Background: 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. Methods: A 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. Results: Altogether, 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. Conclusions: A 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 registration: The trial was prospectively registered on July 6, 2015 and available online at ClinicalTrials.gov ID: ChiCTR-OOC-15006699.

Objectives The epidemiological evidence on the effect of sleep quality on anxiety symptoms has been inconclusive. This study aimed at exploring the relationship between sleep quality and anxiety symptoms in rural China and further validating the association utilizing a meta-analysis.Methods A total of 27,911 participants aged 18–79 years from the Henan Rural Cohort Study completed assessments of sleep quality. Logistic regression and restricted cubic spline analysis was conducted to evaluate the sleep quality with anxiety symptoms. A meta-analysis was used to validate the result of the cross-sectional study.Results Altogether, 6087(21.80%) were poor sleepers and 1557(5.58%) had anxiety symptoms. The odds of anxiety were increased with increment of Pittsburgh Sleep Quality Index (PSQI) score after fitting restricted cubic splines. And the poor sleep qualitywas associated with a higher possibility of anxiety symptoms OR(95%CI) (4.61, 3.71-5.73) in men, and (3.56, 3.10-4.10) in women on multivariable analysis. Further stratified analyses showed that the effect of sleep quality and anxiety symptoms could be modified by age, marital status, lifestyle and chronic disease. The meta-analysis showed that pooled OR of anxiety symptoms was significantly higher for poor sleepers (1.49, 1.41-1.56, I 2 =98.9%, P <0.001).Conclusions These findings indicate that poor sleep quality was associated with increased odds of anxiety symptoms. In addition, relationship between poor sleep quality and anxiety symptoms was observed in this rural population, especially in participants aged ≥60 years and those with unhealthy habits or had a chronic disease.

Objectives The epidemiological evidence on the effect of sleep quality on anxiety symptoms has been inconclusive. This study aimed at exploring the relationship between sleep quality and anxiety symptoms in rural China and investigated whether age, lifestyle and chronic diseases modified the association. Methods A 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). Poor sleep quality was defined as PSQI ≥6. Anxiety symptoms were evaluated with the two-item generalized anxiety disorder scale (GAD-2). A score ≥6 was view as having anxiety symptoms. Logistic regression and restricted cubic spline was conducted to examine the association of sleep quality with anxiety symptoms. Results Altogether, 6,087(21.80%) were poor sleepers and 1,557(5.58%) had anxiety symptoms. The odds of anxiety were increased with increment of PSQI score after fitting restricted cubic splines. And the poor sleep qualitywas associated with a higher possibility of anxiety symptoms (4.60, 3.70-5.72) in men, and (3.56, 3.10-4.09) in women on multivariable analysis. Further stratified analyses showed that the effect of sleep quality and anxiety symptoms could be modified by age, marital status, smoking status, drinking status, hypertension andtype 2 diabetes mellitus. Conclusions A dose-response association between PSQI score and anxiety symptoms was found. In addition, relationship between poor sleep quality and anxiety symptoms was observed in this rural population, especially in participants aged ≥60 years and those with unhealthy habits or had a chronic disease.