Sleep behaviors in traditional‐age college students

Depression, Anxiety and Poor Sleep Quality are Associated with Chronotype and Financial Wellness in University Students

Background: Evidence suggests the importance of a person's chronotype in predicting various aspects of an individual's physical and mental health. While the effect of depression on sleep is well established, the impact of a person's specific sleep timing and chronotype on the prevalence of both depression and anxiety has yet to be fully understood, especially among university students, vulnerable to mental health problems. In addition, other factors also seem to influence the occurrence of depression and anxiety among students as well as their quality of sleep, one of which being the students' financial wellness. The objective was to evaluate the association between chronotype and the severity and prevalence of depression among Lebanese university students, while also taking into account the possible connection between chronotype and financial wellness and both anxiety and sleep quality. Methods: This cross-sectional study was conducted between December 2021 and February 2022; 330 Lebanese university students was included (mean age 21.75 ± 2.43; 67.3% females). Results: The majority of the Lebanese university students in our sample were found to have an intermediate typology (63.0%), followed by the evening typology, which appeared to constitute 28.2% of the sample, while only 8.8% possessed a morning typology. In this study, having an intermediate or evening typology compared to a morning one was significantly associated with higher depression and worse sleep quality. In addition, having an evening chronotype compared to a morningness propensity was significantly associated with more anxiety. Conclusion: This study found a positive association between an evening typology (chronotype) and higher depression and anxiety and poorer quality of sleep. Although preliminary and based on cross-sectional data, this research could help provide a better understanding of the different chronotypes among university students, and of the possible increased susceptibility of some of these typologies (i.e., evening-type) to mental health problems.

Investigating the linkages between food insecurity, psychological distress, and poor sleep outcomes among U.S. college students

OBJECTIVE

Research overwhelmingly demonstrates that sleep is key to human health and wellbeing. Several factors likely contribute to sleep quality, including factors, such as food security and low income. In addition, exposure to structural inequalities early in life likely have downstream effects upon multiple dimensions of health. The objective of this study is to fill gaps in literature by specifically examining the associations between childhood food insecurity, current food insecurity, psychological distress, and sleep among college students.

METHODS

QR codes were randomly distributed to students, linking them to an online quantitative survey. The survey measured sociodemographic variables, food security (current and childhood), diet, mental distress, and sleep quality. A total of n = 134 completed the entire survey. Data were analyzed using binary and multiple linear regressions, as well as cross-tabulations.

RESULTS

The findings revealed that psychological distress was the primary factor influencing sleep health (𝛽 = 1.51, p < .01). Students reporting higher childhood food insecurity were more likely to experience extreme psychological distress (OR = 4.61), food insecurity in college (OR = 8.41), and lack of stable housing (OR = 5.86).

CONCLUSION

This study demonstrates that potential linkages exist between childhood food insecurity, poor sleep, and greater psychological distress. While acknowledging the contribution of other factors, the study highlights the importance of addressing food insecurity in relation to sleep health, considering the significant impact of sleep to overall health and wellbeing.

Are health behaviors associated with academic performance among tertiary education students? A systematic review of cohort studies

OBJECTIVE

To evaluate the association between health behaviors with academic performance among tertiary education students.

METHODS

Six databases were searched until July 2020 for prospective cohort studies evaluating the association between health behavior(s) (dietary intake, physical activity, sedentary behavior, alcohol intake, sleep, smoking or illicit drug use) and academic performance.

RESULTS

Thirty-four studies were included (18 assessed sleep, 16 alcohol intake, 12 illicit drug use, 10 physical activity, 8 diet, 4 smoking, 2 sedentary behavior). A consistent negative association with academic performance was demonstrated for sleep (12/18 studies), alcohol intake (13/16) and illicit drug use (9/12). Most (7/10) studies found no association between physical activity and academic performance.

CONCLUSION

Findings suggest interventions to mitigate the influence of poor sleep, high alcohol intake, and illicit drug use on academic performance may be needed. Further research of other health behaviors, along with their co-occurrence, with academic performance, is required.

Inequalities in emerging adult college students' sleep quality during the COVID-19 pandemic

OBJECTIVE

To examine inequalities in sleep quality during the COVID-19 pandemic by gender, sexual orientation, race/ethnicity, and socioeconomic position (SEP), and test associations between discrimination and sleep quality in a national longitudinal cohort of emerging adult college students.

PARTICIPANTS

Participants were enrolled in college full-time and were aged 18-22 at baseline.

METHODS

Participants completed online surveys in spring 2020 (N = 707) and summer 2021 (n = 313). Measures included the Pittsburgh Sleep Quality Index (PSQI) and the Everyday Discrimination Scale.

RESULTS

Most students reported poor sleep quality (78% in 2020; 82% in 2021) and those from marginalized groups generally experienced worse sleep quality. Discrimination was associated with poorer concurrent sleep quality at both time points.

CONCLUSIONS

Sleep inequalities among college students continued to manifest during the pandemic, even when students were not necessarily on campus. Colleges should take a multi-pronged approach to promote sleep quality through individual, community, and institutional interventions.

Dose-dependent Relationships of Same-day and Typical Substance Use to Sleep Duration in College Cannabis and Alcohol Users: A Multilevel Modeling Approach Using Daily Diary Data

This study characterized how quantities of cannabis and alcohol use affect sleep. Single-day and typical cannabis and alcohol use patterns were considered to assess acute-chronic use interactions. Linear and non-linear associations assessed dose-dependence. College students (n=337; 52% female) provided 11,417 days of data, with up to five time points per day. Daily self-reported sleep duration, cannabis use quantity, and alcohol use quantity were subjected to linear mixed modeling to capture linear and curvilinear associations between single-day and typical use on same-night and typical sleep. Sleep duration (difference between bedtime and waketime) was the outcome. Quantity of cannabis used each day andtypical quantity used across all days were predictors in the cannabis models. Parallel single-day and typical alcohol variables were predictors in the alcohol models. Follow-up analyses excluded days with alcohol-cannabis co-use. Main effects of single-day and typical cannabis quantity on sleep duration were observed when all cannabis-use days were modeled. Higher than typical doses of single-day and typical cannabis were associated with longer sleep durations, but only to a point; at the highest doses, cannabis shortened sleep. A main effect of single-day alcohol quantity and two interactions (single-day use with both linear and curvilinear typical use) on sleep duration were observed when all alcohol-use days were modeled. Greater alcohol consumption on a given day led to shorter same-night sleep, but typically heavier drinkers required higher doses than typically lighter drinkers to experience these adverse effects. Follow-up models suggested alcohol co-use may contribute to the purported sleep-promoting effects of cannabis.

Increased Salivary IL-1 Beta Level Is Associated with Poor Sleep Quality in University Students

Poor sleep quality is a major public health concern for all ages. In particular, university students often face stress levels and changes in social life habits that negatively influence their quality of sleep. This could be associated with psychological well-being in terms of anxiety and depressive symptoms, stress levels, and a poor self-perceived health status. The increases in the pro-inflammatory cytokine interleukin 6 (IL-6), IL-1 beta (IL-1β), and tumor necrosis factor alpha (TNFα), in blood have been linked to poor sleep quality in many diseases, but data on salivary cytokine levels in students are missing or are seldom analyzed. In this study we determined the quality of sleep in a sample of university students and the role of psychological assessment and factors affecting sleep (alcohol intake, tobacco, consumption of stimulant drinks, exercise, and body mass index). We also aimed to shed new light on the associations between sleep quality and salivary inflammatory cytokines (IL-1β, IL-6, and TNFα). Sleep quality was measured with the Athens Insomnia Scale (AIS) and Pittsburgh Sleep Quality Index (PSQI). Perceived stress was assessed using Cohen's Perceived Stress Scale (PSS), and the Goldberg Anxiety and Depression Scale (GADS) was used to assess the level of anxiety or depression. Perceived health status was measured with a visual analogue. Saliva samples was taken in the morning and the inflammatory cytokines was measured via enzyme-linked immunoassay. There was a direct and significant association between the salivary IL-1β concentration and AIS score (r = 0.248; p = 0.038, Pearson correlation) and Pittsburgh scale score (r = 0.274; p = 0.022, Pearson correlation). The relationship between IL-1β and AIS controlling for sex, age, and chronic disease, is still significant (r = 0.260; p = 0.033). The relationship between IL-1β and PSQI controlling for the influence of these variables is also significant (r = 0.279; p = 0.022). Salivary IL-1β concentrations were not significantly associated with any of the scores of the other psychological assessments (PSS, anxiety, depression symptoms, or self-perceived health). Salivary TNFα was significantly and inversely associated with self-perceived health (r = -0.259; p = 0.033, Pearson correlation), but the salivary IL-6 concentration was not associated with any of the sleep quality scale or psychological assessment scores. Our results provide a novel relationship between pro-inflammatory cytokine IL-1β in saliva and poor sleep quality. However, the role of inflammation in poor sleep quality requires further study to identify strategies that could lower inflammation and thus, likely improve sleep quality.

Sleep, Affect, and Emotion Reactivity in First-Year College Students: A Daily Diary Study

BACKGROUND

Sleep is an important factor in well-being, especially during the transition to college when academic and social commitments increase. Identifying factors that contribute to poor sleep (including short duration and increased variability in duration) can support development of interventions. Affect and emotion reactivity are factors that could contribute to sleep, and have not been studied in relation to sleep variables among first-year college students during their adjustment to the college environment. This adjustment might be difficult for some students, and therefore elicit affect fluctuations that contribute to poor sleep. Alternatively, sleep could contribute to daily affect. The present daily diary study examined bidirectional relations between daily sleep and affect, as well as between emotion reactivity and sleep (duration and variability) and affect (daily and overall variability) in first-year college students.

METHOD

First-year college students (n = 244; 86.1% female) completed a baseline survey including measures of emotion reactivity and anxiety and depressive symptoms, followed by 7 days of a once-per-day diary, reporting on their affect and sleep duration.

RESULTS

On days when individuals reported increased sleep duration, they also tended to experience greater positive affect the following day (p = .01). Those who experienced high levels of emotion reactivity also experienced more negative affect (p < .001) and negative affect variability (p < .001).

CONCLUSION

Emotion reactivity might identify college students who experience more negative affect and are possibly at risk to develop mental health disorders. The importance of sleep health should continue to be emphasized to students as they transition to college.

Sleep quality and duration: A key to life satisfaction among military students

Military service is a demanding profession that requires high physical preparedness and mental endurance. At the same time, the demands of military duties often require early rising and shortened sleep duration. Such a reduction in sleep can reduce physical and mental performance, and these changes can be reflected in life satisfaction. For this reason, soldiers' life satisfaction is a crucial variable for their success and long-term service. This study examined the relationship between sleep quality, sleep duration, and life satisfaction in military medical students. The results on 35 military students showed that greater sleep quality corresponded to greater life satisfaction; this relationship was moderate and significant (r = -460, p = .005). Notably, participants (n = 17) who began to wake up without the use of an alarm clock reported an average of 11% higher life satisfaction than the participants who woke to an alarm clock; this difference between participants was statistically significant (p = .011, Cohen's d = .911). Pre- and post-intervention showed that sleep hygiene education could be a suitable solution to prevent sleep deprivation and positively impact life satisfaction. Our findings emphasize the importance of increased sleep hygiene education, especially in preparing future military officers and during military exercises. Prioritizing sleep hygiene in these ways can significantly increase soldiers' life satisfaction.

What complex factors influence sleep quality in college students? PLS-SEM vs. fsQCA

Introduction

Sleep quality has a significant impact on the health-related quality of life, particularly among college students. This study proposes a framework for identifying factors that influence college students' sleep quality, including stress, self-control, bedtime habits, and neighborhood environment.

Methods

The study employed a cross-sectional analytical approach on a convenience sample of 255 medical students from a private university in China during the 2021/2022 academic year, of which 80.39% (205) were women. Two complementary methodologies, partial least squares-structural equation modeling (PLS-SEM), and fuzzy sets qualitative comparative analysis (fsQCA), were utilized in the study.

Results

The results of the PLS-SEM analysis suggest that Stress and Self-control act as mediating variables in the model, with Bedtime habits and Neighborhood environment influencing sleep quality through these variables. Additionally, the fsQCA analysis reveals that Bedtime habits and Neighborhood environment can combine with Stress and Self-control, respectively, to influence sleep quality.

Discussion

These findings provide insight into how multiple factors, such as Stress, Self-control, Bedtime habits, and Neighborhood environment, can impact college students' sleep quality, and can be used to develop intervention programs aimed at improving it. Moreover, the use of both methodologies enables the expansion of new methodological approaches that can be applied to different contexts.

The impact of the COVID-19 pandemic on adolescent sleep behavior

Restorative sleep is a fundamental component of adolescent wellbeing, and the COVID-19 pandemic presented both challenges and opportunities for adolescents' sleep. In this review, we synthesize emergent themes from the growing scientific evidence for the impact of the pandemic on adolescent sleep behavior across different stages of the pandemic and in different locations around the world. We also highlight the ways in which COVID-19 shaped sleep patterns among college students-a subgroup of adolescents transitioning to emerging adulthood that were particularly impacted by the shift to remote learning. Finally, we discuss variations in the impact according to several potential moderating factors in adolescents' lives and point to areas that require additional longitudinal research.

Sleep clusters and modifiable risk behaviors for noncommunicable diseases in young adults: Data from a birth cohort in Brazil

OBJECTIVES

To determine sleep clusters among young adults and describe the prevalence of modifiable risk behaviors for noncommunicable diseases (NCDs) according to these clusters.

METHODS

A cross-sectional analysis was carried out with the 1993 Pelotas Birth Cohort participants at the 22-year follow-up. Sleep onset, sleep offset, total sleep time (TST), TST variability, and sleep efficiency were evaluated by a triaxial accelerometer. We asked participants to wear the devices for 7 days on a nondominant wrist. Excessive daytime sleepiness was assessed by the Epworth sleep scale and sleep quality by the Pittsburgh Sleep Quality Index. Sleep clusters of 2738 individuals were determined using k-means cluster analysis. Crude and adjusted prevalence of modifiable risk behaviors for NCDs (smoking, harmful alcohol intake, leisure physical inactivity, overweight, screen time, and ultra-processed food consumption) were presented according to the sleep clusters. Adjustments included wealth index, skin color, years of schooling, current occupation, shift work, and having children under 2 years. All analyses were stratified according to sex.

RESULTS

We identified 3 sleep clusters for men (Healthy sleepers, Late and variant sleepers, and Shorter and poorer sleepers) and 3 for women (Healthy sleepers, Late and poor-quality sleepers, and Shorter, variant, and inefficient sleepers). Both males and females classified as Healthy sleepers presented a lower prevalence of modifiable risk behaviors for NCDs compared to individuals from other sleep clusters.

CONCLUSIONS

Poor sleep health is associated with higher prevalence of modifiable risk behaviors for NCDs. Prevention strategies for NCDs should also focus on sleep health.

Trait mindfulness and sleep: Interactions between observing and nonreactivity in the association with sleep health

The current study investigated the associations between trait mindfulness and sleep health and examined the interactions between theoretically related mindfulness subscales. Participants (n = 162, M_age = 19.93) reported trait levels of mindfulness and sleep was assessed using questionnaires and actigraphy. Higher mindfulness scores in awareness, nonreactivity, and nonjudgment were associated with better sleep health. The associations between observing and sleep health were moderated by nonreactivity. Results indicate that observing is associated with better sleep health at higher levels of nonreactivity and worse sleep health at lower levels, helping to explain the often-contradictory findings between observing and health outcomes.

Using Alcohol and Cannabis as Sleep Aids: Associations with Descriptive Norms Among College Students

PURPOSE

Young adults may use alcohol and cannabis as sleep aids, a risky behavior that can worsen sleep health over time and lead to substance dependence. Perceived norms for such risky behaviors are often overestimated and related to one's own use. This cross-sectional study examined: (a) the extent to which college students overestimated the prevalence of alcohol and cannabis use as sleep aids (i.e., perceived descriptive norms), and (b) the extent to which perceived descriptive norms were associated with students' own use of alcohol and cannabis as sleep aids.

METHODS

2,642 undergraduate college students (Mage = 18.84 years) reported past 30-day use of alcohol and cannabis as sleep aids. Participants also estimated the percent of college students who use alcohol and cannabis as sleep aids (i.e., perceived descriptive norms).

RESULTS

One-sample t-tests revealed participants, on average, overestimated the norms for using alcohol and cannabis as sleep aids. Participants who endorsed past 30-day use of these substances as sleep aids overestimated these norms to an even greater extent. Count regression models showed perceived descriptive norms were associated with students' use of alcohol and of cannabis as sleeps aids, in respective models, even when controlling for sleep difficulties.

CONCLUSIONS

College students may overestimate the prevalence of using alcohol and cannabis as sleep aids, and students who believe these behaviors are more normative report more frequent use of these substances as sleep aids. Taken together, findings may highlight the potential for norm-correcting strategies as a prudent approach to reducing/preventing the use of alcohol and cannabis as sleep aids.

Healthier movement behavior profiles are associated with higher psychological wellbeing among emerging adults attending post-secondary education

BACKGROUND

Emerging adulthood is a stressful time fraught with new challenges while attending higher education. Identifying protective factors to help reduce the psychological burden that many will experience during this period is therefore important. This study aimed to identify whether emerging adults attending post-secondary education can be classified into distinct profiles based on their 24-h movement behaviors, evaluate correlates of profile membership, and examine relationships between profile membership and indicators of mental health.

METHODS

This cross-sectional study used data from Cycle 1 of the Canadian Campus Wellbeing Survey. Emerging adults (N = 15,080; 67.6 % female; mean age = 20.78 ± 2.00) from 20 post-secondary institutions in Canada self-reported their movement behaviors - moderate-to-vigorous physical activity (MVPA), recreational screen time (ST) and sleep - and completed measures of psychological distress and mental wellbeing. Latent profile analysis was employed.

RESULTS

Five profiles were identified: low ST with very high (12.6 %), high (24.4 %) and low MVPA (51.2 %) as well as high ST with high (2.3 %) and low MVPA (9.4 %). Profiles had similar sleep patterns and were thus characterized by differences in MVPA and ST. Several socio-demographic variables were associated with profile membership. Profiles characterized by healthier combinations of MVPA, ST and sleep generally reported more favorable scores for indicators of mental health.

LIMITATIONS

Cross-sectional data limits causal inference, whereas self-reports may be biased.

CONCLUSIONS

Campus-based interventions should focus on getting students to engage in a healthy balance of physical activity and recreational screen use as it has the potential to reduce the mental health burden on emerging adults attending post-secondary education.

Randomized controlled trial of cognitive refocusing versus stimulus control treatment for college insomnia: feasibility of a brief, electronic-based, and peer-led approach

OBJECTIVE

Performance of Cognitive Refocusing Treatment for Insomnia (CRT-I) relative to stimulus control treatment (SCT) remains unknown among college students. This pilot trial compared single-session, electronic-based, peer-led CRT-I to SCT, and as well as awareness-based (AC) and no-treatment (NTC) controls.

PARTICIPANTS

College students (N = 82; Mage=18.59 [SD = 0.78]; 58% female; 61% White; 16% Hispanic) with insomnia symptoms were randomly assigned to CRT-I (n = 12), SCT (n = 14), and AC (n = 14) conditions, or non-randomly recruited to NTC (n = 42).

METHODS

All participants completed baseline and one-month follow-up surveys, and reported daily task enactment (except NTC).

RESULTS

Feasibility ratings were comparable across conditions. Within-group treatment effects revealed greater improvements in (a) insomnia symptom severity among CRT-I (d = 1.13) and SCT (d = 1.66) groups relative to AC (d = 0.90) and (b) pre-sleep cognitive arousal among CRT-I (d = 0.94) and SCT (d = 1.42) groups relative to AC (d = 0.75).

CONCLUSIONS

Brief, electronic-based, peer-led CRT-I and SCT interventions appear feasible and potentially efficacious for college insomnia.

Sleep paralysis in college students

Objective: We examined the prevalence of sleep paralysis (SP), its association with stress and sleep, and associated subjective experiences and beliefs. Participants: 1,115 college students from a large university in the southwestern United States. The sample was predominantly Hispanic (94%) and female (70%). Methods: Validated measures of life-events stress, self-perceived stress, sleep quality and insomnia were administered to participants online. Results: 35% of students had previously experienced SP and reported greater stress and poorer sleep than those who had never experienced it. Effect sizes were larger when comparing those who had/had not experienced SP within the prior year. Conclusions: Based on our predominantly Hispanic and majority female sample, we found that SP is experienced by approximately one-third of undergraduate students and associated with both higher stress and poorer sleep. We therefore recommend that college health practitioners seek ways to integrate relevant assessment and education into campus health practices.

Mediating Effect of Sleep Quality on the Relationship Between Electronic Screen Media Use and Academic Performance Among College Students

OBJECTIVE

We aimed to examine the effects of sleep quality on the association between pre-bedtime electronic screen media use for entertainment and academic performance among college students. We hypothesized that sleep quality mediates the association between pre-bedtime electronic screen media entertainment use and academic performance among college students.

METHODS

This was a cross-sectional survey with 1385 participants (age 19.99 ± 1.4 years [range, 17-24 years] and 36.82% males) conducted at Shantou University. The levels of academic performance were based on self-reported academic class ranking from average grades of their last final major examinations. Poor sleep quality was defined as a total score of the Pittsburgh Sleep Quality Index >7. The pre-bedtime prolonged electronic screen media use for entertainment (PESM-E) was defined as the use of electronic screen media for entertainment longer than 60 minutes/night after 10:00 p.m. during the past 6 months.

RESULTS

College students with pre-bedtime PESM-E were 1.28-fold more likely to have a poor academic performance than those who used electronic screen media less than 60 minutes (95% confidence interval [CI]: 1.04-1.57, P=0.020). Furthermore, pre-bedtime PESM-E was significantly associated with poor sleep quality (adjusted odds ratio [AOR]=1.87, 95% CI: 1.27-2.74, P=0.001) after controlling for confounders. Mediation model showed that poor sleep quality accounted for 53.08% of the effect of pre-bedtime PESM-E on lower levels of academic performance (Sobel Z=2.04, P=0.041).

CONCLUSION

Pre-bedtime PESM-E is associated with poor academic performance in college students, and this association is mediated by poor sleep quality. Our findings highlight the importance of limiting the use of electronic screen media before bedtime in college students.

Can You Sleep? - Effect of Retrospective Recall of Child Maltreatment on Sleep Parameters and the Mediating Role of Psychological Distress Among Students of Two German Universities

PURPOSE

Child maltreatment may be linked with long-term sleeping disorders and limited coping with stress. Yet, the potential relationships are only marginally studied.

PATIENTS AND METHODS

Based on a sample of young adults (n = 312) this study aims at exploring the effects of child maltreatment and the experience of threat to personal safety and life in childhood on sleep disturbances in early adulthood. Data were collected at the two study sites, Ulm University and Bielefeld University, by an online survey. For both risk factors, child maltreatment and the experience of threat to personal safety and life in childhood, a direct impact on sleep disturbances and an indirect path via psychological distress were tested using Structural Equation Modelling (SEM).

RESULTS

In these models, the direct path to sleep disturbances turned out to be significant for the experience of threat to personal safety and life (Path C: b = 0.18, p = 0.013), but not for child maltreatment (Path C: b = 0.05, p = 0.491). However, the current level of psychological distress was found to have a mediating effect on sleep disturbances for both risk factors, thereby confirming indirect significant effects.

CONCLUSION

Considering that the etiological pathway of child maltreatment on sleeping disturbances is mediated via psychological distress, this provides a venue to test in future research whether stress reduction interventions can reduce the negative consequences of child maltreatment on sleep disorders.

Bedtime repetitive negative thinking moderates the relationship between psychological stress and insomnia

Research suggests that psychological stress is associated with insomnia, but there is limited research on vulnerabilities that might amplify this association, particularly in college students. Based on a sample of 507 undergraduates, the current study demonstrates that the observed positive correlation between self-perceived stress and insomnia severity is moderated by the tendency to engage in repetitive negative thinking (RNT) at bedtime. Additionally, separate analyses of those who scored below/above the threshold for insomnia (non-insomniacs vs. insomniacs) revealed that the interaction between stress and these negative bedtime cognitions differed qualitatively between the two groups. In insomniacs, the stress-insomnia relationship was dampened for those with lower levels of bedtime RNT, but amplified for those with higher levels. For non-insomniacs, the stress-insomnia relationship was stronger for those with minimal bedtime RNT, while higher levels of bedtime RNT appeared to overshadow this association. To develop a better understanding of the contribution of stress and RNT to clinically relevant levels of insomnia, future studies should take into account the dissimilar patterns of moderation seen in non-insomniacs and insomniacs, either through prospective screening or separate analyses. Findings from the current study suggest that insomnia treatments that can simultaneously reduce stress and address bedtime RNT may be optimal.

Social media for students' sleep health promotion - a health intervention report during COVID -19

The COVID-19 pandemic has affected sleep health. Students' sleep health is essential for the performance of neuro-cognitive processes, as well as mental and physical balance. We assume the COVID19 pandemic has modified some sleep habits by prompting environmental and social interaction changes. In this study we surveyed a sample of 300 Brazilian students, with internet access, resident in the Federal District. They completed a questionnaire over two weeks in March 2020, i.e. the second and third week of the social isolation policy enacted in the Federal District due to COVID19. Valid responses from students aged18-24 years were analyzed. The sample was mostly female; 76,3% reported somnolence during the day, 70,2% anxiety and 87,8% worse sleep associated with stress and/or anxiety, which indicated the variables for an educational health intervention design in this context. Further, 53.2% made no effort to avoid screens before sleeping; 73.9% to avoid using the bed for work or watching television and 83.1% to avoid consuming heavy foods before sleeping. We then created an Instagram profile, @comodormimos, which focused on the main sleep issues revealed by participants in the survey. Posts on the profile were based on sleep-related subjects: sleep processes, sleep hygiene practices for students; sleep stages, function and regulation; and sleep-wake circadian rhythms. The profile gained 307 followers, mostly women (61,7%), 18-24 years old. We concluded that the Covid-10 pandemic period increased harmful sleep behavior in students. Further studies are needed to understand the impact of the COVID-19 pandemic on student sleep health.

All around suboptimal health - a joint position paper of the Suboptimal Health Study Consortium and European Association for Predictive, Preventive and Personalised Medicine

First two decades of the twenty-first century are characterised by epidemics of non-communicable diseases such as many hundreds of millions of patients diagnosed with cardiovascular diseases and the type 2 diabetes mellitus, breast, lung, liver and prostate malignancies, neurological, sleep, mood and eye disorders, amongst others. Consequent socio-economic burden is tremendous. Unprecedented decrease in age of maladaptive individuals has been reported. The absolute majority of expanding non-communicable disorders carry a chronic character, over a couple of years progressing from reversible suboptimal health conditions to irreversible severe pathologies and cascading collateral complications. The time-frame between onset of SHS and clinical manifestation of associated disorders is the operational area for an application of reliable risk assessment tools and predictive diagnostics followed by the cost-effective targeted prevention and treatments tailored to the person. This article demonstrates advanced strategies in bio/medical sciences and healthcare focused on suboptimal health conditions in the frame-work of Predictive, Preventive and Personalised Medicine (3PM/PPPM). Potential benefits in healthcare systems and for society at large include but are not restricted to an improved life-quality of major populations and socio-economical groups, advanced professionalism of healthcare-givers and sustainable healthcare economy. Amongst others, following medical areas are proposed to strongly benefit from PPPM strategies applied to the identification and treatment of suboptimal health conditions:Stress overload associated pathologiesMale and female healthPlanned pregnanciesPeriodontal healthEye disordersInflammatory disorders, wound healing and pain management with associated complicationsMetabolic disorders and suboptimal body weightCardiovascular pathologiesCancersStroke, particularly of unknown aetiology and in young individualsSleep medicineSports medicineImproved individual outcomes under pandemic conditions such as COVID-19.

PaLS Study of Sleep Deprivation and Mental Health Consequences of the COVID-19 Pandemic among University Students: A Cross-Sectional Survey

The COVID-19 pandemic has changed the way many people live. To assess its impact on sleep quality and quantity, blue light exposure, and the mental health of Polish university students, a cross-sectional survey was conducted. Almost half of the participants were medical students (47.62%; n = 630). The majority of students were suffering from insomnia (58.13%, n = 769). Almost every third student was sleeping less than 7 h a day (30.39%, n = 402). Our study showed that a short sleep duration correlates with poorer mental health outcomes. Respondents who declared sadness and depression were more likely to suffer from insomnia (OR = 5.6997, 95% CI: 4.3641-7.4441). Difficulty with tasks was also more likely to co-occur with insomnia (OR = 5.4723, 95% CI: 4.3007 to 6.9630). The results of this study showed that the COVID-19 pandemic contributed to the deterioration of sleep quality and quantity as well as the psychological well-being of Polish students. It is important to take steps to promote proper sleeping habits to alleviate the risk of mental health disorders in this group of people.

Sleep Patterns Related to Emotion Dysregulation Among Adolescents and Young Adults

OBJECTIVE

Adolescents and young adults in the college setting often report poor sleep hygiene and quality. These sleep difficulties may be related to emotion dysregulation, which is highly relevant to broader adjustment. The current study aimed to empirically identify latent groups of healthy college students with distinct subjective sleep patterns and examine differences in emotion dysregulation between subgroups.

METHODS

College students (N = 476; Mage=19.38) completed the Adolescent Sleep-Wake Scale-Revised, Adolescent Sleep Hygiene Scale-Revised, and Difficulties in Emotion Dysregulation Scale. Most participants were White (78%), non-Hispanic/Latinx (85%), and female (77%). Latent profile analysis identified patterns of sleep with maximum likelihood estimation. Bolck-Croon-Hagenaars procedure evaluated differences in emotion dysregulation by class.

RESULTS

A three-class model had optimal fit, Bayesian information criterion = 11,577.001, Bootstrapped Parametric Likelihood Ratio Test = -5,763.042, p < .001, entropy = .815. The three profiles identified were good sleep (overall high sleep quality and hygiene; n = 219), moderate sleep (low sleep quality with mix of low and high sleep hygiene; n = 221), and poor sleep (very low sleep quality and hygiene; n = 36). Those in the good sleep group (M = 68.06, SE = 1.5) reported significantly less emotion dysregulation than the moderate sleep group (M = 92.12, SE = 1.67; X2(2) = 98.34, p = .001) and the poor sleep group (M = 99.51, SE = 4.10; p < .001). The moderate and poor sleep groups did not significantly differ, X2(2) = 2.60, p = .11.

CONCLUSIONS

Emotion dysregulation differed across three sleep profiles, with participants classified in the good sleep group reporting, on average, the lowest emotion dysregulation, compared to the moderate and poor sleep groups. These findings highlight contextual factors of sleep that may be clinically targeted to promote emotion regulation.

Relationship between sleep habits and academic performance in university Nursing students

Background

Sleep disorders are composed of a group of diseases of increasing prevalence and with social-health implications to be considered a public health problem. Sleep habits and specific sleep behaviors have an influence on the academic success of students. However, the characteristics of sleep and sleep habits of university students as predictors of poor academic performance have been scarcely analyzed. In the present study, we aimed to investigate sleep habits and their influence on academic performance in a cohort of Nursing Degree students.

Methods

This was a cross-sectional and observational study. An anonymous and self-administered questionnaire was used, including different scales such as the ‘Morningness and Eveningness scale’, an author-generated sleep habit questionnaire, and certain variables aimed at studying the socio-familial and academic aspects of the Nursing students. The association of sleep habits and other variables with poor academic performance was investigated by logistic regression. The internal consistency and homogeneity of the ‘sleep habits questionnaire’ was assessed with the Cronbach’s alpha test.

Results

Overall, 401 students (mean age of 22.1 ± 4.9 years, 74.8 % females) from the Nursing Degree were included. The homogeneity of the ‘sleep habits questionnaire’ was appropriate (Cronbach’s alpha = 0.710). Nursing students were characterized by an evening chronotype (20.2 %) and a short sleep pattern. 30.4 % of the Nursing students had bad sleep habits. Regarding the academic performance, 47.9 % of the students showed a poor one. On multivariate logistic regression analysis, a short sleep pattern (adjusted OR = 1.53, 95 % CI 1.01–2.34), bad sleep habits (aOR = 1.76, 95 % CI 1.11–2.79), and age < 25 years (aOR = 2.27, 95 % CI 1.30–3.98) were independently associated with a higher probability of poor academic performance.

Conclusions

Almost 1/3 of the Nursing students were identified as having bad sleep habits, and these students were characterized by an evening chronotype and a short sleep pattern. A short sleep pattern, bad sleep habits, and age < 25 years, were independently associated with a higher risk of poor academic performance. This requires multifactorial approaches and the involvement of all the associated actors: teachers, academic institutions, health institutions, and the people in charge in university residences, among others.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00635-x.

The Motor Function Evaluation of College Students' Physical Activity State From the Perspective of Educational Psychology

College students have taken part in less and less physical activities as a result of the common static lifestyle in recent years, lowering the level of motor function. This phenomenon has been a source of concern for schools and the government, and it is necessary to take corresponding measures to change it. The general motor function level of Chinese college students is explored first based on artificial intelligence and the human–computer interaction technology. The Physical Activity Questionnaire for College Students is compiled by referring to the International Physical Activity Questionnaire, and 561 students from colleges in Tianjin province are assessed based on the functional movement screen (FMS). Spearman correlation and multivariate regression analysis (MRA) are used to analyze the correlation between the motor function and physical activity status. In terms of lunch break frequency, the proportion of students having one to two lunch breaks in a week is the highest (54.15%); in terms of the frequency of doing moderate physical exercise, the proportion of students doing moderate physical exercise for 1–2 days in a week is the highest (50.61%); in terms of the frequency of doing heavy physical exercise, the proportion of students doing heavy exercise for 1–2 days in a week is the highest (47.26%); in terms of the sedentary time, the proportion of students with sedentary time more than 5 h in a day is the highest (40.61%); in terms of eye use time, the proportion of students with 8–10 h eye use time in a day is the highest (43.61%). Besides, in terms of the FMS score, the proportion of students with 13–15 FMS is the highest (48.46%). The hurdle step (21.03%), straight knee lift (22.52%), and body rotation stability (18.31%) have a relatively low proportion among the three-point items. There is a positive correlation between motor function score with the time of moderate exercise and the time of heavy exercise (P < 0.05). College students generally have insufficient rest time, long eye use time, and long sitting time, leading to a low level of motor function, manifested by an asymmetry between both sides of the body and poor trunk stability. It is recommended to add hurdling steps, straight knee lifts, and body rotation stability tests to college physical education courses.

Sleep Duration and Quality in Relation to Fruit and Vegetable Intake of US Young Adults: a Secondary Analysis

BACKGROUND

Sleep is gaining recognition as a determinant of diet, yet this relationship remains understudied among young adults. We sought to examine how sleep duration and quality were related to fruit and vegetable (FV) intake within a diverse sample of young adults.

METHODS

Participants (n = 1444) ages 21-30 (69% women, 15% African American, 35% full or part time in college) consuming < 5 servings/day of FV (eligibility criteria) completed a baseline survey to enroll in a randomized online FV intervention. Sleep questions included duration, perceived sleep quality, time to fall asleep, and insomnia symptoms. Overall and gender-stratified linear regression models compared average daily FV intake and sleep characteristics, adjusting for confounders.

RESULTS

One-third (32%) of the participants reported < 7 h of sleep per night, and 36% noted insomnia symptoms ≥ 3 times per week. Women, a BMI > 30, African American race/ethnicity, less education, unemployment, higher depression, and stress were related to suboptimal sleep. Bivariate analyses showed that better sleep was associated with higher FV intake. After accounting for confounders, men with better sleep quality and shorter time to fall asleep had higher intakes of FV (1.12 serving/day difference in highest versus lowest quality [95% CI 0.48, 1.75] and a 0.52 serving/day higher intake difference for shortest versus longest fall asleep time [95% CI 0.90, 0.15], respectively).

CONCLUSION

Sleep was highly prevalent in a diverse sample of community-based young adults and may contribute to lower FV intake among men. These associations highlight young adulthood as an important period for promoting healthy sleep habits.

Social Psychological Predictors of Sleep Hygiene Behaviors in Australian and Hong Kong University Students

BACKGROUND

Sleep hygiene behaviors in undergraduate students are associated with night-time sleep duration and quality, daytime sleepiness, and psychological distress. This study aimed to identify the social psychological factors that impact on university students' sleep hygiene behaviors in samples from two countries.

METHOD

Participants were undergraduate students from Australia (N = 201, M_Age = 22.82, SD_Age = 8.89; 165 female) and Hong Kong (N = 161, M_Age = 20.47, SD_Age = 7.80; 84 female). The study used a correlational-prospective design. Individuals self-reported their intention, attitude, subjective norms, perceived behavioral control, and past behavior with respect to sleep hygiene behaviors. Four weeks later, the students self-reported their action plans and participation in sleep hygiene behaviors.

RESULTS

Analysis indicated acceptable model fit to data for both the Australian and Hong Kong samples. Results showed significant direct effects of attitude, subjective norms, perceived behavioral control, and past behavior on intention, and significant direct effects of action planning and past behavior on prospectively measured sleep hygiene behavior. There were also significant indirect effects of attitude, subjective norms (Hong Kong sample only), and perceived behavioral control on behavior mediated by intention and action planning. Overall, the model predicted a large portion of the variance in sleep hygiene behavior for both the Australian (R² = .524) and Hong Kong (R² = .483) samples. Schenker and Gentleman t tests found no parameters significantly differed between samples.

CONCLUSION

Results indicate that university students' sleep hygiene behaviors are a function of both motivational and volitional processes. This formative data can inform future interventions to improve the sleep hygiene practices of university students.

Examining Sleep Disturbance Among Sheltered and Unsheltered Transition Age Youth Experiencing Homelessness

BACKGROUND

The estimated 3.5-million transition age youth (TAY) who experience homelessness in the United States annually are routinely exposed to inadequate sleep environments and other psychosocial risk factors for deficient sleep. Although staying in a shelter versus being unsheltered may facilitate sleep, research suggests that perceived safety wherever one sleeps may be just as important. In this study, which is the first known study to investigate sleep disturbances among TAY experiencing homelessness, we examine associations of sleep disturbances with sheltered status and perceived safety of usual sleep environment.

METHODS

We surveyed TAY (aged 18-25) experiencing homelessness in Los Angeles, CA about their sleep, psychosocial health, and living situations. Participants (n=103; 60% sheltered) self-reported sleep disturbances using the Patient-Reported Outcomes Measurement Information System Sleep Disturbance short form, while individual items assessed sheltered status and perceived safety where they usually slept. Regression analyses examined associations of sheltered status and perceived sleep environment safety with sleep disturbance, adjusting for age, sex, race, self-rated health, depression symptoms, serious mental illness, high-risk drinking, and severe food insecurity.

RESULTS

Twenty-six percent of participants reported moderate-severe sleep disturbances. Sleep disturbance was not associated with sheltered status, but was positively associated with feeling unsafe in one's sleep environment, depression symptoms, severe food insecurity, and decreased age.

CONCLUSIONS

Our findings suggest that sleep disturbances among TAY experiencing homelessness are associated more closely with how safe one feels rather than one's sheltered status. This highlights the importance of providing safe places to live for sheltered and unsheltered TAY.

College student sleep quality and mental and physical health are associated with food insecurity in a multi-campus study

Objective:

To assess the relationship between food insecurity, sleep quality, and days with mental and physical health issues among college students.

Design:

An online survey was administered. Food insecurity was assessed using the ten-item Adult Food Security Survey Module. Sleep was measured using the nineteen-item Pittsburgh Sleep Quality Index (PSQI). Mental health and physical health were measured using three items from the Healthy Days Core Module. Multivariate logistic regression was conducted to assess the relationship between food insecurity, sleep quality, and days with poor mental and physical health.

Setting:

Twenty-two higher education institutions.

Participants:

College students (n 17 686) enrolled at one of twenty-two participating universities.

Results:

Compared with food-secure students, those classified as food insecure (43·4 %) had higher PSQI scores indicating poorer sleep quality (P < 0·0001) and reported more days with poor mental (P < 0·0001) and physical (P < 0·0001) health as well as days when mental and physical health prevented them from completing daily activities (P < 0·0001). Food-insecure students had higher adjusted odds of having poor sleep quality (adjusted OR (AOR): 1·13; 95 % CI 1·12, 1·14), days with poor physical health (AOR: 1·01; 95 % CI 1·01, 1·02), days with poor mental health (AOR: 1·03; 95 % CI 1·02, 1·03) and days when poor mental or physical health prevented them from completing daily activities (AOR: 1·03; 95 % CI 1·02, 1·04).

Conclusions:

College students report high food insecurity which is associated with poor mental and physical health, and sleep quality. Multi-level policy changes and campus wellness programmes are needed to prevent food insecurity and improve student health-related outcomes.

Dysfunctional beliefs, sleep hygiene and sleep quality in university students

ISSUE ADDRESSED

Poor sleep quality is common among university students and can have negative implications for physical, emotional, cognitive and academic wellbeing. Previous research has identified that sleep beliefs and sleep behaviours are associated with poor sleep quality. However, few studies have examined these variables simultaneously. This study explored associations between dysfunctional beliefs about sleep, sleep hygiene and sleep quality in a sample of university students.

METHODS

Participants were recruited from a pool of undergraduate psychology students and included 120 male students and 145 female students with an average age of 20 years (SD = 5.10). Participants completed an online survey including the Pittsburgh Sleep Quality Index, Dysfunctional Beliefs and Attitudes About Sleep Scale, Sleep Hygiene Index and demographic items.

RESULTS

Overall 60.4% of participants (59.4% of women, 40.6% of men) had poor sleep quality. Logistic regression indicated a significant positive association between sleep hygiene and sleep quality, OR = 1.16, P >.001, 95% CI (1.10, 1.23), and no significant relationship between dysfunctional beliefs about sleep and sleep quality, OR = 1.03, P > .79, 95% CI (0.84, 1.26), after adjusting for covariates.

CONCLUSIONS

Sleep interventions for university students are needed and could focus on common hygiene components, such as using the bed for activities other than sleeping, engaging in arousing activities before bed and how to manage thinking and worrying before bed. So What? The results of the study demonstrate poor sleep quality is common among university students and indicates that sleep interventions are warranted. The positive association found between sleep hygiene and sleep quality highlights that interventions should focus on behavioural components of sleep.

Happiness, perceived stress, psychological well-being, and health behaviors of Thai university students: preliminary results from a multinational study on well-being

Objective: Describe and compare levels of happiness, psychological well-being, perceived stress, and health behaviors of university students.Participants: Thai university students were selected (N = 478) during November 2016 using random cluster sampling.Methods: A health and well-being questionnaire was constructed, translated from English to Thai, back-translated, and pilot tested. Descriptive and chi-square statistics were calculated for study variables.Results: Thai male students had lower happiness and psychological well-being than Thai female students. Overall, Thai students had lower happiness and higher perceived stress than US/UK samples. Thai male students reported greater alcohol and tobacco use than Thai female students. Overall, Thai students reported inadequate diet (57%), poor sleep quantity/quality (67%) and depressive symptoms (40%).Conclusions: These preliminary results identify specific areas of concern in the health and well-being of Thai university students. Further analyses are needed to shed light on the factors contributing to these increased health risks.

Associations of Sleep Insufficiency and Chronotype with Inflammatory Cytokines in College Students

PURPOSE

Sleep insufficiency and circadian rhythm disturbances in college students have become prominent. Current findings show that sleep insufficiency is closely related to inflammation. Studies on the correlation between chronotype and inflammatory factors are still lacking. Therefore, this research intended to examine the relationships between sleep duration, chronotype and inflammatory cytokines in young adults, and to estimate the correlation between chronotype and inflammatory cytokines stratified by sleep duration.

PATIENTS AND METHODS

We conducted a cross-sectional study in April and May 2019. Participants were recruited from two colleges located in central China. The Pittsburgh Sleep Quality Index (PSQI) and the Morning and Evening Questionnaire-5 (MEQ-5) were administered to assess sleep duration and chronotype. Sleep duration less than 7 hours was defined as insufficient sleep. Fasting venous blood was collected to measure plasma levels of inflammatory markers including IL-1β, IL-6, TNF-α and IL-10.

RESULTS

A total of 723 participants were included in this study, with a mean age of 18.68 years (standard deviation=0.99). After adjusting for confounding factors, the results of generalized linear model showed that sleep insufficiency was positively correlated with IL-1β, TNF-α and IL-10; and evening-types (E-types) were positively associated with the levels of IL-1β and IL-6 (p<0.05). Compared to the control group (sleep sufficiency and M-types), there were positive interaction effects of sleep insufficiency and neutral-types (N-types) on the levels of IL-1β, IL-6, TNF-α and IL-10 (p<0.05). The hierarchical regression model showed that N-types and E-types were positively correlated to the levels of IL-1β, IL-6, TNF-α and IL-10 among college students with sleep insufficiency (p<0.05).

CONCLUSION

The levels of inflammatory markers were higher among college students with sleep insufficiency and E-types. N-types and E-types were positively correlated with IL-1β, IL-6, TNF-α and IL-10 among college students with sleep insufficiency.

The importance of cardiorespiratory fitness and sleep duration in early CVD prevention: BMI, resting heart rate and questions about sleep patterns are suggested in risk assessment of young adults, 18-25 years : The cross-sectional lifestyle, biomarkers and atherosclerosis (LBA) study

Background

Cardiorespiratory fitness (CRF) and sleep habits are lifestyle factors with potential to prevent cardiovascular disease (CVD). CVD is the leading cause of death worldwide. It is therefore important to establish a healthy lifestyle at a young age. In the Lifestyle, Biomarkers and Atherosclerosis (LBA) study we have examined 834 healthy non-smoking adults, aged 18–25 years. The general purpose of the LBA study was to study the effect of lifestyle on traditional biomarkers known to influence CVD risk. The aims of the present study were to evaluate sleep habits of young adult women and men participating in the LBA study, and to compare the importance of sleep and other lifestyle habits on clinically relevant biomarkers for CVD. An additional aim was to find easy and reliable non-invasive biomarkers to detect young adults with increased risk of developing CVD later in life.

Methods

The participants had previously been examined for lifestyle factors, biomarkers and CVD risk score. They filled in a validated computerized questionnaire about their general physical and mental health. The questionnaire included questions on sleep duration and experienced quality of sleep.

Results

In total 27% of the young adult participants reported difficulties falling asleep or experienced troubled sleep with frequent awakenings per night. The experienced troubled sleep was not related to a higher CVD risk score, but sleep quality and duration were correlated. Shorter sleep duration was significantly associated to higher body mass index (BMI), body fat (%), homeostasis model assessment of insulin resistance (HOMA-IR) and CVD risk. The modifiable lifestyle factor with the highest odds ratio (OR) for CVD risk was CRF. Sleep duration was the second most influential lifestyle factor, more important than moderate- and vigorous physical activity (MVPA) and food habits. Correlations between CRF and heart rate (HR), (P < 0.01) and HOMA-IR and BMI (P < 0.01) were observed, indicating that BMI and resting HR in combination with questions about sleep patterns are easy and reliable non-invasive biomarkers to detect young adults who need counselling on a healthy lifestyle.

Conclusion

Decreased sleep duration in combination with decreased CRF, in young adults, is a serious health issue.

Sleep Pattern Changes in Nursing Students during the COVID-19 Lockdown

The prevalence of poor sleep quality among students is very high and, in nursing students, has been associated with reduced performance, behavioral changes, dietary changes, and even aggressive behavior due to changes in sleep patterns. The lockdown in response to COVID-19 may have resulted in lifestyle changes that affected sleep quality. For this reason, the objective of this study is to determine the difference in nursing students’ sleep quality before and during the lockdown, put in place in response to the coronavirus (COVID-19) pandemic. To meet this objective, we conducted a longitudinal observational study on 207 nursing students, with two cut-off points (February and April). The main dependent variable was sleep quality, measured using the Pittsburgh sleep quality index (PSQI) and its seven components. Parametric and nonparametric tests were used for paired and unpaired data, as well as group-stratified analysis. The mean time students spent in bed was 7.6 h (standard deviation (SD) = 1.1 h) before lockdown and 8.5 h (SD = 1.2 h) during lockdown. The PSQI score got 0.91 points worse during lockdown (95% CI, −0.51, −1.31). Of the five components, five were statistically significantly affected (p ≤ 0.05), and of these, the most changed were sleep latency, sleep duration, and sleep efficiency. When stratified by group, we observed differences in women, first-year students, second-year students, alcohol consumers, those of normal weight, and those that live with family. The main conclusion is that although students spent more time in bed, overall sleep quality was worse during lockdown, as well as being worse in five of the seven components.

Perception and simplified question for assessing problems sleeping among university students at a primary care unit

Introduction:

Students entering university undergo various lifestyle changes, many of which may affect their sleeping habits. This study aimed to evaluate 1) individual perception of the problems sleeping, 2) “actual“ problems sleeping as detected using a simplified questionnaire, 3) the relationship between individual perceptions and actual problems sleeping, and 4) the factors affecting the problems sleeping.

Methods and Material:

This was a descriptive study of 240 university students who attended the “123 Primary Care Unit“ for no sleep-related problems between March and June 2019. The tool was a self-response questionnaire that assessed the respondent's demographic data and sleep patterns over the past year. All parameters and problems sleeping were analyzed for their association.

Results:

Most of the students (51.3%) perceived themselves as having problems sleeping. Actual problems sleeping was found in 174 (72.5%) students. Individual perception was significantly related to the presence of all four of the problems sleeping assessed, which included difficulty in initiating sleep, waking up at night and being unable fall back to sleep, the need for daytime napping, and the feeling that one is sleep deprived (P < 0.05).

Conclusions:

This study provides a simplified method for assessing problems sleeping among university students at a primary care facility. Most of the students had problems sleeping and accurate perceptions of those problems sleeping, but the problems sleeping were often ignored. Further improvements to the system for screening and treating problems sleeping are required.

Poor sleep and emotion dysregulation mediate the association between depressive and premenstrual symptoms in young adult women

A large portion of reproductive-aged women report experiencing distressing premenstrual symptoms. These symptoms can be exacerbated by concurrent mood problems and contribute to long-term depressive risk. However, difficulty sleeping and regulating emotional responses are also associated with the premenstrual phase and represent additional, well-established risk factors for depression. The aim of this study was to investigate whether habitual sleep problems and emotion regulation strategies serve to mediate the relationship between mood and premenstrual symptoms in non-treatment-seeking young women. Participants included 265 adult women between the ages of 18 and 25 who provided retrospective self-reports of depressive symptoms, habitual sleep quality, and premenstrual symptoms for the past month. Trait-based difficulties in regulating emotions were also assessed. Greater depressive symptoms significantly predicted greater premenstrual symptoms and both poor sleep and ineffective emotion regulation were shown to mediate this relationship. Poor sleep may enhance experience of premenstrual symptoms via its well-established impact on physical, cognitive, and/or affective functioning. Similarly, an inability to effectively regulate emotional responses in general may exacerbate experience or perception of somatic and mood symptoms during the premenstrual period, contributing to mood disturbances and risk. Findings require replication in future studies using prospective designs and more diverse samples of women.

Practice parameters for the use of actigraphy in the military operational context: the Walter Reed Army Institute of Research Operational Research Kit-Actigraphy (WORK-A)

BACKGROUND

The Walter Reed Army Institute of Research (WRAIR) Operational Research Kit-Actigraphy (WORK-A) is a set of unique practice parameters and actigraphy-derived measures for the analysis of operational military sleep patterns. The WORK-A draws on best practices from the literature and comprises 15 additional descriptive variables. Here, we demonstrate the WORK-A with a sample of United States Army Reserve Officers' Training Corps (ROTC) cadets (n = 286) during a month-long capstone pre-commissioning training exercise.

METHODS

The sleep of ROTC cadets (n = 286) was measured by Philips Actiwatch devices during the 31-day training exercise. The preliminary effectiveness of the WORK-A was tested by comparing differences in sleep measures collected by Actiwatches as calculated by Philips Actiware software against WORK-A-determined sleep measures and self-report sleep collected from a subset of ROTC cadets (n = 140).

RESULTS

Actiware sleep summary statistics were significantly different from WORK-A measures and self-report sleep (all P ≤ 0.001). Bedtimes and waketimes as determined by WORK-A major sleep intervals showed the best agreement with self-report bedtime (22:21 ± 1:30 vs. 22:13 ± 0:40, P = 0.21) and waketime (04:30 ± 2:17 vs. 04:31 ± 0:47, P = 0.68). Though still significantly different, the discrepancy was smaller between the WORK-A measure of time in bed (TIB) for major sleep intervals (352 ± 29 min) and self-report nightly sleep duration (337 ± 57 min, P = 0.006) than that between the WORK-A major TIB and Actiware TIB (177 ± 42, P ≤ 0.001).

CONCLUSIONS

Default actigraphy methods are not the most accurate methods for characterizing soldier sleep, but reliable methods for characterizing operational sleep patterns is a necessary first step in developing strategies to improve soldier readiness. The WORK-A addresses this knowledge gap by providing practice parameters and a robust variety of measures with which to profile sleep behavior in service members.

Why young women gain weight: A narrative review of influencing factors and possible solutions

Significant weight gain occurs in women during young adulthood, which increases risk of diseases such as diabetes, cardiovascular disease, and many cancers. This review aims to inform future individually targeted weight gain prevention programmes and summarizes possible targets: key life events, mediators that influence energy intake and physical activity levels, and moderators that could identify groups of women at greatest risk. Life events affecting weight include pregnancy and motherhood, smoking cessation, marriage and cohabiting, attending university, and possibly bereavement. Research has identified successful methods for preventing weight gain associated with pregnancy and motherhood, which could now be used in practice, but evidence is inconclusive for preventing weight gain around other life events. Weight gain is mediated by lack of knowledge and skills around food and nutrition, depression, anxiety, stress, satiety, neural responses, and possibly sleep patterns and premenstrual cravings. A paucity of research exists into altering these to limit weight gain. Moderators include socioeconomic status, genetics, personality traits, and eating styles. More research is required to identify at-risk females and engage them in weight gain prevention. There is a need to address evidence gaps highlighted and implement what is currently known to develop effective strategies to limit weight gain in young women.

Associations between Mental Workload and Sleep Quality in a Sample of Young Adults Recruited from a US College Town

OBJECTIVE

To evaluate associations between perceived mental workload (number of hours spent studying and perceived mental intensity) and sleep quality among young adults.

PARTICIPANTS

656 participants [62% male, median age (IQR) = 20 (19, 21) years] recruited from a US college town.

METHODS

As part of an online screener, participants answered questions about perceived workload and sleep quality (Pittsburgh Sleep Quality Index (PSQI)). Number of hours/day of mentally engaging work/study, and mental intensity score were the exposures, categorized into quartiles. Linear regression models were used for continuous sleep quality score, and modified Poisson models were used for poor quality sleep (>5 PSQI score) and individual sleep components, adjusting for sex, age, race, physical activity, and caffeine intake.

RESULTS

Higher mental work-hours were associated with lower-quality sleep; those in the highest quartile of mental work-hours had a 28% higher likelihood of poor sleep quality (95% CI 2% to 62%). Higher mental intensity scores were also related to lower quality sleep; comparing the highest to the lowest quartiles, there was a 45% higher probability of being a poor sleeper (95% CI 15% to 83%). Associations with PSQI components were partly sex-specific: while both sexes had associations between mental intensity and short sleep, males had positive associations with poor sleep quality and sleep medication use. Conversely, females with higher mental intensity reported higher-quality sleep overall and lower sleep medication use but lower sleep efficiency.

CONCLUSIONS

Higher mental workload is associated with lower overall sleep quality in young adults. Associations with individual sleep quality components differed by sex.

Cross-Sectional Survey of Sleep Practices of Australian University Students

Sleep insufficiency is often associated with the life of a university student, yet it is well known that inadequate sleep can have a negative impact on physical and mental health and be detrimental to cognitive skills for learning. The aim of this study was to replicate a Canadian study to survey university student sleep practices, the way in which students address any sleep issues, and the students' preferred method to receive targeted sleep information.

METHODS

An anonymous on-line survey was promoted to all enrolled students at one Australian University in August 2017.

RESULTS

In total, 601 students responded to the survey. One third indicated that they had insufficient sleep (less than 6.5 hrs). Almost two thirds reported a perception of not getting sufficient sleep. There was a significant association between the reported number of sleep hours, and the perception of high-quality sleep. Strategies to get to sleep included the use of social media which is counter to best practice in sleep hygiene.

CONCLUSION

The study supports the need for education about sleep health coupled with stress management to better the demands of student life.

The Quality, Quantity, and Intraindividual Variability of Sleep Among Students and Student-Athletes

BACKGROUND

Student-athletes are subject to significant demands due to their concurrent sporting and academic commitments, which may affect their sleep. This study aimed to compare the self-reported sleep quality, quantity, and intraindividual variability (IIV) of students and student-athletes through an online survey.

HYPOTHESIS

Student-athletes will have a poorer sleep quality and quantity and experience more IIV.

STUDY DESIGN

Case-control study.

LEVEL OF EVIDENCE

Level 4.

METHODS

Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), while sleep quantity and IIV were assessed using the Consensus Sleep Diary. Initially, the PSQI and additional questions regarding sport participation habits were completed by 138 participants (65 students, 73 student-athletes). From within this sample, 44 participants were recruited to complete the sleep diary for a period of 14 days.

RESULTS

The mean PSQI score was 6.89 ± 3.03, with 65% of the sample identified as poor sleepers, but no difference was observed between students and student-athletes. Analysis of sleep patterns showed only possibly to likely small differences in sleep schedule, sleep onset latency, and subjective sleep quality between groups. IIV analysis showed likely moderate to possibly small differences between groups, suggesting more variable sleep patterns among student-athletes.

CONCLUSION

This study highlights that sleep issues are prevalent within the university student population and that student-athletes may be at greater risk due to more variable sleep patterns.

CLINICAL RELEVANCE

University coaches should consider these results to optimize sleep habits of their student-athletes.

Interrupted sleep: College students sleeping with technology

Objective: To examine the influence of cell phones and sleep quality among college students and the prevalence of sleep texting. Participants: Participants were 372 college students at two mid-size universities in 2013. Methods: A survey was used to ask about cell phone use during sleep and sleep quality. Students were asked about hours of sleep, both on a school night, and over the weekend in addition to location of cell phone. Results: A quarter of the sample (25.6%) reported sleep texting behavior along with poor sleep quality and the cell phone influencing their sleep (p < .05). Students that sleep text were more likely to report sleep interruption (p < .000), to place their phone in bed with them (p < .000), have no memory of texting (72%) or what they texted (25%). Conclusions: Sleep texting and its influence on poor sleep habits is a growing trend in a college student population.

Bedtime Procrastination, Sleep-Related Behaviors, and Demographic Factors in an Online Survey on a Polish Sample

The sufficient length and good quality of night sleep play a vital role in maintaining health, well-being and effective functioning. Nevertheless, an increase in the prevalence of sleep deprivation can be observed recently. The concept of bedtime procrastination, defined as going to bed later than intended, has been proposed to explain one of the psychological determinants of sleep deficiency. To investigate the prevalence of bedtime procrastination among Poles we carried out a Polish adaptation of the Bedtime Procrastination Scale (BPS), a self-report questionnaire for measuring the tendency to voluntarily postpone going to bed in the absence of any external circumstances for doing so. The aim of the research was to determine the main psychometric properties of the Polish version of the BPS. We also aimed to identify the relationships between bedtime procrastination and selected demographic variables in the Polish sample, and to examine the impact of bedtime procrastination on self-reported sleep outcomes. The data obtained from online surveys conducted on two Polish samples were analyzed, including demographic factors, self-reported sleep outcomes, and responses to items of the BPS. The Polish version of the BPS has a unifactorial structure like the original version. It also exhibits satisfactory internal consistency and moderate temporal stability in a 10-week retest study. BPS scores were not significantly related to the place of residence, the highest completed level of education, living with a spouse or partner, and living with children. Scores in BPS slightly decreased with age and females scored higher on BPS than males. Higher BPS scores were obtained for a group of students in comparison to a group of subjects who were not students, and lower BPS scores were found in working respondents in comparison to respondents who were not working. BPS scores correlate negatively with sleep length on workdays and a feeling of sleep sufficiency, and positively with sleep length on weekdays relative to workdays, sleeping later than one would like, and a feeling of fatigue. Several relationships between self-reported sleep outcomes and demographic variables were also identified.

Mediating effect of sleep behaviors when predicting weight-related behaviors in nursing students

BACKGROUND AND PURPOSE

The purpose of this study was to identify whether or not sleep behaviors mediated bioecological predictors of weight-related behaviors among college students.

METHODS

This descriptive, quantitative, cross-sectional study, guided by Bronfenbrenner's bioecological model, examined bioecological characteristics and path analysis to assess model fit.

CONCLUSIONS

The fit indices indicated excellent fit of the final model to the data (χ (24) = 30.33, p = .17, root-mean-square error approximation = 0.04, comparative fit index = 0.96, standardized root-mean-square residual = 0.03). Sleep duration mediated significant bioecological predictors of weight-related behaviors, but sleep quality did not. Having children significantly predicted increased sugar-sweetened beverage (SSB) consumption and decreased physical activity (PA) among college students. Conversely, eating the majority of meals at home significantly predicted decreased consumption of SSBs and increased PA.

IMPLICATIONS FOR PRACTICE

Findings support inclusion of sleep duration and use of the bioecological model, when providing patient-centered healthcare focused on weight-related behaviors and weight management in college students.

Are college students told by health care providers about their risk factors for developing diabetes?

BACKGROUND AND PURPOSE

Communication about risk factors for diabetes between nurse practitioners and college students may not be occurring as the prevalence of Type 2 diabetes increases. The purpose of this secondary analysis was to evaluate if college students are being told of their risk for diabetes based on known risk factors of weight, sleep, and depressive symptoms.

METHODS

Descriptive, cross-sectional study was completed using National Health and Nutrition Examination Survey 2011-2012. Using listwise deletion for all variables in the analyses, the sample (N = 313) included college participants aged 18-25 years. Logistic regression model found that body mass index (BMI), sleep quantity, and gender were significant predictors of not being told one was at risk for diabetes. In those with a BMI >25 kg/m (n = 159), only 22% were told about their risk for diabetes by a health care provider.

CONCLUSIONS

Nurse practitioners may not be recognizing the factors that affect on the development of prediabetes in college-age students or not providing guidance for measures to prevent the morbidity related to diabetes.

IMPLICATIONS FOR PRACTICE

Nurse practitioners are in a prime position to identify individuals with overweight/obesity, poor sleep, and depressive symptoms and recommend lifestyle changes to prevent the onset of disease.