Association of Anxiety and Sleep Behaviors Among Adolescents During the Coronavirus Disease 2019 Pandemic

Objectives: To assess the relationship between anxiety and sleep behavior among adolescents during the coronavirus disease 2019 pandemic. Methods: Three cross-sectional surveys were conducted among ninth-grade students in Barrow County, Georgia, during the pre-pandemic, peak pandemic, and transitional phases from 2020 to 2022. The association between anxiety diagnosis, self-reported symptoms (Generalized Anxiety Disorder Criteria for Adolescents [GAD-C]), and sleep behavior was examined using logistic regression. Results: At baseline, 475 students completed the survey, with 36.4% reporting symptoms of anxiety. Students diagnosed with clinical anxiety were more likely to report daily sleep disturbances (adjusted prevalence ratio: pre-pandemic [PRadj,pre]=5.9; 95% confidence interval [CI], 3.2–10.5). Moreover, elevated GAD-C scores were also associated with sleep disturbances (PRadj,pre=14.5; 95% CI, 8.1–26.0). The association remained consistent across all time points. Conclusions: This study demonstrated that adolescents with anxiety were more likely to report poor sleep behaviors, thereby extending previous findings to adolescents in understudied communities. Addressing anxiety and sleep health behaviors should be prioritized among adolescents from low-income semi-rural areas.