The decrease in sleep quality leads to an increased risk of cardiovascular disease and is closely related to the prognosis of various diseases. However, the relationship between preoperative sleep quality and postoperative clinical outcomes in patients with acute aortic dissection is still unclear. We aimed to assess the relationship between sleep quality and the clinical outcomes of acute aortic dissection. We assessed participants' sleep quality and the clinical outcomes of acute aortic dissection, which included prolonged mechanical ventilation, postoperative delirium, in-hospital death, continuous renal replacement therapy, intensive care unit stay time, and length of stay. Patients were divided into good sleep quality group (n = 103) and poor sleep quality group (n = 113). Postoperative delirium, in-hospital death, prolonged mechanical ventilation and intensive care unit stay time were significantly increased in the poor sleep quality group when compared with the good sleep quality group (p < 0.05). Multivariate regression analysis showed that the poorer sleep quality, the greater the risk of in-hospital death (odds ratio = 3.451, 95% confidence interval 1.19-10.004) and prolonged mechanical ventilation (odds ratio = 6.302, 95% confidence interval 3.105-12.791), and the longer intensive care unit stay time (β = 62.37, 95% confidence interval 22.411-102.329). In addition, the higher the incidence of smoking history (odds ratio = 7.417, 95% confidence interval 2.425-22.684), poor sleep quality (odds ratio = 11.59, 95% confidence interval 3.844-34.942) and postoperative delirium (odds ratio = 5.1, 95% confidence interval 1.793-14.504), the greater the risk of prolonged mechanical ventilation. Our findings revealed that poor sleep quality may be a risk factor for adverse clinical outcomes of acute aortic dissection. Rapid assessment of self-reported sleep quality may be a simple and effective way to identify patients with acute aortic dissection who are at high risk for prolonged mechanical ventilation.