ObjectiveThis study examined the complex relationships among insomnia, anxiety, frailty, and cognitive function in middle-aged and older adults, testing whether frailty moderates the mediating role of anxiety between insomnia and cognition.MethodsThis cross-sectional study included 108 insomnia patients recruited from community and hospital settings between August 2025 and February 2026. Assessments included the Pittsburgh Sleep Quality Index, FRAIL Scale, Montreal Cognitive Assessment-Basic, an