Assessment of sleep quality and its relationship with stress and anxiety, and attitudes toward sleep among adults in Riyadh, Saudi Arabia

Sleep is an essential element in every human being's life, as it impacts the quality of an individual's life. When a person's sleep is uncomfortable and irregular, this leads to the possibility of exposure to many mental and physical illnesses that affect activity. This study aimed to measure the quality of sleep and its relationship to stress and anxiety, and what practices and attitudes that people do regarding their sleep. This is a cross-sectional study was employed to assess sleep quality and its relationship with stress and anxiety, and attitudes toward sleep among adults in Riyadh, Saudi Arabia between December 2024 and April 2025. Data were collected via a self-administered survey consisting of 5 validated questionnaires (satisfaction with life scale, hospital anxiety and depression scale, perceived stress scale [PSS], dysfunctional beliefs and attitudes about sleep [DBAS], and Pittsburgh sleep quality index [PSQI]). Logistic regression was used to find the influencing factors for each outcome. The study involved 687 participants. Married individuals were less likely to experience anxiety compared to singles (OR = 0.21, 95% CI: 0.1-0.45, P < .001). Older age was significantly associated with higher odds of elevated DBAS and poor PSQI scores. Individuals aged 61 and above had increased odds of dysfunctional beliefs about sleep (OR = 6.00, 95% CI: 1.25-28.74, P = .025) and poor sleep quality (OR = 22.65, 95% CI: 4.37-117.39, P < .001) compared to those age 18 to 20. Individuals with higher levels of DBAS, PSS, and anxiety (hospital anxiety and depression scale) were significantly associated with poorer sleep quality, as measured by PSQI score. Specifically, higher level of DBAS increased the odds of poor sleep (OR = 1.01, 95% CI:1.00-1.02, P = .02). Similar with stress, 1 point increase in the PSS scale, increased the poor quality of sleeping (OR = 1.16, 95% CI: 1.08-1.24, P < .001), while the anxiety level increased the odds of poor quality of sleeping 14% (OR = 1.14, 95% CI: 1.08-1.19, P = .001). This study emphasizes a robust relationship between inadequate sleep quality and psychological factors. A variety of demographic factors, including age, gender, marital status, nationality, and employment, are identified as substantial contributors.