Relationships Between Sleep Quality, Anxiety and Depression in University Students: Stable Trends over Time and a Pronounced Concern for Sleep Initiation

<b>Background/Objectives</b>: Relationships between sleep quality, anxiety and depression are well-documented across the lifespan. Here we investigated relationships between sleep, mental health and markers of obesity and cardiovascular health in Higher Education students (young adults, 18-28 years) using repeated cross-sectional sampling. <b>Methods</b>: Students (n = 486) participated at one of four timepoints across 2020-2023. The PSQI (sleep quality), GAD7 (anxiety) and PHQ8 (depression) were completed online. Measurements of obesity (Body Mass Index (BMI), body fat percent (BF%) and waist-hip ratio (WHR)) and cardiovascular function (heart rate (HR), diastolic and systolic blood pressure (DP and SP)) were determined. Changes over time, differences between sexes, and correlations between parameters were examined. <b>Results:</b> All measures were stable over the 4-year period. GAD7 (<i>p</i> < 0.0001) and PHQ8 (<i>p</i> = 0.0014) scores were significantly higher in females than males. There were significant, moderate to strong correlations between PSQI, GAD7 and PHQ8 scores for both sexes (r = 0.34-0.71). Only 18.1% of females and 23% of males reported both good quality sleep and no or low levels of anxiety and depression. Significant sex-specific differences were observed across markers of obesity and cardiovascular function (for BF%, WHR, HR and SP-all <i>p</i> ≤ 0.01), which showed weak to moderate correlations with sleep and mental health. Impaired sleep latency (C2) was identified as a potential key contributing factor. <b>Conclusions</b>: These observations provide evidence of multiple established, interlinked chronic challenges affecting sleep, mental and physical health in students. Identification of a key role for impaired sleep latency provides a foundation for targeted intervention, focusing upon improving sleep initiation, to improve mental health outcomes.