Key words : Influencing factor, Quality of life, Renal transplantation, Sleep disturbance

Introduction

Kidney transplant has become a cornerstone treatment for end-stage renal disease as a result of continuous advancements in medical technology, which have substantially improved patient survival rates and quality of life.¹ Although the procedure itself demonstrates clinical success, posttransplant quality of life remains suboptimal because of persistent comorbidities and complications. Among these, sleep disturbances have emerged as a particularly prevalent and clinically significant issue, affecting approxi-mately 67% of kidney transplant recipients. Common manifestations include insomnia (characterized by difficulty initiating or maintaining sleep), excessive daytime somnolence, restless leg syndrome, recurrent nocturnal awakening, and disturbing dream phenomena.^2,3 The persistence of sleep-related anxiety in this population carries multidimensional clinical implications. Beyond the impairments to posto-perative physiological recovery, sleep-related anxiety adversely affects psychological well-being, psycho-social rehabilitation, and long-term functional adaptation.⁴

Sleep, a critical neurobiological mechanism that supports physiological and psychological restoration, plays an essential role in systemic recovery for posttransplant patients. However, emerging clinical evidence has shown sustained sleep architecture disruptions in this vulnerable group, marked by elevated sleep-related anxiety levels and reduced sleep efficiency indices.^5,6 These disturbances not only restrict daily activities but may also elevate risks of postoperative complications and delay recovery.⁷ Despite these challenges, research investigating the heterogeneity of sleep-related distress among Chinese kidney transplant recipients remains limited. A deeper understanding of latent symptom profiles and deter-minants of sleep anxiety in this population could in-form targeted interventions to improve quality of life.

In this study, we used latent profile analysis to classify renal transplant recipients based on sleep anxiety characteristics, elucidating both shared and divergent symptom clusters across subgroups. Through comprehensive multivariate analysis, we systematically examined multidimensional factors influencing sleep anxiety patterns. The identification of predictive factors will advance our understanding of the pathophysiology of posttransplant sleep disturbance and facilitate the development of personalized nursing protocols. These insights are anticipated to optimize clinical management strategies and enhance long-term outcomes in transplant care.

Materials and Methods

Design
We conducted a cross-sectional study with con­venience sampling to enroll kidney transplant recipients treated in the renal transplant department of a tertiary care center between October 2023 and October 2024. Data were collected through structured questionnaire administration. We followed relevant guidelines and principles of the Declaration of Helsinki. We obtained required formal acceptance and permission to conduct the study from the Research Ethics Committee of the Faculty of Nursing, The Second Xiangya Hospital of Central South University, Changsha, China. Informed written consent was received from study participants. The Ethics Committee of the Second Xiangya Hospital of Central South University approved the study (approval No. LYF20240146).

Participants
Inclusion criteria were as follows: (1) first-time kidney transplant recipients with donors restricted to relatives (up to the fourth degree) or spouses of recipients; (2) donors aged ≥18 years; (3) normal consciousness and psychiatric status in recipients; and (4) possession of basic comprehension and com-munication skills, enabling independent completion of questionnaires or completion with investigator assistance. Exclusion criteria were as follows: (1) patients undergoing multiorgan transplant; (2) patients diagnosed with psychiatric disorders; and (3) patients who declined to participate in the study.

Sample size
We determined that the minimum sample size required for latent profile analysis was 200 cases to reliably identify the optimal number of latent catego-ries. To account for an anticipated 20% attrition rate, we adjusted the target sample size to 250 cases. We ultimately enrolled 259 kidney transplant recipients, exceeding the calculated minimum requirement. Ethical approval and study permission were formally granted by the Research Ethics Committee of the Nursing Faculty at The Second Xiangya Hospital, Central South University (Changsha, China).

Study tools
Sociodemographic variables.
We collected demographic and clinical data of respondents, including age, sex, occupation, edu-cation level, marital status, and payment methods for medical expenses. Clinical data included source of transplanted kidneys, whether delayed recovery of transplanted kidney function occurred after surgery, whether there were other complications, and whether dialysis was performed.

Anxiety and Preoccupation About Sleep Question-naire.
This sleep anxiety scale, originally developed by Jansson Fröjmark and translated/adapted into Chinese by Shi Xuliang,⁸ comprises 10 items rated on a 5-point Likert scale (from 1 = strongly disagree to 5 = strongly agree). Total scores range from 10 to 50, with higher scores indicating greater severity of sleep anxiety. The scale demonstrated excellent internal consistency (Cronbach α = 0.938).

Athens Insomnia Scale
The Athens Insomnia Scale is an 8-item instrument that uses a 4-point severity scale (from 0 = no difficulty to 3 = severe impairment/inability to sleep), yielding total scores of 0 to 24. Scores are categorized as follows: <4 (no disorder), 4 to 6 (subclinical insomnia), and ≥7 (clinical insomnia).⁹ The scale exhibited excellent reliability in our sample (Cronbach α = 0.925).

Self-Regulated Fatigue Scale
The Chinese adaptation of Nes’s Self-Regulated Fatigue Scale,¹⁰ validated by Wang and colleagues,¹¹ assesses 3 domains (cognitive, emotional, behavioral) through 16 items. Items are rated on a 5-point Likert scale (from 1 = strongly disagree to 5 = strongly agree), with total scores of 16 to 80 positively correlating with self-regulated fatigue severity. The scale showed good reliability in our cohort (Cronbach α = 0.856).

Data collection
Participants received anonymized questionnaires after providing written informed consent. Before informed consent, researchers explained the study’s purpose and the confidentiality protocols during face-to-face visits. Of 263 questionnaires that were distributed, 259 were valid (98.5% response rate; 4 excluded due to incompleteness).

Pilot study
The research team received standardized training to ensure protocol adherence. The research team administered questionnaires (10-15 min completion time) in person, with compensation provided after completion. For participants with literacy barriers, the team administered the questions orally, with responses documented by staff. Data underwent dual-entry verification after incomplete and inconsistent questionnaires were excluded (quality-controlled screening), with statistical experts ensuring analytical validity.

Statistical analyses
We used SPSS version 26.0 software and Mplus8.3 software for data management and statistical analysis. According to the explicit variable of sleep anxiety as a continuous variable, we used latent profile analysis for analysis. The model category gradually increases from “1,” and the optimal model is selected by comparing the fitting indicators and actual meanings between the models. For fitting indicators, we included Akaike information criterion, Bayesian information index, and adjusted Bayesian information. The smaller the statistical value, the better the model fit. The range of entropy values was from 0 to 1. The closer the entropy was to 1, the higher the classification accuracy. The comparison of model fitting differences uses likelihood ratio test and bootstrap-based likelihood ratio test. P < .05 indicated that the model with k categories was better than the model with k-1 categories. We presented count data as numbers and percentages and used the X² test to make comparisons between groups. We used the normality test on measurement data for normal distribution, with data presented as mean ± SD. We used the t test for intergroup comparison. We used logistic regression analysis for multivariate analyses, with P < .05 indicating significant differences.

Results

Score of various scales in patients after kidney transplant
Our study included 259 kidney transplant recipients aged 50.46 ± 11.71 years; mean sleep anxiety scale score was 40.38 ± 4.316 for kidney transplant recipients. Mean score of the Athens Insomnia Scale was 9.529 ± 3.324 points, and mean score of the Self-Regulated Fatigue Scale was 47.03 ± 3.108 points.

Analysis of sleep anxiety in patients after kidney transplant
Based on the scores of items that assessed sleep anxiety in study patients, latent profile models with 1 to 5 categories were constructed. As the number of potential categories increased, the Akaike infor-mation criterion, Bayesian information index, and adjusted Bayesian information index values exhibited gradual declines. When we included 4 latent categories, the model demonstrated an entropy value of 0.913, with both the Lo-Mendell-Rubin adjusted likelihood ratio test and bootstrap-based likelihood ratio test yielding statistically significant results (P < .05). After comprehensive evaluation of model parsimony and fit indices, 3 categories were ultimately selected for interpretation. Detailed results are presented in (Table 1).

Characteristics and naming of potential profiles of sleep anxiety status
According to the latent profile analysis of sleep anxiety item scores in kidney transplant recipients derived from model 3 (Figure 1), 3 distinct subca-tegories were identified. Category 1, characterized by uniformly low scores across all items, was labeled the “low-level sleep anxiety group” (16.6% of patients). Category 2, characterized by intermediate scores (higher than category 1 but lower than category 3), was designated the “moderate sleep anxiety group” (23.2% of patients). Category 3, characterized by elevated scores on all metrics, was classified as the “high-level sleep anxiety group” (60.2% of patients).

Univariate analysis of potential category influencing factors of sleep anxiety
Results of univariate analysis showed that sex, age, education level, occupational status, presence or absence of complications, per capita monthly income of the family, the Athens Insomnia Scale, and the Self-Regulated Fatigue Scale demonstrated significance (P < .05) with regard to sleep anxiety status of patients (Table 2).

Multivariate analysis of potential category influencing factors of sleep anxiety
Multivariate logistic regression was performed using the 3 latent sleep anxiety profiles as the dependent variable and all univariately significant predictors (α = 0.05) serving as covariates. Continuous variables (self-regulated fatigue scores, insomnia severity) were entered as raw measurements, whereas the categorical variables followed the codingscheme detailed in (Table 3). Final regression coefficients and significance thresholds are presented in (Table 4).

Discussion

Population heterogeneity in sleep anxiety among kidney transplant recipients
Our study identified 3 distinct sleep anxiety profiles among kidney transplant recipients through latent profile analysis: a low-level sleep anxiety group, a moderate-level sleep anxiety group, and a high-level sleep anxiety group. The low-level group demonstrated significantly lower scores across all assessment items compared with the other 2 profiles. With the low-level group comprising 16.6% of the total cohort, we showed that <20% of patients exhibited relatively low levels of sleep anxiety. Analysis of characteristics revealed that the low-level group was younger and had higher educational attainment than the other groups and had clinical features that included self-reported insomnia and reduced fatigue levels. These traits were associated with enhanced disease acceptance and self-regulatory capacity. Although the low-level anxiety group had the lowest sleep anxiety levels among the identified profiles, this group remains clinically important. Targeted interventions addressing specific vulnerability factors should be implemented to mitigate potential progression to heightened anxiety states.

The moderate-level (23.2%) and high-level (60.2%) sleep anxiety groups comprised 83.4% of the cohort. These groups demonstrated elevated scores across all sleep anxiety domains, coupled with substantial insomnia symptoms and self-reported fatigue. This clinical pattern likely originated from a cyclical relationship where sleep disturbances engender anxiety about potential consequences including impaired physical recovery, reduced social functioning, occupational limitations, and emotional distress secondary to chronic sleep deprivation.¹²

Sleep disturbances in kidney transplant recipients typically present with impaired sleep architecture characterized by reduced total sleep time, prolonged sleep latency, diminished sleep efficiency, and excessive daytime somnolence. The multifactorial etiology of these disturbances includes physiological determinants, psychological determinants, and behavioral and environmental determinants.

Physiological determinants include postoperative complications, such as surgical site pain, transplant-related discomfort (including suboptimal graft care sequelae), and side effects from medications, collectively compromising sleep quality.¹³ Patients can have pharmacological contributors, including immunosuppressive regimens, particularly high-dose corticosteroids, which may induce central nervous system stimulation linked to sleep initiation difficulties. Concurrently, calcineurin inhibitors such as tacrolimus are associated with neuropsychiatric sequelae including cephalalgia and psychological distress, resulting in secondary sleep disruption.¹⁴ Patients may also have gastrointestinal pathop-hysiology: postoperative ileus frequently induces intestinal distention through gas accumulation, creating mechanical discomfort that disrupts sleep architecture. Positional constraints may occur from use of mandatory postoperative positioning to mitigate surgical site tension and vascular strain, often resulting in musculoskeletal discomfort and contributing to sleep fragmentation.

Psychological determinants include perioperative psychological burden, which is the protracted disease trajectory involving prolonged pretransplant dialysis and establishing a neurochemical vulne-rability to anxiety-depression spectrum disorders. Postoperatively, heightened recovery expectations coupled with outcome uncertainty exacerbate this predisposition. Psychological determinants may result from financial toxicity. Substantial treatment-related expenditures impose financial strain, potentiating neuroendocrine stress responses that interact bidirectionally with sleep regulation mechanisms.^15,16 Environmental disruptions may occur during hospitalization, with alterations in ward conditions and established behavioral patterns inducing emotional dysregulation in patients and contributing to sleep architecture disturbances.

Behavioral and environmental determinants can include dietary patterns, including evening hyperphagia and caffeine consumption before sleep. Sleep-disruptive environmental conditions include excessive ambient noise, inadequate light regulation, and suboptimal thermal conditions. Such patients can be treated with pharmacological management (hypnotic agent administration under clinical supervision) and immunosuppressant regimen optimization (dose titration and neurotolerant agent substitution) to mitigate medication-induced sleep disturbances. Patients can also receive nonpharma-cological approaches, including cognitive-behavioral interventions (mindfulness-based stress reduction protocols and progressive muscle relaxation training), psychoeducation for anxiety/depression symptom management, and other methods. To improve lifestyle habits, patients should be advised to maintain consistent sleep-wake cycles while avoiding strenuous physical activity and consumption of caffeinated or stimulant-containing beverages in the evening hours before bedtime. Moderate-intensity aerobic exercise (eg, brisk walking, light jogging) within individual physical tolerance thresholds may also contribute to ameliorate sleep disturbances, enhance overall quality of life, and facilitate recuperative processes.

Effect of demographic and clinical characteristics on sleep anxiety
Multiple logistic regression analysis identified sex, educational attainment, monthly household income, and comorbidity burden as factors independently associated with postoperative sleep-related anxiety among renal transplant recipients. The mechanisms and patient-specific recommendations are elaborated as described here.

First, with regard to sex, logistic regression analysis revealed that female renal transplant recipients versus male renal transplant recipients had significantly higher propensity for moderate-level sleep anxiety than low-level sleep anxiety (odds ratio = 0.134, P < .001). This sex-based disparity may originate from fundamental psychological divergen-ces in stress adaptation, pain perception, and chronic disease management. Female patients frequently exhibit heightened emotional expressivity and somatic awareness, potentially amplifying postoper-ative concerns about sleep quality and recovery trajectories.^17,18 We recommend that clinical teams implement sex-specific psychological support proto-cols, prioritizing targeted emotion regulation training and evidence-based sleep hygiene education for female transplant recipients. Interventions should incorporate psychoeducational components address-ing sex-nuanced coping patterns, while integrating cognitive-behavioral strategies for catastrophic thinking reduction.

Second, regarding educational level, our study found that patients with lower educational attainment were more likely to experience moderate-level and high-sleep anxiety than low-level sleep anxiety. This association may reflect education’s role in shaping health literacy, treatment adherence, and prioritization of self-care. Highly educated indivi-duals typically demonstrate stronger comprehension and application of medical information, enabling them to integrate clinical guidance into daily practice. Such skills facilitate proactive management of sleep-related challenges, including targeted behavioral adjustments and informed utilization of health care resources.¹⁹ We recommend implemen-tation of education-tiered communication by adapting medical explanations in accordance with literacy levels of patients (eg, plain language, visual guides) and integrating teach-back methods. This should be complemented with curated educational resources to foster self-efficacy in health management, addressing knowledge gaps that exacerbate sleep anxiety in less-educated populations.

Third, with regard to income, our logistic regres-sion analysis showed that patients with a per capita monthly household income exceeding ¥5000 were significantly more likely to be classified into the low-level sleep anxiety group than in the moderate-level sleep anxiety group (odds ratio = 0.221, P = .027). Economic status emerged as a significant deter-minant of psychological well-being and health-seeking behaviors. Regions with lower average household incomes may experience heightened financial stress, potentially manifesting as sleep-related concerns. Conversely, patients with stronger financial capacity demonstrated greater motivation for self-management, enabling them to adopt targeted interventions that facilitate disease recovery.²⁰ We recommend that health care systems and community stakeholders should prioritize socioeconomic inter-ventions for low-income patients, including targeted financial subsidies and enhanced care accessibility. These measures would alleviate socioeconomic constraints, thereby impro-ving psychological well-being and sleep quality through reduced treatment-related stressors.

With respect to accompanying complications, we demonstrated that renal transplant recipients with postoperative complications exhibited significantly higher odds of classification in the high-level sleep anxiety category than in the low-level sleep anxiety group (odds ratio = 0.316, P = .004). Posttransplant complications, including infection and rejection, were found to impair physiological recovery while concurrently inducing psychological distress, thereby establishing a mechanistic link to exacerbated sleep-related apprehensions.²¹ We recommend that health care providers prioritize vigilant monitoring for posttransplant complications in renal transplant recipients, initiate prompt therapeutic interventions, and deliver structured psychosocial support to enhance disease coping efficacy, thereby mitigating sleep-related distress through improved physio-logical and psychological stabilization.

Impact of insomnia on potential categories of sleep anxiety
Logistic regression analysis revealed a significant dose-response relationship between insomnia severity and sleep anxiety among renal transplant recipients. Patients classified in the moderate-level and high-level sleep anxiety cohorts exhibited markedly greater insomnia severity than the low-anxiety group, with anxiety levels demonstrating a proportional escalation to worsening sleep distur-bances. These may be because postoperative renal transplant recipients who experience insomnia frequently develop heightened sleep-related anxiety, establishing a self-perpetuating cycle where sleep preoccupation exacerbates insomnia severity.²² Apprehension before sleep about perceived inability to initiate sleep amplifies physiological arousal, directly impairing sleep onset efficiency. Chronic sleep disruption elevates psychological distress, fostering maladaptive hypervigilance toward sleep-related stimuli.

Insomnia-induced diurnal dysfunction in renal transplant recipients manifests as mental fatigue, attention deficits, and memory impairment. These cognitive deficits foster maladaptive hypervigilance toward sleep-related stimuli, amplifying sleep-related distress while progressively eroding self-efficacy regarding sleep improvement.²³

Physiological consequences can occur; chronic insomnia precipitates somatic manifestations, including dizziness, tinnitus, and psychophysical exhaustion in transplant recipients. Prolonged sleep disruption potentiates pathological progression through cardiometabolic comorbidity activation, thereby exacerbating somatosensory amplification and perpetuating maladaptive sleep-related cognitions.²⁴

Sociofunctional impairment can occur, with chronic insomnia inducing affective dysregulation in transplant recipients, compromising occupational performance and social reciprocity. This deterioration fosters maladaptive emotional states characterized by occupational learned helplessness, while simul-taneously perpetuating sleep-related cognitive distortions through reciprocal neurobehavioral pathways.²⁵

Insomnia progression mechanistically amplifies sleep-related distress through 4 interlinked pathways: potentiation of anxiety neurocircuitry, degradation of neurocognitive performance, exacerbation of somatic comorbidities, and disruption of psychosocial functioning. These pathophysiological interactions establish a self-reinforcing cycle of pathological sleep preoccupation. Consequently, early intervention through evidence-based sleep hygiene protocols and cognitive-behavioral therapy for insomnia represents a critical intervention pathway for attenuating mala-daptive sleep cognitions. Public health initiatives should also be used, such as health literacy campaigns for at-risk populations, coupled with multidis-ciplinary care models that address insomnia’s biopsychosocial determinants.

Potential effect of self-regulated fatigue on sleep anxiety categories
Self-regulated fatigue can substantially influence the subtypes of sleep anxiety in kidney transplant recipients. Compared with the low-level sleep anxiety group, patients in the moderate-level and high-level sleep anxiety groups exhibited elevated levels of self-regulated fatigue. The severity of sleep anxiety in kidney transplant recipients was positively associated with the degree of self-regulated fatigue, indicating a dose-response relationship between these clinical parameters. These may be due to depletion of psychological resources, compromised emotion regulation capacity, and deficient coping strategy implementation.

Depletion of psychological resources occurs when self-regulation fatigue depletes psychological resources, rendering individuals more susceptible to feelings of powerlessness and anxiety when confronting sleep-related challenges.²⁶ Depletion of psychological resources impairs self-regulatory capacity to manage cognitive intrusions before sleep, thus increasing vulnerability to exacerbated nocturnal anxiety symptoms.

Compromised emotion regulation capacity occurs when self-regulation fatigue induces dose-dependent erosion of affective modulation mechanisms, with clinically significant levels correlating with mala-daptive responses to anxiety and depression spectrum symptoms.²⁷ These negative emotions exacerbate sleep-related anxiety, thereby perpetuating a vicious cycle.

Deficiencies in coping strategy implementation occur when self-regulation fatigue compromises the employment of adaptive coping mechanisms for sleep-related challenges, fostering perceived helples-sness and maladaptive cognitive patterns that intensify nocturnal apprehension through cognitive-affective reinforcement pathways.²⁸ Patients in the elevated sleep anxiety groups exhibit heightened pre-occupation with sleep-related concerns. Elevated self-regulation fatigue may potentiate worry severity, further impairing sleep initiation and maintenance. These individuals require targeted psychological interventions, such as cognitive-behavioral therapy, relaxation training, and evidence-based anxiety mitigation strategies, to disrupt the self-reinforcing cycle of sleep-related distress.²⁹ Patients in the low-level sleep anxiety cohort demonstrated lower sleep-related hypervigilance. Nevertheless, self-regulation fatigue may still precipitate subclinical sleep anxiety manifestations in this population, underscoring the importance of preserving optimal sleep hygiene and self-regulation capacity. Intermediate-level sleep anxiety phenotypes can emerge from multifactorial interactions, including self-regulation fatigue severity, insomnia comorbidity, psychophysiological stress load, and exogenous environmental disruptors. Management requires multidimensional assessment to formulate stratified intervention protocols.

Specific interventions for different sleep anxiety groups
Interventions for the low-level sleep anxiety cohort (16.6% of study population) include prophylactic maintenance through circadian-aligned sleep hy-giene optimization (including stabilized sleep-wake schedules, psychoactive substance modulation) complemented by evidence-based relaxation protocols (diaphragmatic breathing, progressive muscle relaxation). Implementation of structured follow-up intervals with longitudinal polysomnographic monitoring is recommended to preempt phenotypic shifts toward clinical anxiety thresholds.

Interventions for the moderate-level sleep anxiety cohort (23.2% of study population) should include dual-pathway intervention targeting symptom-emotion interactions. On the insomnia axis, pro-tocolized cognitive-behavioral therapy for insomnia should be prioritized to modify maladaptive sleep-related cognitions and safety behaviors. Concurrently, the affect regulation axis necessitates multimodal psychological support that would combine anxiety-specific cognitive restructuring protocols and peer-mediated support collectives to facilitate structured case-based peer learning. This integrated approach can enhance disease-specific self-efficacy while mitigating symptom escalation risks through behavioral activation and social cognitive reinforcement.

Interventions for the high-level sleep anxiety group (60.2% of study population) should include a multidisciplinary collaborative intervention frame-work to include medical evaluation (screening for comorbidities such as depression and anxiety by psychiatrists and initiating medication interventions if necessary); treatment optimization (adjust immuno-suppressive regimen in conjunction with the pharmacy department, such as replacing neuroexcitatory drugs) to reduce drug-induced sleep disturbances; and psychological and social support (adopting high-intensity psychotherapy, such as acceptance and commitment therapy) to reconstruct the relationship between patients and sleep concerns, while simultane-ously providing social resource links (such as guidance on medical expense reduction policies and vocational rehabilitation counseling). These interventions can systematically block the negative cycle of sleep concern to insomnia to self-regulation exhaustion.

Limitations and Future Directions of Research

Our study had several limitations. First, the exclusive recruitment of participants from a single tertiary hospital introduced potential limitations in generalizability because of regional homogeneity in health care access and sociocultural characteristics. Geographic variations in medical infrastructure, socioeconomic status, and cultural health beliefs may differentially influence sleep anxiety phenotypes. Future multicenter investigations should incorporate diverse demographic and socioeconomic populations to enhance external validity. Second, the cross-sectional design inherently restricted temporal analysis, capturing only static snapshots of posttransplant sleep anxiety rather than its longitudinal trajectory or cumulative clinical impacts. Prospective cohort studies that use repeated measures are needed to elucidate dynamic interactions between sleep anxiety fluctua-tions and rehabilitation outcomes. Finally, the lack of systematic comorbidity documentation can present opportunities for refinement. Subsequent research should integrate comprehensive clinical profiling with latent class analysis to inform the development of phenotype-specific intervention algorithms.

Conclusions

This study identified 3 distinct sleep anxiety profiles among kidney transplant recipients through latent profile analysis, demonstrating significant popu-lation heterogeneity. The sleep anxiety profiles in transplant recipients exhibited marked complexity and diversity, with sex, educational level, monthly income, insomnia severity, and self-reported fatigue levels emerging as key determinants. These findings underscore the necessity for clinicians to implement tailored, evidence-based intervention strategies aligned with specific clinical and phenotypic characteristics of patients. This study not only potentially improves the understanding of sleep problems in kidney transplant recipients but also provides new ideas and directions for developing personalized intervention strategies and improving sleep quality and quality of life among transplant patients. A large, multicenter longitudinal survey in the future could find further potential profile categories and characteristics and enhance the reliability of research conclusions.

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