Non-Pharmacological Interventions for Sleep Quality and Related Symptoms in Patients with End-Stage Renal Disease: A Systematic Review and Meta-Analysis.

BACKGROUND: Sleep-related problems are common among patients receiving dialysis for end-stage renal disease (ESRD), while pharmacological management may be complicated by comorbidities, polypharmacy, and altered drug clearance. This systematic review and meta-analysis evaluated the effects of non-pharmacological interventions on sleep-related outcomes, anxiety symptoms, depressive symptoms, and fatigue symptoms in this population. METHODS: PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception to February 2026. The prespecified eligibility criterion was restricted to randomized controlled trials (RCTs) involving adults with ESRD receiving hemodialysis or peritoneal dialysis and reporting an eligible sleep-related outcome. One quasi-cluster randomized trial was retained as a documented protocol deviation. Standardized mean differences (SMDs) calculated using Hedges' g and 95% confidence intervals (CIs) were pooled using random-effects models with restricted maximum-likelihood estimation and the Hartung-Knapp-Sidik-Jonkman adjustment (REML-HKSJ). Risk of bias was assessed using the revised Cochrane Risk of Bias tool for randomized trials (RoB 2), and evidence certainty was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. PROSPERO: CRD420251123449. RESULTS: The 19 RCTs and one quasi-cluster randomized trial contributed an effective sample size of 1294 participants. The pooled estimate favored non-pharmacological interventions for sleep-related outcomes (Hedges' g = -0.820, 95% CI -1.188 to -0.451; p = 0.0002), with substantial heterogeneity (I2 = 83.1%; τ2 = 0.4879). The 95% prediction interval (PI) ranged from -2.325 to 0.685. The pooled effects on anxiety symptoms (Hedges' g = -0.29, 95% CI -0.99 to 0.41; p = 0.219), depressive symptoms (Hedges' g = -0.64, 95% CI -2.32 to 1.04; p = 0.313), and fatigue symptoms (Hedges' g = -0.41, 95% CI -0.93 to 0.11; p = 0.087) were not statistically significant. Effect estimates differed significantly by comparator type (Q-between = 11.28, df = 2; p = 0.0036). CONCLUSIONS: Non-pharmacological interventions may improve sleep-related outcomes in patients receiving dialysis for ESRD. However, substantial heterogeneity and a prediction interval crossing the null value limit confidence in the pooled estimate. Current evidence does not demonstrate clear benefits for anxiety symptoms, depressive symptoms, or fatigue symptoms.