Background Sleep disturbances are highly prevalent among older adults, with prevalence ranging from 40–70%. While numerous meta-analyses have examined the association between sleep and depression, the relationship between sleep problems and anxiety—particularly in older adults—has received comparatively less attention. Direct meta-analytic comparisons between sleep quality and sleep duration in relation to anxiety among older adults remain limited. Methods We searched PubMed, Web of Science, Embase, Cochrane Library, and CNKI from inception to January 2026 according to the PRISMA 2020 guidelines. The studies that provided the odds ratios (ORs) with 95% confidence intervals (CIs) for the associations between sleep quality/disturbance or sleep duration and anxiety in adults aged 60 years or older were included. The DerSimonian–Laird random-effects model was used to synthesize the pooled ORs. Subgroup analysis, meta-regression, sensitivity analyses, and publication bias assessment were performed. Results A total of 19 studies with 70,716 participants were included in this meta-analysis and 21 effect-size records were available. Poor sleep quality (OR = 4.00, 95% CI: 2.96–5.41; I 2 =93.4%; k = 16) and short sleep duration (OR = 2.14, 95% CI: 1.85–2.46; I 2 = 39.4%; k = 5) were significantly associated with anxiety among older adults. Compared with short sleep duration, poor sleep quality showed a larger pooled association ( z = 3.69, P 0.001; OR ratio = 1.87). Associations remained significant across subgroups defined by geographic region, study design, and anxiety measurement tool. The leave-one-out ORs ranged from 3.68 to 4.26. The trim-and-fill analysis indicated that only one missing study was required to balance the funnel plot. Substantial heterogeneity in the sleep quality analysis ( I 2 = 93.4%) reflected differences in measurement instruments and geographic regions. Conclusion Poor sleep quality and short sleep duration were both associated with anxiety in older adults, with a larger but more heterogeneous association for sleep quality. These findings support routine assessment of sleep quality in older adults with anxiety symptoms. Prospective studies are needed to clarify directionality. Systematic review registration https://www.crd.york.ac.uk/prospero/ , identifier CRD420261348264.
Zhang et al. (Thu,) studied this question.