Dreaming, sleep quality, and psychological distress among patients with chronic kidney disease at a national nephrology hospital in Sri Lanka: a descriptive cross-sectional study

Abstract Background Chronic kidney disease (CKD) imposes substantial psychological and sleep-related burdens that are frequently underdiagnosed in low- and middle-income countries (LMICs). Dream characteristics, an understudied marker of psychological state, have not previously been examined in CKD populations in Sri Lanka. This study assessed sleep quality, dream characteristics, and psychological distress among patients with CKD and identified independent factors associated with distress.

Methods: A descriptive cross-sectional study was conducted among 422 adult patients with CKD receiving dialysis at the National Nephrology Specialised Hospital, Polonnaruwa, Sri Lanka, recruited by convenience sampling. Data were collected using an interviewer-administered questionnaire incorporating the Pittsburgh Sleep Quality Index (PSQI), the Depression Anxiety Stress Scales-21 (DASS-21), and items adapted from the Mannheim Dream Questionnaire (MADRE). Associations were examined using chi-square tests, Spearman correlations, and multiple linear regression, with Benjamini-Hochberg correction for multiple comparisons and significance set at p < 0.05.

Results: Of 422 participants (67.4% male; mean age 54.6 ± 11.5 years), 304 (72.0%) were poor sleepers (mean global PSQI = 9.58 ± 3.85). The mean total DASS-21 score was 20.71 (SD 10.34), with approximately one-third of participants classified into each of the low, moderate, and high distress categories. In bivariate analysis, distress was associated with gender (Cramér's V = 0.22), age group (V = 0.16), employment (V = 0.13), religion (V = 0.16), and dialysis duration (V = 0.18). Six of the ten dream characteristics were significantly correlated with distress, the strongest being nightmare distress (ρ = 0.50), dream-related sleep disturbance (ρ = 0.47), and nightmare frequency (ρ = 0.46). In multiple linear regression, dream-related sleep disturbance (β = 0.34, p < .001), nightmare frequency (β = 0.27, p < .001), and male sex (β = 0.10, p = .006) remained independently associated with distress (adjusted R² = 0.43).

Conclusions: Poor sleep, moderate psychological distress, and emotionally charged dreaming were common among patients with CKD. Nightmare frequency was independently associated with distress after adjustment for socio-demographic and sleep variables. Routine psychological and sleep screening, including enquiry about distressing dreams, should be incorporated into nephrology care in Sri Lanka and comparable LMIC settings.