Behavioral and Clinical Correlates of Poor Sleep and Anxiety Symptoms in Adults Aged 50 Years and Older: A Cross-Sectional Study.

Background/Objectives: Sleep quality, anxiety symptoms, physical activity, musculoskeletal pain, and multimorbidity are interrelated health domains, but evidence examining these factors together among adults aged ≥50 years in Saudi Arabia remains limited. This study described their prevalence and assessed cross-sectional associations among these domains. Methods: A cross-sectional online survey using convenience sampling was conducted in Saudi Arabia between December 2024 and April 2025. Participants completed measures of musculoskeletal pain, self-reported morbidity, physical activity (Global Physical Activity Questionnaire), sleep quality (Brief Version of the Pittsburgh Sleep Quality Index), and anxiety symptoms (Generalized Anxiety Disorder-7). Associations were examined using Spearman rank correlations and logistic regression with core adjustment for age, sex, and BMI. The Benjamini-Hochberg false discovery rate correction was applied to eight focal comparisons; Firth penalized logistic regression was applied as a sensitivity analysis for models in which multimorbidity was the outcome. Results: The sample included 298 adults (mean age 58.2 +/- 6.3 years; 75.5% male). Musculoskeletal pain was reported by 73.8%, multimorbidity by 8.4%, poor sleep by 43.3%, and moderate-to-severe anxiety symptoms by 23.8%. Better sleep quality was moderately associated with lower anxiety severity (Spearman rho = -0.45, p < 0.001). Poor sleep was associated with higher odds of moderate-to-severe anxiety symptoms (OR 6.49, 95% CI 3.45-12.20), and low total physical activity was associated with higher odds of both moderate-to-severe anxiety symptoms (OR 7.87, 95% CI 2.68-23.08) and poor sleep (OR 5.09, 95% CI 2.40-10.83). These focal associations remained significant after FDR correction. In an exploratory sensitivity analysis, the poor sleep-multimorbidity association remained comparable when Firth regression was applied (OR 2.71, 95% CI 1.12-7.06; p = 0.027). Conclusions: In this online convenience sample of adults aged ≥50 years, sleep quality, anxiety symptoms, and total physical activity showed consistent cross-sectional associations. Findings involving multimorbidity were exploratory because of the limited number of events. These results require confirmation in representative longitudinal studies.