Sleep disruption is highly prevalent among patients undergoing maintenance haemodialysis and has been associated with autonomic dysfunction and haemodynamic instability. However, previous studies have primarily examined individual haemodynamic parameters, providing limited understanding of the relationship between sleep quality and fluctuations in vital signs. To examine the association between sleep quality and fluctuations in blood pressure, pulse rate, and respiratory rate among patients undergoing maintenance haemodialysis. An analytical observational study with a cross-sectional design was conducted among 100 patients with end-stage kidney disease undergoing routine haemodialysis. Participants were selected using total sampling. Sleep quality was assessed using a structured questionnaire that had been tested for validity and reliability. The validity test demonstrated that all questionnaire items were valid, while the reliability test showed good internal consistency, with a Cronbach's alpha coefficient of ≥ 0.70. Haemodynamic parameters, including blood pressure, pulse rate, and respiratory rate, were measured using standard clinical equipment and classified as normal or abnormal according to established clinical criteria. Data were analysed using descriptive statistics and the Chi-square test, with statistical significance set at p < 0.05. Poor sleep quality was identified in 58.0% of participants. Significant associations were observed between sleep quality and all assessed haemodynamic parameters. Participants with good sleep quality were more likely to have normal blood pressure (76.2% vs. 39.7%; p < 0.001), normal pulse rate (81.0% vs. 50.0%; p = 0.002), and normal respiratory rate (83.3% vs. 56.9%; p = 0.006) compared with those reporting poor sleep quality. Sleep quality was significantly associated with blood pressure, pulse rate, and respiratory rate among patients undergoing maintenance haemodialysis. Participants with poor sleep quality had a higher proportion of abnormal haemodynamic parameters.