COVID-19 anxiety and sleep in middle-aged and older adults: Impact of age and sex

ABSTRACT

Introduction: COVID-19 is an infectious respiratory illness that was declared a pandemic in March 2020. During the course of COVID-19, studies have demonstrated worsening sleep quality and anxiety. No studies have examined age-related and sex-specific associations between COVID-19 anxiety and sleep in aging populations. We examined associations between COVID-19 anxiety and sleep, and evaluated age and sex as moderators, in middle-aged/older adults. Methods: Two hundred and seventy-seven middle-aged/older adults aged 50+ (Mage=64.68, SD=7.83;44% women) living in the United States who were cognitively healthy (no cognitive impairment/dementia/ neurological disorders) completed an online Qualtrics survey in July/August 2020 measuring sleep (Pittsburgh Sleep Quality Index;PSQI) and COVID-19 anxiety (Coronavirus Anxiety Scale;CAS). Multiple regressions examined whether CAS was independently associated with or interacted with age or sex in its associations with PSQI total score/subscores (sleep quality, sleep duration, sleep efficiency, daytime dysfunction), controlling for age, education, number of medical conditions, sleep/pain medication use, and COVID-19 status. Results: CAS interacted with age (B=-.008, SE=.003 p=.02, R-squared=.02), not sex (p=.31), in its association with sleep duration. Higher CAS was associated with shorter sleep duration in oldestolder adults (∼73 years old;B=.12, SE=.05, p=.01) and younger-older adults (∼65 years old;B=.07, SE=.03, p=.02), not middle-aged adults (∼57 years old, p=.47). CAS interacted with age (B=.01, SE=.004, p=.02), not sex (p=.56), in its association with sleep efficiency. Higher CAS was associated with worse sleep efficiency in oldest-older adults (B=.14, SE=.05, p=.009) and younger-older adults (B=.08, SE=.04, p=.03), not middle-aged adults (p=.60). Higher CAS was associated with greater daytime dysfunction (B=.26, SE=.07, p<.001) and higher PSQI total score (B=.82, SE=.33, p=.01), and did not interact with age or sex (ps>.05). Conclusion: Increased COVID-19 anxiety is associated with several aspects of worse sleep (shorter sleep duration, sleep efficiency) in older adults but not middle-aged adults. Generally, in middle-aged/older adults, higher COVID-19 anxiety is associated with worse daytime dysfunction and overall sleep quality. Sex does not moderate these associations. Increased COVID-19 morbidity and mortality in aging populations may translate to increased anxiety and subsequent sleep disruptions. Interventions aimed at mitigating negative pandemicrelated psychological and sleep outcomes may be particularly relevant for older adults.