Impaired Alertness Correlates With Chronic Anxiety: A Prospective Tertiary University Centre Cohort

The Maintenance of Wakefulness Test (MWT) is a widely used objective measure of daytime alertness, especially in patients with sleep disorders at increased risk of accidents. Anxiety and depression are common in this population and may influence subjective sleepiness and objective alertness. This study aimed to assess the relationship between acute emotional states, including state anxiety, as well as chronic anxiety and depression, with objective alertness measured by the MWT, alongside subjective sleepiness. In this prospective single-centre study, 100 patients undergoing polysomnography and MWT completed validated questionnaires including the State (STAI-A) and Trait (STAI-B) Anxiety Inventory, Hospital Anxiety (HAD-A) and Depression (HAD-D) scale, Epworth Sleepiness Scale (ESS) and the Self-Assessment Manikin (SAM) for acute emotional states. Correlations and regression analyses examined the relationships of anxiety, depression and emotional states with objective alertness and subjective sleepiness. The mean age was 44.8 ± 11.2 years; 75% patients were treated for sleep apnea and 25% for central disorders of hypersomnolence. STAI-B and HAD-A showed mild negative correlations with mean sleep latency on MWT (ρ≈-0.21 to -0.25, p < 0.05), whereas STAI-A, SAM and HAD-D did not. STAI-B, HAD-A and HAD-D positively correlated with subjective sleepiness (ESS) (ρ≈0.23 to 0.38, p < 0.05). Univariate logistic regression identified STAI-B but not STAI-A as a significant independent predictor of MWT sleep onset among emotional, anxiety and depression variables. Chronic, but not acute, anxiety is linked to reduced residual objective alertness and increased subjective sleepiness, underscoring the need to assess and manage anxiety in patients with hypersomnolence.