Latent Profiles of Emotional Distress and Sleep and Their Correlates Among Hospitalized Patients With Hypertension and Diabetes: A Multicenter Cross-Sectional Study

Abstract Background Depressive symptoms, anxiety symptoms, and sleep problems are common among hospitalized patients with hypertension and diabetes, but their patterns of co-occurrence and associated factors remain poorly understood. Guided by the Theory of Unpleasant Symptoms, we aimed to identify latent profiles of emotional distress and sleep characteristics and examine clinical and psychosocial factors associated with profile membership. Methods This multicenter cross-sectional study included 529 hospitalized patients with medical-record-confirmed hypertension and diabetes. Latent profile analysis (LPA) was performed using the Patient Health Questionnaire-9 (PHQ-9) total score, Generalized Anxiety Disorder-7 (GAD-7) total score, and the seven Pittsburgh Sleep Quality Index (PSQI) component scores as profile indicators. Associations with profile membership were examined using mean bias-reduced multinomial logistic regression to mitigate sparse-data bias. Results Three profiles were identified: low emotional distress–low sleep burden (n = 327, 61.81%), emotional distress–predominant (n = 164, 31.00%), and sleep medication use–daytime dysfunction (n = 38, 7.18%). The three-profile solution showed high classification quality (entropy = 0.918; average maximum posterior probability = 0.967). Serious or critical clinical status (adjusted odds ratio [aOR] = 1.60, 95% CI: 1.04–2.47), higher Nutritional Risk Screening 2002 (NRS 2002) scores (per 1-point increase: aOR = 1.24, 95% CI: 1.09–1.40), avoidance coping (per 1-point increase: aOR = 1.27, 95% CI: 1.17–1.37), and acceptance-resignation coping (per 1-point increase: aOR = 1.19, 95% CI: 1.11–1.26) were associated with higher odds of membership in the emotional distress–predominant profile. Conclusions Hospitalized patients with hypertension and diabetes showed distinct configurations of emotional distress and sleep characteristics. Nursing assessment may benefit from considering joint emotional and sleep symptom patterns alongside clinical status, nutritional risk, and illness-related coping. These findings may inform stratified assessment and symptom management during hospitalization.