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

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 are less studied and may reflect waking emotional burden, but their clinical relevance in dialysis populations remains uncertain. This study assessed sleep quality, dream characteristics, and psychological distress among patients with CKD and identified factors independently associated with distress. Methods A descriptive cross-sectional study was conducted among 422 adults with CKD receiving maintenance dialysis at the National Nephrology Specialised Hospital, Polonnaruwa, Sri Lanka, recruited by consecutive non-probability sampling. Data were collected using an interviewer-administered questionnaire incorporating the Pittsburgh Sleep Quality Index (PSQI), the Depression Anxiety Stress Scales-21 (DASS-21), six selected items from the Mannheim Dream Questionnaire (MADRE), and four additional study-specific dream items. 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 (67.1% 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), and within-sample tertiles showed that psychological symptom burden was widely distributed. 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 < 0.001), nightmare frequency (β = 0.27, p < 0.001), male sex (β = 0.10, p = 0.006), longer dialysis duration (β = 0.10, p = 0.008), global PSQI score (β = 0.09, p = 0.011), and unemployment (β = 0.08, p = 0.026) were positively associated with distress, while being married was inversely associated (β = − 0.09, p = 0.023; adjusted R 2 = 0.43). Conclusions Poor sleep and psychological symptom burden were common among patients receiving dialysis. Distressing dream features were associated with psychological distress after adjustment for sleep and socio-demographic factors, but the cross-sectional design and absence of a comparison group do not establish causality or a CKD-specific excess of nightmares. Sleep and psychological assessment should remain clinical priorities; targeted enquiry about recurrent distressing dreams may be useful in symptomatic patients and warrants further evaluation.