Prevalence of Anxiety and Depression Symptoms and Their Association with Sleep Quality in Patients with Hypertension

BACKGROUND: In recent years, substantial evidence has accumulated regarding the negative impact of psychoemotional stress, sleep disorders, and anxiety and depressive disorders on the course of arterial hypertension, as reflected in national guidelines. However, in real-world clinical practice, these aspects are often assessed subjectively and rarely incorporated into the diagnosis; as a result, they frequently receive insufficient attention and are not addressed properly.

AIM: To assess the prevalence of subclinical and clinically significant anxiety and depression symptoms, as well as their association with sleep quality in patients with hypertension.

METHODS: A single-center, observational, cross-sectional study was conducted. The study included patients admitted for follow-up inpatient examination and treatment at the Department of Propaedeutics of Internal Diseases, S.M. Kirov Military Medical Academy, from 2021 to 2024. During their first days in the hospital, patients completed validated questionnaires assessing psychoemotional status, sleep disorders, and risk of obstructive sleep apnea. The questionnaires included the Hospital Anxiety and Depression Scale, the Insomnia Severity Index, the STOP-BANG Risk Score for Obstructive Sleep Apnea, and the Epworth Sleepiness Scale.

RESULTS: A total of 348 patients were surveyed, with a mean age of 49.5 ± 20.6 years. The majority of participants were male (83.3%), whereas females comprised 16.7%. Symptoms of subclinical and clinically significant anxiety and depression were reported in 112 patients (32.2%) and 132 patients (37.9%), respectively. A high risk of obstructive sleep apnea was identified in 228 patients (65.5%), whereas 282 patients (81.1%) had moderate sleep disorders. The severity of anxiety and depression moderately correlated with sleep quality (ρ = 0.51 and 0.50, respectively; p < 0.001) and daytime sleepiness (r = 0.43 and 0.57, respectively; p < 0.001). Individuals with moderate sleep disorders were 12.88 times more likely to have depression symptoms (95% CI: 4.6–36.4) and 9.62 times more likely to have anxiety symptoms (95% CI: 3.40–27.20); these differences were significant. Moreover, there were significant differences in anxiety and depression severity in patients with exertional angina and a high risk of obstructive sleep apnea, regardless of sex. In female patients, significant differences in anxiety severity were reported (p < 0.05).

CONCLUSION: The findings show that patients with hypertension have a high prevalence of cardiovascular risk factors, including psychoemotional disorders, sleep disorders, and obstructive sleep apnea, emphasizing the importance of comprehensive history taking and using specialized questionnaires in routine clinical practice.