Exploring the relationship between sleep quality, anxiety, depression and frailty in older adults with stroke: a latent profile and mediation analysis

Stroke patients often experience reduced sleep quality, and sleep disturbances not only impair the rehabilitation process but may also increase the risk of frailty. Meanwhile, anxiety and depression are highly prevalent in this population and may mediate the relationship between sleep and frailty. However, research on the potential heterogeneity of sleep quality and its association with frailty in older stroke patients remains limited, and the mechanisms underlying the role of psychological factors are still unclear. Therefore, this study aimed to identify the potential subtypes of sleep quality in older stroke patients, examine their associations with frailty, and further analyze the mediating roles of anxiety and depression, providing evidence for precise assessment and intervention of frailty in this population. A total of 310 older stroke patients hospitalized in the neurology department of a tertiary hospital in Shandong Province from November 2024 to June 2025 were recruited using convenience sampling. General demographic and clinical data were collected, and patients were assessed using the Tilburg Frailty Indicator, Pittsburgh Sleep Quality Index, and Hospital Anxiety and Depression Scale. Latent profile analysis of sleep quality was performed using Mplus, and mediation analyses were conducted using SPSS. Two latent profiles of sleep quality were identified: relatively good sleep group (76.7%) and inefficient sleep with daytime dysfunction group (23.2%). Significant differences were observed in total frailty scores and all dimensions across the different sleep quality profiles ( p < 0.001). Bootstrap mediation analysis indicated that anxiety and depression significantly mediated the association between sleep quality profiles and frailty, accounting for 30.7% and 34.6% of the total effect, respectively. Sleep quality among older stroke patients demonstrated heterogeneity, with those in the inefficient sleep with daytime dysfunction group exhibiting significantly higher frailty levels than those in the good sleep group. Furthermore, anxiety and depression played mediating roles in the relationship between sleep quality profiles and frailty.