Study Finds Association Between Sleep Disorders and Anxiety

A man with insomnia looks at the clock at dawn from the bed with concern. Lifestyle concept
Among participants living in a culturally diverse area of Greece, people with anxiety were more likely to experience loss of sleep or other sleep-related disorders.

People with anxiety were found to be 5 times more likely to experience lack of sleep or other sleep disorders, according to a study published in Psychiatry Research. Investigators also found that anxiety was more prominent among minorities, and rates of anxiety were slightly higher in men.

Sleep disturbances and anxiety disorders are common among the general population, and the former is frequently observed in individuals with the latter. The authors report that epidemiologic studies suggest that 24% to 36% of people with insomnia also experience anxiety. The relationship is bidirectional: sleep disturbances may surface as symptoms of mental disorders or they may play a role in the development of anxiety.

The researchers conducted a cross-sectional, population-based study to evaluate the association between sleep disorders and anxiety. Using self-reported questionnaires, the study assessed 957 participants aged 19 to 86. The study took into account socio-demographic characteristics, lifestyle habits, and health-related characteristics. The adults all lived in Thrace, a culturally diverse area of Greece.

The Greek version of the Zung Self-rating Anxiety Scale was used to assess anxiety. After answering a sleep questionnaire, participants were divided into 3 groups: short sleep duration (<6 hours), normal sleep duration (6-8 hours), and long sleep duration (>8 hours). Participants self-reported their sleep habits using the Epworth Sleepiness Scale, the Athens Insomnia Scale, the Pittsburgh Sleep Quality Index, and the Berlin Questionnaire.

The researchers found that 33.6% of the participants presented with an anxiety disorder. The presence of anxiety was significantly (P <.001) higher in people with short sleep duration (37.6% vs 13.9%) and lower in people with long sleep duration (9.9% vs 16.4%) compared with people without anxiety.

People with anxiety reported increased daytime sleepiness (adjusted odds ratio [aOR], 5.20) and insomnia symptoms (aOR, 3.92), poorer sleep quality (aOR, 3.39), higher risk for obstructive sleep apnea OSA (aOR, 2.40; P <.001 for all), and difficulty falling asleep (aOR,1.49, P =.010), maintaining sleep (aOR, 2.48, P <.001), and early morning awakening (aOR, 2.07; P <.001).

Prevalence of anxiety was also higher (84.1%) in people who engaged in a low amount of physical activity compared with those who reported a high level of exercise (15.9%).

Although the study included a large sample size, it was conducted in a rural area of Greece and is not representative of the country in its entirety.

“Taking into account the strong points, as well as its limitations, this study dictates conduction of larger scale prospective studies in order to assess causality on the clinically important relationship between sleep characteristics and anxiety disorders,” the authors concluded.


Serdari A, Manolis A, Tsiptsios D, et al. Insight into the relationship between sleep characteristics and anxiety: a cross-sectional study in indigenous and minority populations in northeastern Greece. Psychiatry Res. Published online August 4, 2020. doi:10.1016/j.psychres.2020.113361