Globally, 80 % of patients with end-stage renal disease (ESRD) undergoing hemodialysis. In developing countries like Egypt, there has been a significant increase in the annual occurrence of ESRD, currently estimated at around 74 cases per million. The overall prevalence of patients undergoing dialysis has reached 264 cases per million (Bayoumi et al., 2016). In 2017, the number of patients with ESRD undergoing hemodialysis in the Sharqia governorate was reported to be 442 per million individuals (Zahran et al., 2020).

Many patients suffering from ESRD undergoing dialysis treatment encounter sleep disturbances, which is a commonly associated complication. This problem impacts around 40 to 80 % of these individuals and has been thoroughly documented, displaying varying degrees of severity in sleep disorders (Sen, 2018). Such disturbances greatly impair patients' physical and social functioning, psychological health, work performance, and overall quality of life (Saiednejad et al., 2018).

Patients receiving maintenance hemodialysis encounter significant difficulties, as the symptoms associated with the treatment greatly affect their physical and emotional well-being (Rai et al., 2011). A significant evidence suggests that sleep disturbances rank among the most frequently reported symptoms by patients undergoing hemodialysis. The main manifestations of this problem include frequent nighttime awakenings, reduced sleep quality, insomnia, extended dependence on sedative medications, and the presence of sleep apnea (Lin et al., 2022).

Sleep quality has become a critical issue that threatens patients' well-being and longevity. Poor sleep quality heightens anxiety, depression, memory impairments, fatigue, and behavioral problems (Medic et al., 2017). Additionally, inadequate sleep quality weakens immune responses, raises the likelihood of cardiovascular diseases, disrupts physiological functions, and heightens mortality risk (Benetou et al., 2022). A deterioration in sleep quality directly contributes to a reduction in the overall quality of life for patients undergoing hemodialysis (Mixson et al., 2023). Nurses hold a crucial and impactful position in fostering healthy sleep among individuals who struggle with sleep issues. Their interventions should be grounded in the identification of factors and underlying causes that influence patients' sleep patterns (Alshammari et al., 2023).

Recent research has highlighted that various factors influence sleep quality in patients receiving regular hemodialysis (HD). A comprehensive review indicated that demographic variables, electrolyte imbalances, pain, and itching are associated with diminished sleep quality (Huang et al., 2023). The contributors to sleep disturbances in dialysis patients have been categorized by Parker (Parker, 2003) and Merlino et al. (Merlino et al., 2008) into several groups: treatment-related factors (such as premature disconnection from dialysis machine, fluid and electrolyte imbalance, changes in medication, and dialysis scheduling); psychological factors (including stress, anxiety, depression, and concerns); factors related to disease (like co-morbidities, anemia, uremia, and metabolic alterations); lifestyle factors (such as excessive caffeine intake, smoking, and inadequate sleep hygiene); and demographic factors (including advanced age, gender, and ethnicity).

Assess sleep quality and predicting factors among patients undergoing hemodialysis.

Is sleep quality good or poor among patients undergoing hemodialysis?

What are the factors affecting sleep pattern among patients undergoing hemodialysis?

What are the predicting factors affecting sleep quality among patients undergoing hemodialysis?