Explore the impact of sleep-related factors on anxiety in adolescents: A meta-analysis of cross-sectional, longitudinal and RCT studies.

Adolescence is a sensitive period for the onset of anxiety disorders. Research suggests that sleep disorders involve problems with the quality, timing, and amount of sleep, are linked to anxiety development. However, the magnitude of these associations remains unclear. This meta-analysis synthesizes findings from cross-sectional, longitudinal, and randomized controlled trials (RCTs) to clarify the role of sleep-related factors in adolescent anxiety. The databases PubMed, Embase, PsycINFO, Web of Science, and Scopus were searched from inception to October 10, 2023. Eligible studies included adolescents assessed via validated anxiety and sleep measures or clinical criteria. A total of 129 independent samples (N = 416,426) were included. Cross-sectional analyses (k = 117) revealed significant associations between sleep and anxiety. Specifically, overall sleep quality (r = 0.34; odds ratio (OR) = 2.93), sleep disturbance (r = 0.36) and daytime dysfunction (r = 0.38) showed the strongest correlations, followed by sleep onset latency (r = 0.20). Significant but weaker associations were found for short sleep duration (r = -0.07; OR = 1.52), and evening circadian preference (r = -0.16; OR = 1.58). Longitudinal findings (k = 32) indicated that baseline poor sleep quality (r = 0.28; OR = 1.45), with predictive power peaking within a 12-month window. In contrast, while short sleep duration was a significant continuous predictor an (r = -0.11), its categorical risk was non-significant (OR = 1.07). RCTs (k = 19) found that poor sleep quality, sleep restriction, and evening chronotype increased anxiety (SMD = 0.43), while sleep interventions (e.g., cognitive behavioral therapy for insomnia) reduced anxiety (SMD = -0.47). Sleep quality, particularly daytime dysfunction and sleep disturbance, and circadian preference are robust, prospective, and modifiable predictors of adolescent anxiety. These findings suggest that sleep should be prioritized as a transdiagnostic therapeutic target.