Impaired Alertness Correlates With Chronic Anxiety: A Prospective Tertiary University Centre Cohort
Anice Borjon1,2,3, Lucie Bobin1, François Ricordeau1
1Center for Sleep Medicine, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France.
Journal of Sleep Research
|July 31, 2026
Summary
Chronic anxiety, not acute anxiety, is linked to reduced alertness and increased sleepiness in patients with sleep disorders. This highlights the importance of managing anxiety in hypersomnolence care.
Area of Science:
- Sleep Medicine
- Psychiatry
- Clinical Psychology
Background:
- Daytime alertness is crucial for patients with sleep disorders, who are at higher risk of accidents.
- Anxiety and depression are prevalent in this population and can affect alertness and sleepiness.
- The Maintenance of Wakefulness Test (MWT) objectively measures alertness, while subjective sleepiness is assessed using scales like the Epworth Sleepiness Scale (ESS).
Purpose of the Study:
- To investigate the relationship between acute and chronic anxiety, depression, and emotional states with objective alertness (MWT) and subjective sleepiness (ESS).
- To determine if anxiety and depression predict objective alertness in patients with sleep disorders.
Main Methods:
- Prospective single-centre study of 100 patients undergoing polysomnography and MWT.
- Patients completed questionnaires: State (STAI-A) and Trait (STAI-B) Anxiety Inventory, Hospital Anxiety (HAD-A) and Depression (HAD-D) scale, ESS, and Self-Assessment Manikin (SAM).
- Correlation and regression analyses were used to examine relationships between psychological variables and sleepiness/alertness measures.
Main Results:
- Chronic anxiety (STAI-B, HAD-A) negatively correlated with MWT sleep latency (objective alertness).
- Chronic anxiety (STAI-B, HAD-A) and depression (HAD-D) positively correlated with subjective sleepiness (ESS).
- Trait anxiety (STAI-B) independently predicted MWT sleep onset, while state anxiety (STAI-A) did not.
Conclusions:
- Chronic anxiety is associated with poorer objective alertness and higher subjective sleepiness in patients with sleep disorders.
- Assessing and managing anxiety is crucial for improving the care of patients with hypersomnolence and related sleep disorders.
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