Associations Between Sleep Quality, Anxiety, Depression, and Gastroesophageal Reflux Disease in a Tertiary Hospital Sleep Center: A Retrospective Study

Abstract

Background: Gastroesophageal reflux disease (GERD) often coexists with anxiety, depression, and poor sleep quality, which worsen symptom perception and reduce quality of life. While each factor has been linked to GERD, their combined effects have rarely been examined, especially in sleep clinic populations. This study aimed to assess the individual and combined associations of anxiety, depression, and sleep quality with probable GERD in patients at a tertiary hospital sleep center.

Methods: This retrospective cross-sectional study examined patient data from the Sleep Center of National Cheng Kung University Hospital collected between July 2020 and July 2021. All included patients completed the Gastroesophageal Reflux Disease Questionnaire (GERDQ), Pittsburgh Sleep Quality Index (PSQI), and Hospital Anxiety and Depression Scale (HADS). Multivariable logistic regression was used to determine associations between elevated HADS-A (anxiety), HADS-D (depression), PSQI scores, and probable GERD (GERDQ score ≥ 9), adjusting for relevant confounders.

Results: Among 877 patients, 93 (10.6%) had probable GERD. Elevated HADS-A (adjusted odds ratio [aOR]: 2.18, 95% confidence interval [CI]: 1.40-3.39, p < 0.001), HADS-D (aOR: 2.10, 95% CI: 1.34-3.29, p = 0.001), and PSQI (aOR: 3.32, 95% CI: 2.10-5.27, p < 0.001) scores were significantly associated with probable GERD. Patients with both high HADS-A and PSQI scores had a stronger association (aOR: 4.74, 95% CI: 2.62-8.60), and those with both high HADS-D and PSQI scores had the greatest odds (aOR: 5.09, 95% CI: 2.72-9.41).

Conclusion: Results reaffirm that anxiety, depression, and poor sleep quality are significantly associated with probable GERD. However, given the cross-sectional design, causal relationships cannot be established. The combined use of HADS and PSQI may enhance GERD risk identification, suggesting that individuals with psychological and/or sleep disturbances should consider gastroenterological evaluation.

Keywords: anxiety; depression; gastroesophageal reflux disease; sleep.

Figure 1

Associations between the joint effects of Hads-A, HADS-S, and PSQI scores and probable GERD.