Impact of COVID-19 pandemic on sleep of undergraduate students: A systematic literature review

Sleep duration and quality during the COVID-19 pandemic and the association with physical activity and screen time among Brazilian college students

BACKGROUND

As a result of social isolation during the COVID-19 pandemic, changes in sleep patterns have been observed in many countries, as well as changes in physical activity and screen time. The objective was to investigate sleep duration and quality during the COVID-19 pandemic and its association with physical activity and screen time.

METHODS

Cross-sectional study with students from a University in Rio de Janeiro who answered an online questionnaire between August 2020 and March 2021. Physical activity was assessed using IPAQ-SF. Sleep was investigated based on questions about duration and sleep quality change, and screen time through self-reported questions. Multinomial logistic regression was performed to assess the association between physical activity and screen time with sleep duration and quality. Secondary analyses investigated the influence of the isolation time on this association. The confounding factors used were diagnosis of COVID-19, time of isolation, anxiety, depression, skin color, and gender.

RESULTS

A total of 771 college students with a mean age of 24.5 years (±8.6) answered the questionnaire. About 75% reported more than 8 h of screen time per day and 49.8% were physically inactive. Regarding sleep, 54.9% had worsening sleep, while 40.6% had inadequate sleep duration during the pandemic. Physical activity was associated with improved sleep quality (Odds ratio (OR) 1.72; confidence interval (95% CI) 1.05-2.97). Also, physically active students who spent more than 14 weeks in social isolation demonstrated improved sleep quality (OR 1.99; 95% CI 1.02-3.78) compared to physically inactive individuals. No association was observed for sleep duration. No association was observed between screen time and sleep quality, or sleep duration.

CONCLUSION

During the COVID-19 pandemic, there was considerable worsening of sleep quality, and physical activity was positively associated with improved sleep quality.

Recent Stressful Life Events and Perceived Stress as Serial Mediators of the Association between Adverse Childhood Events and Insomnia

Insomnia is common in college students and linked to poorer mental and physical health. There is growing evidence that adverse childhood experiences (ACEs) may contribute to insomnia in adulthood. However, beyond the need for additional replication of these findings, there is a need to identify underlying mechanisms that plausibly connect the two experiences. Based on a serial mediation model, the current study examined the role of two theoretically informed mediators: recent stressful life events and perceived stress. A cross-sectional survey of 2,218 college students at a large university in the southwestern United States was conducted between August 2020 and December 2021. The sample was predominantly Hispanic (96%) and female (73%), with a mean age of 20.7 years. Standardized measures of adverse childhood experiences, recent stressful life events, perceived stress, and insomnia were administered to participants online. Almost 20% of participants reported having experienced four or more adverse childhood experiences and 63% met the threshold for insomnia. Reporting four or more ACEs was associated with significantly greater insomnia severity, and this relationship was serially mediated by both recent stressful life events and perceived stress. However, recent stressful life events appeared to be the most powerful mediator. The results of the current study indicate that recent exposure to stressful life events serves as a plausible mechanism linking early adversity during childhood to adult insomnia and could therefore serve as a potential target for intervention. The findings suggest that students would benefit from university-wide efforts to reduce the number and/or intensity of common stressors.

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.

Insomnia and behaviorally induced sleep syndrome in undergraduates tested during the COVID-19 pandemic: associations with health, stress, and GPA

STUDY OBJECTIVES

This study was conducted to determine (1) whether the distribution of undergraduates who endorse insomnia or behaviorally induced insufficient sleep syndrome (BIISS) varied during the coronavirus disease 2019 (COVID-19) pandemic relative to normal sleepers and in comparison to values reported pre-pandemic and (2) whether group (insomnia, BIISS, and normal sleepers) was differentially associated with health, stress, and academic achievement mid-pandemic.

METHODS

Two hundred ninety-three undergraduates completed online questionnaires assessing demographics, global sleep quality, insomnia severity, health, and perceived stress; cumulative grade point averages (GPAs) were also collected for each participant.

RESULTS

The proportion of participants in each group did not differ from the pre-pandemic values reported in Williams et al (2020). Relative to the normal-sleepers group, the insomnia group reported poorer sleep quality, greater insomnia severity, poorer functioning on measures of physical health, and increased stress; only 1 significant difference was found concerning the BIISS group. Group differences were not found on GPA.

CONCLUSIONS

Despite the various challenges brought about by the COVID-19 pandemic, the distribution of participants by group was similar to those reported pre-pandemic. The insomnia group fared most poorly in terms of sleep quality, insomnia severity, physical health, and stress. As such, additional effort should be devoted to identifying undergraduates with insomnia to provide treatment that may improve their sleep and their health.

CITATION

Lukowski AF, Kamliot DZ, Schlaupitz CA. Insomnia and behaviorally induced sleep syndrome in undergraduates tested during the COVID-19 pandemic: associations with health, stress, and GPA. J Clin Sleep Med. 2024;20(2):261-269.

Analyzing mechanisms of interdisciplinary cooperation in promoting students' health at university

BACKGROUND

Interdisciplinary cooperation among university actors and resulting intersectoral synergies are considered cornerstones in the process of incorporating health promotion practices in everyday university life in order to break down barriers and provide better access to health promotion services. To date, no network of a health-promoting university has been examined regarding the processes underlying tie formation, network emergence, and maintenance.

OBJECTIVES AND METHODS

The goals of this study are to obtain insight into the mechanisms of cooperation between university actors in a health-promoting network and to identify the structural and attributive factors associated with establishing cooperation between actors in the observed network in order to better understand how to build and develop successful networks in the future. For this purpose, a social network analysis was carried out and exponential random graph models were estimated to test corresponding hypotheses.

RESULTS

The network at hand consists of 33 actors (e.g. University Sports Center, General Student Committee) and shows a flat, non-hierarchical structure. Data reveal that attributed competence predicts cooperation (0.32; p < 0.05). Significant homophily effects among student actors (1.31; p < 0.05) and among university actors (0.59; p < 0.05) were found. All structural predictors examined were significant (0.22-5.40; p < 0.05) and are therefore essential in determining the likelihood of cooperation between actors involved in the network.

CONCLUSION

The results of this study provide for a better understanding of the mechanisms of cooperation and can be used to further develop the network at hand (e.g. selection of key actors for information dissemination or integration of peripheral actors). In addition, the findings offer starting points for sustained network development at other universities (e.g. significance of network governance form or goal consensus). Knowing the factors that influence the network structure, here the conditions of cooperation, results in opportunities to encourage empowerment among actors. However, the analysis of the network undertaken does not directly bear on the success of the network.

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.

Determinants of Sleep Quality: A Cross-Sectional Study in University Students

When entering the university setting, poor sleep quality is reportedly prevalent among students and has been linked to a range of adverse health outcomes, including reduced academic performance. Moreover, determinants of sleep quality are not yet fully understood. This study was designed to (1) assess the prevalence of poor sleep quality and (2) identify determinants of sleep quality in German university students. In total, 1,684 undergraduate and graduate students (50.6% female, mean age 22.87 ± 3.15 years) from multiple academic disciplines completed a cross-sectional online survey assessing socio-demographic, health, and study-related indicators and sleep quality using the Pittsburgh Sleep Quality Index (PSQI). In our sample, 820 (48.7%) met the PSQI cut-off score (>5) for poor sleep quality. Multiple regression analysis showed that older age, being a business student, lower subjective social status, poorer self-rated health, stress, exhaustion, and poor academic performance significantly predicted poor sleep quality. Our findings document a high prevalence of poor sleep quality among university students and suggest that business students, especially, might be exposed to a greater risk for poor sleep quality. Furthermore, the results of this study are valuable for academic staff to develop tailored interventions to promote healthy sleep-in university students.

Mental Health of Students at Polish Universities after Two Years of the Outbreak of COVID-19

BACKGROUND

Mental health deterioration in young adults in the aftermath of the COVID-19 pandemic is being increasingly studied. It is clear that the psychological consequences of the pandemic will be evident for many years, especially among the younger generation, who did not have time to acquire adaptive coping strategies before the outbreak of COVID-19. The purpose of this study was to assess the condition of the mental health of students at Polish universities after two years of the pandemic. The types of coping strategies used by the respondents to deal with stress were also evaluated in order to establish which of them could have a beneficial effect on the psyche of young people.

METHODS

This study included 721 participants (age [years]: M = 25.7, SD = 5.3; 269 (37.2%) males) recruited using snowball sampling from students at two universities in Lodz, Poland, and full-time doctoral students from across Poland (phase I of the study was conducted in March 2019 (N = 352); phase II of the study was conducted in April 2022 (N = 369)). The following tools were used in this study: The General Health Questionnaire (GHQ-28) by D. Goldberg, the Perceived Stress Scale (PSS-10), and the Inventory for Measuring Coping with Stress (Mini-COPE) by Carver et al. Pearson's chi-square test and multivariate logistic regression were used in the statistical analysis.

RESULTS

The results detailing the condition of the mental health of the subjects, as measured using GHQ-28, were significantly worse in the group surveyed after two years of the pandemic than the results of the survey conducted in March 2019 (adjusted odds ratio for GHQ-28 ≥ 5: 3.66, 95%CI 2.12-6.30, p < 0.001). Statistically significant differences were seen for each of the subscales of the GHQ-28 questionnaire. Most often, the subjects complained of anxiety symptoms and sleep disorders, in addition to somatic symptoms. The risk factors for worsening mental health included female (odds ratio 1.70, 95%CI 1.20-2.40, p = 0.003) and professional inactivity (odds ratio 1.55, 95%CI 1.04-2.31, p = 0.031). On the other hand, the ages of the people surveyed, their relationship status, whether they had children, or the type of university they attended all proved to be insignificant. The following coping strategies had a positive impact on the mental health of the respondents: positive reframing (Z = -2.951; p = 0.003) and seeking emotional support (Z = -2.351; p = 0.019). In contrast, strategies such as self-distraction (Z = 2.785; p = 0.005), denial (Z = 2.948; p = 0.003), venting (Z = 2.337; p = 0.019), self-blame (Z = 5.511; p < 0.001) and behavioral disengagement (Z = 4.004; p < 0.001) were associated with poorer mental health among the respondents.

CONCLUSIONS

1. Of the students surveyed, 33% reported elevated stress levels after two years of the COVID-19 pandemic. 2. The overall mental health of students at Polish universities, as measured by GHQ-28, was significantly worse in the group evaluated after two years of the COVID-19 pandemic, mainly in respect of anxiety symptoms and sleep disorders. 3. Female gender and professional inactivity appeared to be risk factors for the students' worsening mental health, which may be an indication of the need for further research and planning of psychotherapeutic interventions.

Research trends in college students' sleep from 2012 to 2021: A bibliometric analysis

BACKGROUND

A great proportion of college students experience various sleep problems, which damage their health and study performance. College students' sleep problems, which are caused by several factors, have been easily ignored before. In the past decade, more research has been published to expand our understanding of undergraduates' sleep. The purpose of the study is to explore the research hotspots and frontiers regarding college students' sleep using CiteSpace5.8.R3 and offer guidance for future study.

METHODS

We retrieved relevant literature from the Web of Science Core Collection Database and imputed the downloaded files into CiteSpace5.8.R3 for visualization analysis. We generated network maps of the collaborations between authors, countries, institutions, the cited journals, and co-occurrence keywords. The analysis of keywords clusters, timeline views, and keywords citation bursts help us identify the hotspots and research trends.

RESULTS

A total of 1,841 articles related to college students' sleep, published from 2012 to 2021, were selected. The number of publications gradually increased. Karl Peltzer was the most prolific authors with 15 publications. The United States and Harvard University separately contributed 680 and 40 articles and had the greatest impact in this field. SLEEP ranked first in the frequency of cited journals. The article published by Lund HG was the most influential publication. Based on the analysis of keywords, we summarized research hotspots as follows: current status, affecting factors, and adverse outcomes of college students' sleep. The frontiers were the further understanding of the relationships between sleep and mental and physical health, and various interventions for sleep disorders.

CONCLUSION

Our study illustrates the research hotspots and trends and calls for more research to expand the findings. In the future, the cooperation between institutions and authors needs to be strengthened. The complex relationships between sleep and mental and physical health and problematic substance use disorders are necessary to be explored. Longitudinal studies or randomized controlled trials should be constructed to verify the current findings or assumptions.