Sleep Duration and Insomnia with Comorbid Depression and Anxiety Symptoms in Chinese Adults: A Cross-Sectional Study

Zhongxin Hou; Yang Chen; Yunrui Sun; Chongwei Song; Haoyuan Deng; Nan Cheng; Xiaoyu Han; Jianghui Zhang; Qian Wang; Yi Li; Jianzhong Yin; Qiong Meng

doi:10.2147/NSS.S440584

Sleep Duration and Insomnia with Comorbid Depression and Anxiety Symptoms in Chinese Adults: A Cross-Sectional Study

Nat Sci Sleep. 2023 Dec 21:15:1079-1091. doi: 10.2147/NSS.S440584. eCollection 2023.

Authors

Zhongxin Hou^#¹, Yang Chen^#^{1

2}, Yunrui Sun¹, Chongwei Song¹, Haoyuan Deng³, Nan Cheng⁴, Xiaoyu Han², Jianghui Zhang⁵, Qian Wang¹, Yi Li¹, Jianzhong Yin^{1

6}, Qiong Meng¹

Affiliations

¹ School of Public Health, Kunming Medical University, Kunming, Yunnan, People's Republic of China.
² Institute for Acute Communicable Disease Prevention and Control, Yunnan Provincial Center for Disease Control and Prevention, Kunming, Yunnan, People's Republic of China.
³ Medical Department, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, People's Republic of China.
⁴ Department of Hospital Infection, Wuhan Mental Health Center, Wuhan, Hubei, People's Republic of China.
⁵ AIDS Care Center, Yunnan Provincial Hospital of Infectious Disease, Anning, Yunnan, People's Republic of China.
⁶ Baoshan College of Traditional Chinese Medicine, Baoshan, Yunnan, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: Depression and anxiety are two highly prevalent mental disorders that commonly coexist. However, little is known about the association between sleep and comorbid depressive and anxiety symptoms (CDAS). Therefore, this study aims to explore the relationship between sleep duration, insomnia and CDAS.

Methods: This is a cross-sectional study of 22,004 community adults who participated in the China Multi-Ethnic Cohort (CMEC) study. Chinese version of Patient Health Questionnaire-2 and Generalized Anxiety Disorder-2 were used to screen CDAS in community adults. A positive score on each scale was considered indicative of CDAS. All participants received face-to-face interviews, medical examinations, and biochemical examinations to assess sleep duration and insomnia and collect covariates. The self-reported sleep duration was divided into three groups: <7 hr, 7-9 hr and >9 hr groups. Logistic regression was used to analyze the association between sleep duration, insomnia and CDAS. A restricted cubic spline (RCS) was used to explore the dose-response relationship between sleep duration and CDAS. Stratified analysis based on gender and age was conducted.

Results: Overall, 2.8% (95% CI 2.6%~3.0%) of participants reported having CDAS. After adjusting the potential covariates, sleep duration <7 hr (OR=1.635, 95% CI=1.335~2.004) was significantly associated with CDAS, compared with sleep 7-9 hr. After RCS analysis, there was a nonlinear relationship between sleep duration and CDAS. The increase in the number of types of insomnia, the greater the likelihood of CDAS (p for trend<0.05). In sensitivity analysis, it was found that the results were consistent with those of the main analysis. After stratification by gender and age, the association between sleep duration and CDAS was only observed in female and young and middle-aged adults, not in men and older adults.

Conclusion: Both insufficient sleep duration and insomnia are associated with a higher prevalence of CDAS in Chinese adults.

Keywords: adults4; comorbid depressive and anxiety symptoms3; cross-sectional study5; insomnia2; sleep duration1.

Grants and funding

This study was funded by the National Natural Science Foundation of China (No. 81960617) and Yunnan Applied Basic Research Projects-Kunming Medical University Union Foundation (No. 202001AY070001-182). The study funder had no influence on the study design, collection, management, analysis, and interpretation of data, writing of the report, or decision to submit the report for publication.