Systematic review links poor sleep quality and short duration to anxiety in older adults

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Frontiers in Medicine Published May 28, 2026 Medically reviewed May 28, 2026 DOI ↗ By Dr. Ji-eun Park, MD · Brain, Mind & Pain

Key Takeaway

Note that poor sleep quality and short duration associate with anxiety in older adults.

This systematic review and meta-analysis evaluated the relationship between sleep quality, sleep duration, and anxiety symptoms among a population of 70,716 participants aged 60 years or older. The analysis pooled data to determine the strength of the association between specific sleep metrics and anxiety outcomes in this demographic group.

The results indicate that poor sleep quality was significantly associated with anxiety symptoms, yielding an odds ratio of 4.00 with a 95% CI of 2.96–5.41. Short sleep duration was also significantly associated with anxiety, with an odds ratio of 2.14 and a 95% CI of 1.85–2.46. When comparing the two metrics, poor sleep quality showed a larger pooled association than short sleep duration, with a z statistic of 3.69 and a P value less than 0.001.

The authors note substantial heterogeneity in the sleep quality analysis, with an I2 value of 93.4%. This heterogeneity reflects differences in measurement instruments and geographic regions across the included studies. Safety data, adverse events, and discontinuations were not reported in the source material.

These findings support routine assessment of sleep quality in older adults with anxiety symptoms. However, prospective studies are needed to clarify directionality. The certainty of the evidence is limited by the heterogeneity and the observational nature of the underlying data.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

BackgroundSleep disturbances are highly prevalent among older adults, with prevalence ranging from 40–70%. While numerous meta-analyses have examined the association between sleep and depression, the relationship between sleep problems and anxiety—particularly in older adults—has received comparatively less attention. Direct meta-analytic comparisons between sleep quality and sleep duration in relation to anxiety among older adults remain limited.MethodsWe searched PubMed, Web of Science, Embase, Cochrane Library, and CNKI from inception to January 2026 according to the PRISMA 2020 guidelines. The studies that provided the odds ratios (ORs) with 95% confidence intervals (CIs) for the associations between sleep quality/disturbance or sleep duration and anxiety in adults aged 60 years or older were included. The DerSimonian–Laird random-effects model was used to synthesize the pooled ORs. Subgroup analysis, meta-regression, sensitivity analyses, and publication bias assessment were performed.ResultsA total of 19 studies with 70,716 participants were included in this meta-analysis and 21 effect-size records were available. Poor sleep quality (OR = 4.00, 95% CI: 2.96–5.41; I2 =93.4%; k = 16) and short sleep duration (OR = 2.14, 95% CI: 1.85–2.46; I2 = 39.4%; k = 5) were significantly associated with anxiety among older adults. Compared with short sleep duration, poor sleep quality showed a larger pooled association (z = 3.69, P < 0.001; OR ratio = 1.87). Associations remained significant across subgroups defined by geographic region, study design, and anxiety measurement tool. The leave-one-out ORs ranged from 3.68 to 4.26. The trim-and-fill analysis indicated that only one missing study was required to balance the funnel plot. Substantial heterogeneity in the sleep quality analysis (I2 = 93.4%) reflected differences in measurement instruments and geographic regions.ConclusionPoor sleep quality and short sleep duration were both associated with anxiety in older adults, with a larger but more heterogeneous association for sleep quality. These findings support routine assessment of sleep quality in older adults with anxiety symptoms. Prospective studies are needed to clarify directionality.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD420261348264.