"To die, to sleep": A systematic review and meta-analysis of the relationship between death anxiety and sleep.

Poor sleep has long been established as both a symptom and cause of psychopathology. Similarly, death anxiety has attracted growing attention for its transdiagnostic role in mental illnesses, particularly anxiety-related disorders. However, the relationship between death anxiety and sleep has not been systematically explored. This systematic review and meta-analysis examined the relationship between sleep and death anxiety. In total, 15 studies were included in this review, representing a total sample size of 2786 participants. A review of these studies revealed that death anxiety was significantly associated with a number of sleep outcomes, particularly insomnia and poor sleep quality. Mixed results were found regarding the relationship between death anxiety and nightmare frequency. A meta-analysis of seven studies revealed a significant but small relationship between death anxiety and sleep problems (r = .225). Neither gender nor age emerged as a significant moderator of this relationship. These studies were generally of moderate quality, and there was limited evidence of publication bias. The current findings support the relationship between death anxiety and sleep. Further research is needed to clarify the direction of this effect, and whether targeting one in treatment may produce direct improvements in the other.