Abstract
<title>Abstract</title> <p> <bold>Background</bold> Sleep quality and duration are fundamental determinants of adolescent health, influencing physical development, cognitive function, and psychological well-being. Adolescence represents a critical period of neurodevelopmental and psychosocial change, making secondary school students particularly vulnerable to sleep disturbances. Despite growing evidence linking poor sleep to mental health problems, limited data exist on this relationship among Yemeni adolescents, who face unique challenges including political instability, economic hardship, and ongoing conflict. <bold>Objectives</bold> This study aimed to assess sleep quality, sleep duration, and anxiety levels among secondary school students in Aden, Yemen, and to examine their associations, as well as the influence of sociodemographic and lifestyle factors. <bold>Methods</bold> A cross-sectional study was conducted among 483 secondary school students (Grades 10–12) in Aden Governorate, Yemen, during March to July 2026. A multistage stratified cluster sampling approach was employed. Data were collected using a self-administered structured questionnaire comprising sociodemographic variables, lifestyle factors, the validated Arabic version of the Pittsburgh Sleep Quality Index (PSQI), and the Generalized Anxiety Disorder-7 (GAD-7) scale. Poor sleep quality was defined as PSQI > 5, while clinical anxiety was defined as GAD-7 ≥ 10. Statistical analyses included descriptive statistics, chi-square tests, Spearman's correlation, and multivariable logistic regression. <bold>Results</bold> Among the 483 participants, the majority were female (54.0%), aged ≥ 16 years (52.2%), and attended public schools (60.7%). The prevalence of poor sleep quality was 68.3% (n = 330), while clinical anxiety (GAD-7 ≥ 10) was present in 43.9% (n = 212). Significant associations were found between poor sleep quality and sex (p < 0.001) and school type (p < 0.001). A statistically significant positive correlation was observed between sleep quality and anxiety (χ² = 21.76, df = 9, p = 0.009; Cramer's V = 0.122). Multivariable logistic regression identified sex (Female vs. Male: aOR = 0.57, 95% CI: 0.38–0.85, p < 0.001), school type (Private vs. Public: aOR = 0.60, 95% CI: 0.44–0.81, p < 0.001), and GAD-7 score (per 1-point increase: aOR = 1.07, 95% CI: 1.03–1.11, p = 0.002) as independent predictors of poor sleep quality. Ordinal logistic regression demonstrated that poor sleep quality was the strongest predictor of higher anxiety severity (aOR = 1.73, 95% CI: 1.16–2.58, p = 0.007). A significant negative correlation was found between sleep duration and anxiety (Spearman's r = -0.21, p = 0.002). <bold>Conclusion</bold> This study reveals an alarmingly high prevalence of poor sleep quality and clinical anxiety among secondary school students in Aden, Yemen, with a significant positive association between these conditions. These results provide evidence for the urgent need for integrated school-based interventions addressing both sleep hygiene and mental health. </p>