The prevalence and influencing factors of comorbid sleep disorders and anxiety among military personnel stationed in plateau regions

Plateau regions are characterized by extremely harsh environmental conditions, the substantial psychological stress associated with military service increases the susceptibility of soldiers to sleep disturbances and anxiety symptoms. This study aims to systematically examine the co-occurrence of sleep and anxiety disorders among military personnel stationed in plateau areas and to identify key influencing factors. A cross-sectional was conducted from March 2023 to December 2025.

A total of 2111 eligible participants were recruited from 20 garrisons located in the plateau regions of China, the majority of participants were male(95.4%), and aged below 30 years(86.5%). The self-administered questionnaire comprised the Pittsburgh Sleep Quality Index and Zung’s Self-Rating Anxiety Scale. Data analysis was investigate the prevalence and associated influencing factors of the co-occurrence of sleep and anxiety disorders.

The prevalence rates of sleep disorders, anxiety disorders, and their co-occurrence among participants were 43.7%, 44.5%, and 29.5%, and approximately two-thirds of participants with either sleep disorders or anxiety also present with the comorbid condition respectively. Multivariate logistic regression revealed that sex, residence duration (2–5 years), and residential altitude (2000–2500 m, 2500–3500 m, ≥ 3500 m) were strongly correlated with disease comorbidity. Considering that marked gender imbalance could bias the estimates, female participants were excluded.

Residence duration (2–5 years) and residential altitude (2000‑2500 m, 2500–3500 m, ≥ 3500 m) were then identified as high‑risk factors for disease comorbidity. Military personnel stationed in plateau regions frequently suffer from sleep disorders, anxiety disorders, and their comorbidity. Residence and residential altitude are key factors associated with the comorbidity of these conditions.

Interventions should therefore target the comorbid state of sleep disturbances and anxiety rather than managing either symptom in isolation, and greater attention is required for high-risk groups including those with longer deployments and individuals stationed at higher altitudes. These authors contributed equally to this work: Lei Shi and Fei Ren. Department of Medical Research, The Ninth Medical Center, Chinese PLA General Hospital, Beijing, 100101, China Department of Critical Care Medicine, The Ninth Medical Center, Chinese PLA General Hospital, Beijing, 100101, China Department of Emergency, The Ninth Medical Center, Chinese PLA General Hospital, Beijing, 100101, China Correspondence to Qin Sun, Ye Tian or Ming Zhu.

The authors declare no competing interests. This study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the Military Medical Center of Strategic Support Force (batch number: K2023 No.8). All participants signed a written informed consent before the study.