Renal Transplantation May Lower Sleep Disorder Risk Versus Dialysis

In patients with end-stage renal disease (ESRD), new research suggests renal transplantation is associated with significantly decreased risks of sleep disorders compared to dialysis.1

These findings suggest renal transplantation may improve sleep quality in patients with ESRD, reducing the risk of sleep disorders like insomnia, excessive daytime sleepiness, obstructive sleep apnea, and restless legs syndrome (RLS).1

“This study highlights the negative effects of ESRD on sleep disorders in affected patients,” wrote study investigator Hamdan AL-Jahdali, a professor at King Saud bin Abdulaziz University for Health Sciences, and colleagues. “It reinforces existing research demonstrating the benefits of renal transplantation in lowering the risk of obstructive sleep apnea, insomnia, and RLS, while also improving overall sleep quality.”1

The most common sleep disorders in patients with chronic kidney disease (CKD), such as ESRD, include insomnia, RLS, and periodic limb movement disorder. The detection and management of these disorders can be difficult, considering the symptomatology frequently coincides with general CKD symptoms.1,2

In patients with ESRD, those on dialysis often experience poor sleep quality, which has been linked to increased morbidity and mortality. Post-transplant patients may have sleep disturbances, mainly related to immunosuppressive therapy, pain, or psychological factors. Until now, direct comparisons of the outcomes of sleep quality between the groups have been limited.1,2

In a clinic-based cross-sectional study, investigators compared the association between sleep disorders and patients with post-organ transplant and those with ESRD on dialysis. They collected demographic data and administered structured sleep questionnaires, including the Epworth Sleepiness Scale (ESS), Berlin Questionnaire (BQ), STOP-BANG questionnaire, Pittsburgh Sleep Quality Index (PSQI), and questionnaires for insomnia and RLS.1

The study included 386 participants ≥ 18 years of age. Of these, 58.8% were patients with ESRD on dialysis (n = 227), and 41.2% had undergone renal transplants (n = 159).1

Unmatched analysis revealed renal transplantation patients had significantly decreased odds of sleep disorders compared to those with ESRD on dialysis.1

In matched analysis, investigators observed that this association remained significant among the following sleep disorders:

• Insomnia (Odds Ratio [OR], 0.083; 95% Confidence Interval [CI], 0.030-0.231)
• Excessive daytime sleepiness (OR, 0.034; 95% CI, 0.005-0.253)
• RLS (OR, 0.229; 95% CI, 0.106-0.493)
• Poor sleep quality (OR, 0.265; 95% CI, 0.127-0.552)
• The likelihood of increased risk for obstructive sleep apnea using BQ (OR, 0.217; 95% CI, 0.119-0.395)
• Increased risk for obstructive sleep apnea using STOP-BANG criteria (OR, 0.122; 95% CI, 0.063-0.236).1

“A significant limitation is the lack of objective assessment of obstructive sleep apnea through formal sleep studies, and the use of a historical dialysis cohort may introduce bias due to changes in patient management or population characteristics over time,” concluded study investigators. “This limitation should be acknowledged, as the reliance on subjective evaluations can result in inaccuracies or misrepresentations in obstructive sleep apnea diagnosis.”1

References

1. Alharbi T, Salman A, Turki A, et al. Sleep disorders in renal patients: a comparative analysis of dialysis and post-renal transplant outcomes. Scientific Reports. Published online December 14, 2025. doi:https://doi.org/10.1038/s41598-025-28159-3

2. ‌Gopal A, Farragher J, Jassal SV, Mucsi I. Sleep Disorders in CKD. American Journal of Kidney Diseases. Published online February 2025. doi:https://doi.org/10.1053/j.ajkd.2024.12.010