Association Between Sleep Quality and Cognitive Function in Patients with Hypertension in Rural Areas of Shanxi Province, China: The Chain Mediating Role of Anxiety and Depression

Many studies have found that sleep quality is associated with cognitive function, but how sleep quality is related to cognitive function indirectly through anxiety and depression is still unclear. This study aims to investigate the association between sleep quality and cognitive function among patients with hypertension in rural areas of Shanxi Province and to analyze the potential mediating role of anxiety and depression.

325 patients with primary hypertension were selected as the research subjects from Daning County and Yonghe County of Shanxi Province using the multistage cluster random sampling method. The Pittsburgh Sleep Quality Index, Montreal Cognitive Assessment, Generalized Anxiety Disorder-7, and Patient Health Questionnaire-9 were used to assess their sleep quality, cognitive function, anxiety, and depression levels, respectively. Structural equation modeling was employed to analyze the mediating effects of anxiety and depression.

The scores of sleep quality and cognitive function of patients with hypertension were 7.0 (4.0, 8.0) and 19.0 (15.0, 25.0), respectively. The results of the structural equation model analysis demonstrated that sleep quality was directly associated with cognitive function in patients with hypertension, with a path coefficient of -0.544, accounting for 59.85% of the total association. Anxiety and depressive symptoms showed a mediating role in the relationship between sleep quality and cognitive function, with indirect effects of -0.190 and -0.069, accounting for 20.90% and 7.59% of the total association, respectively. The chain mediating role of anxiety and depressive symptoms in the relationship between sleep quality and cognitive function among patients with hypertension was -0.105, accounting for 11.55% of the total association.

These findings underscore the necessity of improving sleep quality and mitigating anxiety and depression as potential strategies for addressing cognitive deterioration. It is also of great importance for screening and comprehensive management of sleep and mental health in hypertension care.