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Background <p>Insomnia is a common sleep disturbance that often co-occurs with anxiety. While insomnia is a known risk factor for anxiety, anxiety can also exacerbate insomnia. This hypothesis-driven study aimed to: (1) test whether patients of insomnia comorbid with anxiety exhibit greater subjective-objective sleep discrepancy than those with insomnia alone; and (2) identify risk factors for comorbidity and predictors of anxiety severity.</p> Methods <p>A total of 221 patients with insomnia were recruited and divided into an anxiety group (<i>n</i> = 163) and a non-anxiety group (<i>n</i> = 58) according to the Beck Anxiety Inventory (BAI) ≥ 10 points or &lt; 10 points. Subjective sleep and emotional states were assessed using the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Beck Depression Inventory (BDI), and BAI. Objective sleep parameters (e.g., total sleep time, sleep efficiency) were monitored via 7-day actigraphy (ACT). Differences and correlations among subjective scales and objective indicators were analyzed using Logistic regression and Spearman correlation analyses to identify sleep characteristics and risk factors for insomnia comorbid with anxiety.</p> Results <p>The anxiety group showed significantly higher PSQI, ISI, BDI, and BAI scores compared to the non-anxiety group (all <i>P</i> &lt; 0.001). Act data indicated that the anxiety group spent more time in bed (<i>P</i> = 0.017), but no significant differences were observed in total sleep time, sleep efficiency, sleep onset latency, or wake time after sleep onset (<i>P</i> &gt; 0.05). The anxiety group also exhibited more severe sleep disturbances and daytime dysfunction in PSQI subitems (<i>P</i> &lt; 0.05). Spearman correlation analysis revealed positive correlations between BAI grade and PSQI, ISI, and BDI grades (all <i>P</i> &lt; 0.05). Both univariate and multivariate binomial logistic regression analyses indicated that a disease duration of 36–120 months significantly increased the risk of insomnia comorbid with anxiety (<i>P</i> &lt; 0.05). Ordinal logistic regression further identified sleep efficiency (<i>P</i> = 0.008), sleep disturbances (<i>P</i>&lt;0.001) and daytime dysfunction (<i>P</i> = 0.043) as significant positive predictors of anxiety severity.</p> Conclusions <p>Patients of insomnia comorbid with anxiety report poorer subjective sleep quality, more depressive symptoms, and longer time in bed. PSQI, ISI, and BDI scores are associated with the development of insomnia comorbid with anxiety. Sleep efficiency, sleep disturbances, and daytime dysfunction are significant factors influencing anxiety severity. Disease duration is a core risk factor and should be addressed clinically through early intervention.</p>

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Sleep characteristics and risk factors in patients of insomnia comorbid with anxiety

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月21日

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  • Cong Wang,
  • Sangyi Lin,
  • Wenlin Xu,
  • Xinghong Bing,
  • Chaojun Fang,
  • Yijia Wan,
  • Shuo Jiang,
  • Na Zhao,
  • Chen Xie

摘要

Background

Insomnia is a common sleep disturbance that often co-occurs with anxiety. While insomnia is a known risk factor for anxiety, anxiety can also exacerbate insomnia. This hypothesis-driven study aimed to: (1) test whether patients of insomnia comorbid with anxiety exhibit greater subjective-objective sleep discrepancy than those with insomnia alone; and (2) identify risk factors for comorbidity and predictors of anxiety severity.

Methods

A total of 221 patients with insomnia were recruited and divided into an anxiety group (n = 163) and a non-anxiety group (n = 58) according to the Beck Anxiety Inventory (BAI) ≥ 10 points or < 10 points. Subjective sleep and emotional states were assessed using the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Beck Depression Inventory (BDI), and BAI. Objective sleep parameters (e.g., total sleep time, sleep efficiency) were monitored via 7-day actigraphy (ACT). Differences and correlations among subjective scales and objective indicators were analyzed using Logistic regression and Spearman correlation analyses to identify sleep characteristics and risk factors for insomnia comorbid with anxiety.

Results

The anxiety group showed significantly higher PSQI, ISI, BDI, and BAI scores compared to the non-anxiety group (all P < 0.001). Act data indicated that the anxiety group spent more time in bed (P = 0.017), but no significant differences were observed in total sleep time, sleep efficiency, sleep onset latency, or wake time after sleep onset (P > 0.05). The anxiety group also exhibited more severe sleep disturbances and daytime dysfunction in PSQI subitems (P < 0.05). Spearman correlation analysis revealed positive correlations between BAI grade and PSQI, ISI, and BDI grades (all P < 0.05). Both univariate and multivariate binomial logistic regression analyses indicated that a disease duration of 36–120 months significantly increased the risk of insomnia comorbid with anxiety (P < 0.05). Ordinal logistic regression further identified sleep efficiency (P = 0.008), sleep disturbances (P<0.001) and daytime dysfunction (P = 0.043) as significant positive predictors of anxiety severity.

Conclusions

Patients of insomnia comorbid with anxiety report poorer subjective sleep quality, more depressive symptoms, and longer time in bed. PSQI, ISI, and BDI scores are associated with the development of insomnia comorbid with anxiety. Sleep efficiency, sleep disturbances, and daytime dysfunction are significant factors influencing anxiety severity. Disease duration is a core risk factor and should be addressed clinically through early intervention.