After removing duplicates from 587 reviews, 517 remained for title and abstract assessment, and 72 were retrieved for full-text review. Finally, 50 systematic reviews met the eligibility criteria and were included in the quality assessment. The IRR for title/abstract screening and full-text screening was k = 0.58001 and k  = 0.75294, respectively. Figure 1 outlines the flow of searches through the inclusion process.

Flow diagram indicating selection of articles

The critical appraisal scores of the 50 reviews ranged from 3 to 11; the median (interquartile) score was 11 (9.5, 11). Thirteen reviews (26%) did not assess the potential presence of publication bias and its impact on the results. Ten reviews (20%) either did not have evidence or were unclear regarding independent appraisal. Seven reviews (14%) either did not have evidence or were unclear regarding the study combination. A summary of the methodological quality of each criterion from the included reviews is presented in Table 1.

Table 2 reports the characteristics of the reviews included in this umbrella analysis. The 50 included reviews were published between 2007 and 2024, and 33 included a meta-analysis.

Three main aspects of sleep were observed: sleep apnoea (including sleep-disordered breathing), restless legs syndrome (including periodic limb movement syndrome) and other sleep disturbances (including sleep quality, poor sleep, insomnia, and total sleep time). Most reviews (72%, 36 reviews) were on other sleep disturbances, followed by seven reviews each on sleep disorders in restless legs syndrome and sleep apnoea. Five main focuses were identified in the included reviews: (1). Interventions (58%, 29 reviews), (2). Prevalence (28%, 14 reviews), (3). Health outcomes (10%, 5 reviews), (4). Determinants of sleep (2%, 1 review), and (5). Patient experience (2%, 1 review).

The study populations mainly consisted of patients on haemodialysis (HD) (44%, 22 reviews), followed by mixed stages of CKD patients (32%, 16 reviews) and a mix of kidney replacement therapy (KRT) (16%, 8 reviews). Fewer reviews examined specific groups, such as CKD not on dialysis (1 review), CKD pre-dialysis (1 review), elderly individuals (> 60 years old) with CKD receiving conservative management (1 review) and peritoneal dialysis (PD) patients (1 review). Instruments used to report sleep disturbances were not reported in three reviews [24, 34, 35]. A detailed description of the instruments is presented in Table 2.

The prevalence of sleep disturbances was investigated in three systematic reviews and four meta-analyses. The narrative findings from the three systematic reviews reported that sleep disturbances were one of the most prevalent symptoms in CKD patients [1], with a prevalence of over 40% [15, 36]. There was a slight study overlap among four meta-analyses (CCA: 1.55%, 129 primary studies). The pooled results from four meta-analyses [14, 37,38,39] demonstrated that the overall prevalence of sleep disturbance in people with CKD was 55% (95% CI 41, 69). The pooled prevalence of sleep disturbances for HD patients [14, 37, 39], CKD patients not receiving KRT [14, 38] and transplant recipients [14, 38] was 58% (95% CI 41, 74), 52% (95% CI 45, 59), and 34% (95% CI 23, 46), respectively (Fig. 2). A complete list of overlap graphs is included in Supplementary Table 3.

Summary pooled prevalence of sleep disturbances to different stages of CKD

Sleep apnoea prevalence was investigated in three meta-analyses and one systematic review. The systematic review [40] reported the prevalence of central sleep apnoea as 9.6% in people with CKD. There was a high overlap among the meta-analyses [16, 41, 42](CCA: 10.08%, 122 primary studies). Therefore, the prevalence is reported based on the most recent meta-analysis [16] that included 107 primary studies, demonstrating that the overall prevalence for CKD patients not on dialysis was 59% (95% CI 42, 71) and 49% (95% CI 47, 52) for the end-stage kidney disease population.

Three meta-analyses reported the prevalence of restless legs syndrome, and the overlap among these meta-analyses was very high (CCA: 23.08%, 127 primary studies). Therefore, the prevalence is reported based on the most recent review [17] that included 97 primary studies, demonstrating that the overall prevalence of restless legs syndrome in HD patients was 27.2%. Of the other two meta-analyses, one reported the prevalence across different stages of CKD [43], which showed a lower prevalence in the early stages of CKD (9.9%) and transplant recipients (6.7%). The prevalence of restless legs syndrome in Iranian HD patients was reported at 50% [34].

A total of twenty-nine reviews reported the effectiveness of interventions in improving sleep disturbances [18,19,20, 44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62], sleep apnoea [63, 64] and restless legs syndrome [21, 65,66,67]. These interventions were categorised into 12 groups of intervention namely; acupressure [18, 20, 48,49,50, 68, 69], exercise [18, 19, 55, 56, 65, 67, 68], aromatherapy [44, 46, 70], mindfulness [59, 60, 68], dialysis [53, 54, 63, 64], muscle relaxation [18, 58], music [57], acupuncture [51, 52], yoga [50, 61], combination of non-pharmacological [66], nurse-led disease management [62], and combination of pharmacological interventions [18, 21, 67]. Table 3 presents a summary of the results of interventions from the review and the overlap among reviews.

The effects of acupressure on sleep quality were reported in two systematic reviews and five meta-analyses. The two systematic reviews presented inconsistent results, with one including three studies [69] and the other six studies [50](Table 2). The overlap among the five meta-analysis reviews [18, 20, 48, 49, 68]was very high (CCA: 20.90%). Consequently, the pooled effect of acupressure was calculated from two non-overlapped meta-analysis [49, 68] and a Cochrane review [18], which found no significant difference in sleep quality with acupressure (mean difference (MD): – 0.51, 95% CI – 2.75, 1.73).

The effects of exercise on sleep quality were reported in four meta-analyses [18,