Factors associated with insomnia in hemodialysis patients: A protocol for systematic review and meta-analysis

Introduction: Insomnia is a prevalent sleep disorder among hemodialysis (HD) patients, significantly impairing quality of life and increasing mortality risk. However, current evidence regarding the factors associated with insomnia in this population remains inconsistent. This systematic review and meta-analysis aim to comprehensively identify and synthesize the physiological, psychological, and dialysis-related factors associated with insomnia in HD patients. Methods: We will systematically search PubMed, Web of Science, Cochrane Library, EMBASE, CINAHL, CNKI, SinoMed, and Wanfang Data from inception to February 1, 2026. We will include observational studies (cohort, case-control, and cross-sectional) investigating potential associated factors for insomnia in adult HD patients. Two reviewers will independently screen titles, abstracts, and full texts, extract data, and assess the risk of bias using the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality methodology. Data synthesis will be performed using RevMan 5.4 and Stata 16.0 software. We will calculate Odds Ratios and Mean Differences with 95% Confidence Intervals. Given the anticipated heterogeneity, a random-effects model will be employed. Subgroup and sensitivity analyses will be conducted to explore sources of heterogeneity. The certainty of the evidence will be evaluated using the GRADE system. Discussion: This study will represent a comprehensive systematic review integrating factors associated with insomnia in HD patients. By applying the GRADE system, this review will systematically evaluate the strength and certainty of evidence for each identified factor. The anticipated findings will guide the development of targeted preventive strategies and personalized management protocols, ultimately improving sleep quality and prognosis for HD patients. Trial registration: PROSPERO (CRD420251241385).