Dose-response association of sleep quality with anxiety symptoms in Chinese rural population: the Henan Rural Cohort

Abstract

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.