Sleep quality, particularly daytime dysfunction and sleep disturbance, and circadian preference are robust, prospective, and modifiable predictors of adolescent anxiety, suggesting that sleep should be prioritized as a transdiagnostic therapeutic target.
Overall sleep quality showed one of the strongest cross-sectional associations with adolescent anxiety among all sleep-related factors examined.
Sleep disturbance and daytime dysfunction showed the strongest cross-sectional correlations with adolescent anxiety among specific sleep quality components.
Sleep onset latency showed a significant but moderate cross-sectional association with adolescent anxiety.
Short sleep duration and evening circadian preference showed significant but weaker cross-sectional associations with adolescent anxiety.
Longitudinal analyses showed that baseline poor sleep quality prospectively predicted anxiety, with predictive power peaking within a 12-month window.
Short sleep duration as a continuous measure was a significant longitudinal predictor of anxiety, but its categorical risk was non-significant.
RCT evidence showed that poor sleep quality, sleep restriction, and evening chronotype increased anxiety, while sleep interventions reduced anxiety.
The meta-analysis synthesized a large and methodologically diverse evidence base covering cross-sectional, longitudinal, and experimental study designs.
This research synthesized findings from 129 studies involving over 416,000 adolescents to understand how different aspects of sleep are connected to anxiety. The researchers looked at studies that simply measured sleep and anxiety at one point in time, studies that followed adolescents over time, and experiments that deliberately changed sleep to see how it affected anxiety. Across all three types of evidence, poor sleep quality — especially experiencing disturbances during the night and feeling impaired during the day as a result — was consistently and meaningfully linked to higher anxiety levels in teenagers. The strength of association was stronger for sleep quality measures than for simply sleeping too few hours. This research suggests that the relationship between sleep and adolescent anxiety is not just a snapshot association but a prospective one: teenagers who had poor sleep quality were more likely to develop or worsen anxiety over the following months, with the predictive window strongest within 12 months. Experimental evidence from randomized controlled trials further supported this, showing that when sleep was restricted or disrupted, anxiety increased, and when sleep was improved through interventions like cognitive behavioral therapy for insomnia (CBT-I), anxiety decreased by a meaningful amount. Evening chronotype — a natural tendency to stay up late — also emerged as a modifiable risk factor. The practical implication of these findings is that sleep quality may be an important and treatable contributor to anxiety in adolescents. Rather than treating sleep problems and anxiety as separate issues, this research supports the idea that improving sleep — particularly addressing nighttime disturbances and daytime impairment — could be a useful part of efforts to prevent or reduce anxiety during this vulnerable developmental period. The authors suggest sleep should be considered a 'transdiagnostic therapeutic target,' meaning it may be relevant across different types of anxiety and mental health concerns in young people.
Zhang J, Wan J, Wang Y, Li H, Lei Y. (2026). Explore the impact of sleep-related factors on anxiety in adolescents: A meta-analysis of cross-sectional, longitudinal and RCT studies.. Journal of affective disorders. https://doi.org/10.1016/j.jad.2026.121320