo","family":"Ishii","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Toho University Sakura Medical Center, Chiba 285-8741, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keisuke","family":"Yamazaki","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Toho University Sakura Medical Center, Chiba 285-8741, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1670-9498","authenticated-orcid":false,"given":"Yasushi","family":"Ohashi","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Toho University Sakura Medical Center, Chiba 285-8741, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.jsmc.2022.03.003","article-title":"Epidemiology of Insomnia: Prevalence, Course, Risk Factors, and Public Health Burden","volume":"17","author":"Morin","year":"2022","journal-title":"Sleep Med. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/s41100-023-00478-z","article-title":"Annual dialysis data report 2019, JSDT Renal Data Registry","volume":"9","author":"Hanafusa","year":"2023","journal-title":"Ren. Replace. Ther."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"100458","DOI":"10.1016\/j.xkme.2022.100458","article-title":"Insomnia and Poor Sleep in CKD: A Systematic Review and Meta-analysis","volume":"4","author":"Tan","year":"2022","journal-title":"Kidney Med."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Matsui, K., Yoshiike, T., Nagao, K., Utsumi, T., Tsuru, A., Otsuki, R., Ayabe, N., Hazumi, M., Suzuki, M., and Saitoh, K. (2021). Association of Subjective Quality and Quantity of Sleep with Quality of Life among a General Population. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph182312835"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1007\/s11255-014-0860-5","article-title":"Sleep disorders in patients with end-stage renal disease undergoing dialysis: Comparison between hemodialysis, continuous ambulatory peritoneal dialysis and automated peritoneal dialysis","volume":"47","author":"Losso","year":"2015","journal-title":"Int. Urol. Nephrol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.sleep.2016.07.026","article-title":"The effect of sleep apnea on all-cause mortality in nondialyzed chronic kidney disease patients","volume":"27\u201328","author":"Xu","year":"2016","journal-title":"Sleep Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"182","DOI":"10.2215\/CJN.07880719","article-title":"Association of Sleep Apnea with Mortality in Patients with Advanced Kidney Disease","volume":"15","author":"Jhamb","year":"2020","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"122","DOI":"10.13175\/swjpcc017-19","article-title":"Impact of Sleep and Dialysis Mode on Quality of Life in a Mexican Population","volume":"18","author":"Baldwin","year":"2019","journal-title":"Southwest J. Pulm. Crit. Care"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1093\/ndt\/gfm630","article-title":"Sleep quality predicts quality of life and mortality risk in haemodialysis patients: Results from the Dialysis Outcomes and Practice Patterns Study (DOPPS)","volume":"23","author":"Elder","year":"2008","journal-title":"Nephrol. Dial. Transpl."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Kuna, K., Szewczyk, K., Gabryelska, A., Bia\u0142asiewicz, P., Ditmer, M., Strzelecki, D., and Sochal, M. (2022). Potential Role of Sleep Deficiency in Inducing Immune Dysfunction. Biomedicines, 10.","DOI":"10.3390\/biomedicines10092159"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1707","DOI":"10.5664\/jcsm.9304","article-title":"Functional outcomes of sleep predict cardiovascular intermediary outcomes and all-cause mortality in patients on incident hemodialysis","volume":"17","author":"Fitzpatrick","year":"2021","journal-title":"J. Clin. Sleep Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1007\/BF00451725","article-title":"Development of the Kidney Disease Quality of Life (KDQOLTM) Instrument","volume":"3","author":"Hays","year":"1994","journal-title":"Qual. Life Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1023\/A:1016630825992","article-title":"Translation, cultural adaptation, and initial reliability and multitrait testing of the Kidney Disease Quality of Life instrument for use in Japan","volume":"10","author":"Green","year":"2001","journal-title":"Qual. Life Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1159\/000187980","article-title":"Determination of Kt\/V and protein catabolic rate using pre- and postdialysis blood urea nitrogen concentrations","volume":"67","author":"Shinzato","year":"1994","journal-title":"Nephron"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1093\/ajcn\/82.4.777","article-title":"Geriatric Nutritional Risk Index: A new index for evaluating at-risk elderly medical patients","volume":"82","author":"Bouillanne","year":"2005","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1093\/geroni\/igae098.3720","article-title":"Sleep quality, cognitive aging, and mortality among middle to older aged us adults","volume":"8","author":"Tate","year":"2024","journal-title":"Innov. Aging"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1038\/s41581-021-00396-5","article-title":"The challenge of insomnia for patients on haemodialysis","volume":"17","author":"Cukor","year":"2021","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.jpsychores.2008.09.002","article-title":"Gratitude influences sleep through the mechanism of pre-sleep cognitions","volume":"66","author":"Wood","year":"2009","journal-title":"J. Psychosom. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"zsac265","DOI":"10.1093\/sleep\/zsac265","article-title":"Sleep restriction reduces positive social emotions and desire to connect with others","volume":"46","author":"Palmer","year":"2023","journal-title":"Sleep"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1152\/physrev.00010.2018","article-title":"The Sleep-Immune Crosstalk in Health and Disease","volume":"99","author":"Besedovsky","year":"2019","journal-title":"Physiol. Rev."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Lee, H.W., Yoon, H.S., Yang, J.J., Song, M., Lee, J.K., Lee, S.A., Choi, J.Y., and Kang, D. (2020). Association of sleep duration and quality with elevated hs-CRP among healthy Korean adults. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0238053"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1007\/s11136-015-1068-6","article-title":"The joint subclinical elevation of CRP and IL-6 is associated with lower health-related quality of life in comparison with no elevation or elevation of only one of the biomarkers","volume":"25","author":"Garvin","year":"2016","journal-title":"Qual. Life Res."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Proctor, M.J., McMillan, D.C., Horgan, P.G., Fletcher, C.D., Talwar, D., and Morrison, D.S. (2015). Systemic inflammation predicts all-cause mortality: A glasgow inflammation outcome study. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0116206"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"gfaf116.1672","DOI":"10.1093\/ndt\/gfaf116.1672","article-title":"#1601 Sleep disorders and sleep quality among hemodialysis patients in a Tertiary Hospital in Valenzuela, Philippines: A one center cross sectional study","volume":"40","author":"Lu","year":"2025","journal-title":"Nephrol. Dial. Transpl."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"4655","DOI":"10.3760\/cma.j.issn.0366-6999.20131540","article-title":"Effect of long intermittent hemodialysis on improving dialysis adequacy of maintenance hemodialysis patients","volume":"126","author":"Dai","year":"2013","journal-title":"Chin. Med. J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e37371","DOI":"10.2196\/37371","article-title":"Sleep Disorders and Quality of Life in Patients with Cancer: Prospective Observational Study of the Rafael Institute","volume":"6","author":"Scher","year":"2022","journal-title":"JMIR Form. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e13604","DOI":"10.1111\/jsr.13604","article-title":"Insomnia disorder: State of the science and challenges for the future","volume":"31","author":"Riemann","year":"2022","journal-title":"J. Sleep Res."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/24\/8729\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T16:16:14Z","timestamp":1765383374000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/24\/8729"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,10]]},"references-count":27,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["jcm14248729"],"URL":"https:\/\/doi.org\/10.3390\/jcm14248729","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,10]]}}}