Abstract
BackgroundThe epidemiological evidence on the association of sleep quality on anxiety symptoms has been inconclusive. This study aimed to explore the association between sleep quality and anxiety symptoms in rural Chinese population and investigate whether age, lifestyles, and chronic diseases modified this association.MethodsA total of 27,911 participants aged 18–79 years from the Henan Rural Cohort Study were included in the study. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) scale. Poor sleep quality was defined as PSQI ≥6. Anxiety symptoms were evaluated with the two-item generalized anxiety disorder scale (GAD-2). Individual with score ≥ 3 was viewed as having anxiety symptoms. Logistic regression and restricted cubic spline were conducted to examine the association of sleep quality with anxiety symptoms.ResultsAltogether, 6087 (21.80%) participants were poor sleepers and 1557 (5.58%) had anxiety symptoms. The odds of anxiety were increased with increment of PSQI score after fitting restricted cubic splines. The poor sleep quality was associated with a higher possibility of anxiety symptoms [odd ratio (OR): 4.60, 95% confidence interval (CI): 3.70–5.72] in men, and (OR: 3.56, 95% CI: 3.10–4.09) in women for multivariable analysis. Further, stratified analyses showed that the effect of sleep quality on anxiety symptoms could be modified by age, marital status, smoking status, drinking status, hypertension, and type 2 diabetes mellitus.ConclusionsA dose-response association between PSQI score and anxiety symptoms was found. In addition, the relationship between poor sleep quality and greater anxiety symptoms was observed in this rural population, especially in participants aged ≥60 years and those with unhealthy habits or had a chronic disease.Trial registrationThe trial was prospectively registered on July 6, 2015 and available online at ClinicalTrials.gov ID: ChiCTR-OOC-15006699.
Highlights
The epidemiological evidence on the association of sleep quality on anxiety symptoms has been inconclusive
To fill in the gap and add to the evidence for adverse effect of poor sleep quality on anxiety symptoms, this study was aimed at investigating the relationship between sleep quality assessed by Pittsburgh Sleep Quality Index (PSQI) and anxiety symptoms in Chinese rural population aged 18–79 years, and determined whether age, lifestyles and chronic diseases modified this association
This study presented the association between poor sleep quality and anxiety symptoms, which is consistent with a previous study that poor sleep quality was strongly associated with anxiety symptoms among women [41]
Summary
The epidemiological evidence on the association of sleep quality on anxiety symptoms has been inconclusive. This study aimed to explore the association between sleep quality and anxiety symptoms in rural Chinese population and investigate whether age, lifestyles, and chronic diseases modified this association. The prevalence of anxiety disorders was globally up to 15% in the general population [2]. It was reported that generalized anxiety disorder (GAD) was present in 8.4% of adults from the Manaus Metropolitan Region [3]. A web-based study showed a high prevalence of GAD and poor sleep quality in the Chinese public during COVID-19 outbreak [12]. Another study has shown that it is difficult to determine the cause and effect of sleep disturbance and anxiety [17]
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