Sleep Characteristics and Risk Factors in Patients with Comorbid Insomnia and Anxiety

Background Insomnia is a common sleep disturbance that often co-occurs with anxiety. While insomnia is a known risk factor for anxiety, anxiety can also exacerbate insomnia. This study aimed to analyze sleep characteristics and risk factors in patients with comorbid insomnia and anxiety by comparing subjective and objective sleep indicators, emotional scales, and insomnia-related factors between patients with anxious insomnia and those with insomnia alone, so as to provide new insights for clinical diagnosis and treatment. Methods A total of 221 patients with insomnia were recruited and divided into an anxiety group (n = 163) and a non-anxiety group (n = 58) according to the Beck Anxiety Inventory (BAI) ≥ 10 points or < 10 points. Subjective sleep and emotional states were assessed using the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Beck Depression Inventory (BDI), and BAI. Objective sleep parameters were monitored via actigraphy (ACT). Differences and correlations among subjective scales and objective indicators were analyzed using Logistic regression and Spearman correlation analyses to identify sleep characteristics and risk factors for anxious insomnia. Results The anxiety group showed significantly higher PSQI, ISI, BDI, and BAI scores compared to the non-anxiety group (all P  < 0.001). Act data indicated that the anxiety group spent more time in bed ( P  = 0.017), but no significant differences were observed in total sleep time, sleep efficiency, sleep onset latency, or wake time after sleep onset ( P  > 0.05). The anxiety group also exhibited more severe sleep disturbances and daytime dysfunction in PSQI subitems ( P  < 0.05). Spearman correlation analysis revealed positive correlations between BAI grade and PSQI, ISI, and BDI grades (all P  < 0.05). Both univariate and multivariate binomial logistic regression analyses indicated that a disease duration of 36–120 months significantly increased the risk of anxious insomnia ( P  < 0.05). Ordinal logistic regression further identified sleep efficiency ( P  = 0.008), sleep disturbances ( P <0.001) and daytime dysfunction ( P  = 0.043) as significant positive predictors of anxiety severity. Conclusions Patients with comorbid insomnia and anxiety report poorer subjective sleep quality, more depressive symptoms, and longer time in bed. PSQI, ISI, and BDI scores are associated with the development of anxious insomnia. Sleep efficiency, sleep disturbances, and daytime dysfunction are significant factors influencing anxiety severity. Disease duration is a core risk factor and should be addressed clinically through early intervention.