Mediating and moderating effects of experiential avoidance between excessive daytime sleepiness and anxiety symptoms.

Background: Anxiety symptoms (AS) are prevalent among college students and are associated with various negative outcomes. Excessive daytime sleepiness (EDS) is also prevalent in this group, with some studies suggesting a possible association with AS, though the underlying mechanisms remain unclear. Experiential avoidance (EA), which reflects individuals' unwillingness to remain in contact with negative experiences, may play a mediating or moderating role in this relationship. This study aims to explore these potential roles of EA to inform future interventions targeting sleep and emotion regulation.

Methods: A total of 4835 college students participated in the study. The questionnaires were distributed and collected via the QuestionStar platform. The study used logistic regression to test the association between EDS, EA and AS in college students. The mediation model and moderated effects were tested using bias-corrected percentile bootstrapping.

Results: 44.5 % of college students reported AS, and 35.1 % experienced EDS. Both EDS (OR = 1.11; 95 %CI: 1.09-1.13) and EA (OR = 1.13; 95 %CI: 1.12-1.14) were associated with AS. Additionally, EA negatively moderated the association between EDS and AS (β = -0.002, P < 0.001). EA also partially mediated this association, accounting for 44.07 % of the total effect. No significant gender differences were observed in the moderated mediation model.

Conclusions: AS and EDS were prevalent among college students. EA mediated and weakened the association between EDS and AS. Targeting EA through interventions like ACT may reduce AS and improve sleep-related outcomes.