The Epidemiology of Sleep Quality, Sleep Patterns, Consumption of Caffeinated Beverages, and Khat Use among Ethiopian College Students

Sleep quality and associated factors among university students in Africa: a systematic review and meta-analysis study

Background

Poor sleep quality significantly impacts academic performance in university students. However, inconsistent and inconclusive results were found in a study on sleep among university students in several African nations. Therefore, this study aimed to estimate the pooled prevalence and associated factors of poor sleep quality among university students in Africa.

Methods

The databases PubMed, Scopus, Cochrane Library, Science Direct, African Journal Online, and Google Scholar were searched to identify articles. A total of 35 primary articles from 11 African countries were assessed and included in this systematic review and meta-analysis. Data were extracted by using a Microsoft Excel spreadsheet and exported to STATA version 14 for analysis. The I2 test was used to assess the statistical heterogeneity. A random effect meta-analysis model was employed with 95% confidence intervals. Funnel plots analysis and Egger regression tests were used to check the presence of publication bias. A subgroup analysis and a sensitivity analysis were done.

Results

A total of 16,275 study participants from 35 studies were included in this meta-analysis and systematic review. The overall pooled prevalence of poor sleep quality among university students in Africa was 63.31% (95% CI: 56.91-65.71) I2 = 97.2. The subgroup analysis shows that the combined prevalence of poor sleep quality in East, North, West, and South Africa were 61.31 (95% CI: 56.91-65.71), 62.23 (95% CI: 54.07-70.39), 54.43 (95% CI: 47.39-61.48), and 69.59 (95% CI: 50.39-88.80) respectively. Being stressed (AOR= 2.39; 95% CI: 1.63 to 3.51), second academic year (AOR= 3.10; 95% CI: 2.30 to 4.19), use of the electronic device at bedtime (AOR= 3.97 95% CI: 2.38 to 6.61)) and having a comorbid chronic illness (AOR = 2.71; 95% CI: 1.08, 6.82) were factors significantly associated with poor sleep quality.

Conclusion

This study shows that there is a high prevalence of poor sleep quality among university students in Africa. Being stressed, in the second year, using electronic devices at bedtime, and having chronic illness were factors associated with poor sleep quality. Therefore, addressing contributing factors and implementing routine screenings are essential to reduce the burden of poor sleep quality.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42023493140.

Poor sleep quality and associated determinants among textile and garment manufacturing workers in Addis Ababa, Ethiopia

Background

Sleep is a physiological process that is essential to human physical, emotional, and mental health. Sleep difficulties affect an estimated 150 million individuals globally, with roughly 17% of the population in developing countries. As a result, the purpose of this study was to determine the prevalence and associated factors of poor sleep quality among textile and garment manufacturing workers in Addis Ababa, Ethiopia, in 2022.

Methods

A facility-based cross-sectional study was done from July 15th to August 15th, 2022, using a simple random sample technique. The degree of self-reported poor sleep quality was quantified using a validated, interviewer-administered, standardized Pittsburgh Sleep Quality Index. To determine the relationship between independent variables and poor sleep quality, multivariable logistic regression analysis was carried out with a p-value of less than 0.05 and a 95% confidence interval (CI).

Results

The prevalence of poor sleep quality was 75.4% (95% CI: 70.8, 80). Working more than 8 h per day (AOR = 2.83, 95% CI: 1.01, 7.94), work dissatisfaction (AOR = 3.27, 95% CI: 1.52-7.05), and using electronic materials before sleeping (AOR = 2.08, 95% CI: 1.01-4.30) were all associated with poor sleep quality.

Conclusion

Poor sleep quality was common among garment and textile industrial workers. Work dissatisfaction, working hours, and the utilization of electronic materials before bedtime were all substantially related to poor sleep quality, which should be taken into account and addressed early to reduce poor sleep quality.

Insomnia Medication Use by University Students: A Systematic Review

Problematic sleep or insomnia has been a recognised issue for many individuals in society, and university students can be of particular concern due to unique academic pressures. A systematic review was designed to summarise the current evidence about the extent of insomnia medication used by university students and identify characteristics of those more willing to use medication to manage insomnia. Searches were undertaken using Psych INFO, PubMed, Embase, and Web of Science, resulting in 25 eligible studies across multiple countries between 1994 and 2020. The prevalence of sleep medication use by students varied widely, from 2% to 41.2%, with an average of 13.1%. Female gender, students experiencing poor sleep, smoking, drinking stimulant beverages, and undertaking fewer physical activities were associated with the use of insomnia medication. Insomnia medication use exists within university student populations but appears to vary considerably worldwide; identifying multiple population characteristics associated with such use would offer opportunities to identify and support those affected.

Prevalence and associated factors of poor sleep quality among industrial workers in Addis Ababa, Ethiopia: findings from a cross-sectional study

OBJECTIVE

This study aimed to investigate the prevalence and associated factors of poor sleep quality among Bole Lemi Industrial Park workers in Addis Ababa, the capital of Ethiopia.

DESIGN

An institution-based cross-sectional study was conducted from July to August 2022. The data were collected using a validated and standardised Pittsburgh Sleep Quality Index Questionnaire. The collected data were entered into EpiData V.4.6 and analysed using Stata V.14. A multivariable binary logistic regression analysis was conducted to identify factors associated with poor sleep quality. The association was determined using an adjusted OR (AOR) with a 95% CI at a p value of <0.05.

SETTING

The study was conducted in Bole Lemi Industrial Park in Addis Ababa.

PARTICIPANTS

A total of 370 workers participated in this study.

OUTCOME MEASURES

The primary outcome of the study was the prevalence of poor sleep quality.

RESULTS

The total response rate was 87.7%. The majority (260, 70.3%) of the participants were female. The mean (±SD) age of the participants was 30.5 (±10.6) years. The prevalence of poor sleep quality during the last months was found to be 75.4% (n=279) (95% CI: 70.7% to 79.7%). Undiversified dietary intake (AOR: 1.63; 95% CI (1.09 to 2.78)), caffeine consumption more than 250 mg per day (AOR: 2.57; 95% CI (1.12 to 6.05)) and night shift work (AOR: 2.36; 95% CI (1.27 to 4.41)) were risk factors for poor sleep quality among sampled workers.

CONCLUSION

This study detected that poor sleep quality is highly prevalent among garment and textile industry workers, indicating that it is a significant public health issue that requires immediate attention. Therefore, modifications of the work environment involving night shift work and the improvement of workers' personal lifestyles involving dietary diversification and caffeine consumption are needed to minimise the burden of poor sleep quality among workers.

Consumption of energy drinks and their effects on sleep quality among medical students

Background and Objectives

Energy drinks contain caffeine, which causes genuine concern among health professionals and authorities about their negative health effects. Their effect on sleep quality specifically was not well studied. In our study, we aim to assess the prevalence of energy drink consumption and its effect on the quality of sleep among Saudi medical students.

Materials and Methods

A cross-sectional study was done on 260 medical students who were in their first till the sixth academic year at King Abdulaziz University Jeddah, Saudi Arabia. An online questionnaire was distributed as a Google form including demographics, the beverage questionnaire (BEVQ-15), and the Pittsburgh sleep quality index (PSQI).

Results

Coffee was found to be the most favorite (56.5%) caffeinated beverage among medical students, 46.2% reported a sleep duration of 5 h, and 15% reported a sleep latency of more than 30 min. Also, 19.3% were found to have reduced sleep efficiency (less than 74%) and 82.6% used sleep medication once a week. Male students had a significantly higher mean frequency of drinking Energy & Sports drinks (Red Bull, code red, Gatorade, etc.) compared to females. Moreover, 74.6% of the medical students studied had poor sleep quality, with no relationship found between sleep quality and participant demographics, favorite caffeinated beverages, BEVQ-15 scale scores, or the frequency of energy drink consumption. In contrast, the PSQI and BEVQ-15 scores showed a significant positive correlation.

Conclusion

Students at the university level should be educated on the causes of poor sleep quality and the effect of energy drinks on sleep quality. More research on a larger sample of Saudi university students is needed to determine the scope of the problem.

Association between depression and dysmenorrhea among adolescent girls: multiple mediating effects of binge eating and sleep quality

BACKGROUND

Dysmenorrhea has a significant negative impact on teenagers' quality of life, and its prevalence is increasing annually. Although studies have explored the factors affecting dysmenorrhea, it remains unclear how these factors interact with one another. This study aimed to explore the mediating role of binge eating and sleep quality between depression and dysmenorrhea.

METHODS

This cross-sectional study recruited adolescent girls from the Health Status Survey of adolescents in Jinan, Shandong Province, and used multistage stratified cluster random sampling. Data was collected using an electronic questionnaire between March 9, 2022, and June 20, 2022. The Numerical Rating Scale and Cox Menstrual Symptom Scale were used to assess dysmenorrhea and the Patient Health Questionnaire-9 to assess depression. The mediation model was tested by Mplus 8.0, and the mediating effect was analyzed using the Product of Coefficients approach and the Bootstrap method.

RESULTS

Among the total of 7818 adolescent girls included in this study, the prevalence of dysmenorrhea is 60.5%. A significant positive association was found between dysmenorrhea and depression. Binge eating and sleep quality seemingly mediate this association. The mediating effect of sleep quality (21.31%) was greater than that of binge eating (6.18%).

CONCLUSIONS

The findings of this study point in the right direction for preventing and treating dysmenorrhea in adolescents. For adolescent dysmenorrhea, mental health should be considered and proactive steps taken for educating adolescents on healthy lifestyles to reduce negative consequences of dysmenorrhea. Longitudinal studies on the causal link and influence mechanisms between depression and dysmenorrhea should be conducted in the future.

Which Shiftwork Pattern Is the Strongest Predictor for Poor Sleep Quality in Nurses?

Shiftwork is related to an increased risk of several diseases, including gastric ulcers, myocardial infarction, and diabetes. Several shiftwork patterns are related to poor sleep quality, such as a quick returns or extended shifts. This study aimed to find the shiftwork patterns strongly associated with poor sleep quality amongst nurses. A cross-sectional analytical study was conducted among nurses working for at least one month. The sub-groups were the good sleep quality group (n = 150) and the poor sleep quality group (n = 472). Eligible participants were asked to complete a self-reported questionnaire comprising personal characteristics, job characteristics, shiftwork characteristics, and sleep quality. Factors associated with poor sleep quality were determined using logistic regression analysis. Two factors associated with poor sleep quality remained in the final model: viz., depression and backward rotational shift. The only independent factor for poor sleep quality was a backward rotational shift with an adjusted odds ratio (95% CI) of 1.946 (1.344, 2.871). In conclusion, compared with other shift patterns, backward shiftwork was the most significant factor associated with poor sleep quality and should be avoided.

Association of healthy beverage index with circadian rhythm and quality of sleep among overweight and obese women: a cross-sectional study

PURPOSE

Circadian rhythm is a behavioral, physiological, and molecular change with a cycle length of approximately 24 h. Changes to the circadian rhythm can result in sleep difficulty. The healthy beverage index (HBI) is a holistic concept for evaluating the quality of overall beverage intake and its association with health-related outcomes in nutritional epidemiological studies. This study aimed to assess the relationship of HBI with circadian rhythm and sleep quality among overweight/obese women.

METHODS

The current study was conducted among 208 overweight and obese women between 18-48 years in Tehran, Iran. We evaluated potential HBI with a valid food frequency questionnaire. Following standard procedures, trained personnel assessed anthropometric measures, blood samples, and other baseline characteristics. The Pittsburgh Sleep Quality Index and the morning-eveningness questionnaire were applied to evaluate sleep quality and circadian rhythm respectively.

RESULTS

The mean (SD) BMI for this study was 30.8 (4.2) kg/m². We observed that subjects in the least tertile had significantly high levels of triglyceride (p = 0.04) and low-density lipoprotein (p = 0.009). High-density lipoprotein was significantly different across the tertiles (p = 0.003). After adjusting for potential covariates, subjects in the second tertile of HBI had 5.07 odds of having the worst quality of sleep as compared to those in the third tertile, p < 0.05. We also observed a significant inverse association between the HBI and the "moderately evening type" participants (OR 0.86; 95% CI 0.68-0.99; p: 0.02) after adjusting for potential confounders.

CONCLUSION

Healthy beverage consumption may have the potential of improving sleep quality among overweight and obese subjects.

LEVEL OF EVIDENCE

Level IV, evidence obtained from a descriptive study.

Prevalence and associated factors of sleep deprivation among Haramaya University students, Ethiopia, 2021: cross-sectional study

Background

Sleep deprivation is the lack of sleep that is associated with an increased risk of cardiovascular illness, diabetes, obesity, cognitive impairment, vehicle accidents, and workplace accidents, as well as being a direct source of daily dysfunction. Despite the fact that some studies have been undertaken, there is a shortage of data on the incidence of sleep deprivation and associated factors among university students in Africa, particularly in Ethiopia, where the study area is located. As a result, the purpose of this study was to determine the incidence of sleep deprivation and its associated factors among Haramaya University students in Eastern Ethiopia.

Methods

A cross-sectional study design was employed among Haramaya University students. A total of 624 students participated in this study. A multistage sampling technique was used to select the participants. A pretested structured self-administered questionnaire was used to collect data. Using Epi Data Version 3.1, the data was checked, coded, entered, and cleaned before being exported to SPSS Version 20 for analysis. Bivariate and multivariate logistic regression analysis was undertaken. For statistical significance, P ≤ 0.001 was used as the cutoff point.

Results

In this study, 586 study participants were participated, with a response rate of 96.2%. Among participants, the majority of 324(55.3%) were males, and the majority of 311(53.1%) were in the age range of 17–20 years with a median age of 19. Most of the study participants were single 561(95.7%). The overall prevalence of sleep deprivation was 68.4% (95% CI: 64.8–72.4). Coffee/tea drinkers (AOR = 2.83, 95% CI:1.17–6.86), Khat chewers (AOR = 2.33, 95%CI: 1.20–4.50), participants with stress (AOR = 3.49,95% CI: 1.22–9.95), participants exposed to moderate stage of anxiety (AOR = 2.87,95% CI:1.14–7.18), and being in the third and fourth study years (AOR = 0.33,95% CI:0.13–0.85) were significantly associated factors with sleep deprivation.

Conclusion

The prevalence of sleep deprivation was found to be high in this study. Coffee/tea users, khat chewers, being stressed, exposed to moderate levels of anxiety, and being in the third and fourth study years were all found to be significantly associated with sleep deprivation.

In hypertensive individuals, sleep time and sleep efficiency did not affect the number of angina episodes: a cross-sectional study

Previous studies have reported adverse effects of short and long sleep duration on cardiovascular health. However, how sleep time and sleep efficiency affect angina have not been studied in hypertensive individuals. This study aimed to assess the relationship of sleep with angina. Using a cross-sectional design, data from 1563 hypertensive individuals were collected from the parent Sleep Heart Health Study (SHHS). Age, alcohol use, average diastolic blood pressure (ADBP), average systolic blood pressure (ASBP), cigarette use, sleep time, sleep efficiency, percent time in stage N3 of sleep, and body mass index (BMI) were used as covariates. Multiple linear regression, the Chi-Square test, and Pearson’s correlation coefficient were used for data analysis. Unadjusted sleep efficiency, sleep time, ADBP, and age were significant (p < 0.05) predictors of the number of angina episodes (Angina_n). When the covariates were adjusted, only ADBP and ASBP were significant (p < 0.05) predictors of Angina_n. Sleep efficiency, BMI, ADBP, sleep time, and age had a significant (p < 0.05) correlation with Angina_n. In hypertensive individuals, sleep time and sleep efficiency did not affect Angina_n when adjusted for covariates. ADBP and ASBP were found to be significant predictors of Angina_n when the covariates were adjusted.

Sleep deprivation and associated factors among students of the Institute of Health in Jimma University, Southwest Ethiopia

Objective

Despite getting sufficient sleep being one of the most important things that we can do to keep our body and mind healthy, sleep deprivation has become a major public health concern. This study aimed to determine the prevalence of sleep deprivation and its associated factors among students of the Institute of Health in Jimma University.

Methods

An institution-based cross-sectional study was conducted from April 10 to April 24 in 2019. Data were collected from 365 randomly selected participants and analyzed using Statistical Package for the Social Sciences (SPSS; version 23). Multivariate logistic regression analysis was used to identify the factors associated with sleep deprivation. The level of significance was declared at a P-value of <0.05.

Results

A total of 365 participants participated, with a response rate of 97.6%. The study findings showed that 60.8% of students had sleep deprivation and 68.2% had sleep latency. Health problems (adjusted odds ratio [AOR] = 1.91 [95% confidence interval {CI} = 1.01–3.58]), alcohol consumption [AOR = 0.42 (95% CI = 0.2–0.89)], cigarette smoking [AOR = 0.31 (95% CI = 0.09–0.93)], khat chewing [AOR = 0.47 (95% CI = 0.12–0.82)], use of an electronic device before bedtime [AOR = 5.26 (95% CI = 1.78–15.52)], and cumulative grade point average (CGPA) [AOR = 0.48 (95% CI = 0.27–0.83)] were significantly associated with sleep deprivation.

Conclusions

Sleep deprivation was common in the study area. This is mainly due to health problems, substance utilization, long-time use of an electronic device, and low CGPA. Therefore, a strategy and system should be established to limit substance use, enhance proper use of electronic devices, and create awareness on the impact of nonoptimal sleep.

Quality of Sleep and Its Correlates among Yemeni Medical Students: A Cross-Sectional Study

Background

Sleep disturbance is particularly common among medical students worldwide and affects their wellbeing and academic performance. However, little is known about this issue in Yemen. This study looks at sleep quality and its association with personal and life-style factors and self-reported academic performance among medical students at the largest Yemeni university.

Methods

A cross-sectional survey was conducted at Sana'a University, Yemen, in 2017. The Pittsburgh Sleep Quality Index (PSQI), consisting of 19 items and 7 components (score range = 0‐3), was used to assess sleep quality. The summation of the components' scores yields the global PSQI score (range = 0‐21). A global PSQI value higher than 5 indicates poor quality of sleep. Logistic regression was applied to look at relationships.

Results

240 male (41%) and female (59%) medical students took part in the study with 54% being preclinical and 46% clinical with an average age of 23.3 years (SD = 1.7). The mean global score (SD) was 6.85 (2.8), and 68% of the students (N = 163) were identified as poor sleepers. The mean global PSQI score (SD) and proportion of poor sleepers were higher among males (7.7 (2.8) and 81%, respectively) than females (6.27 (2.42) and 59.2%, respectively), p ≤ 0.001. Good sleep quality was more likely (OR (95% CI)) among females (3.4 (1.3-8.8)), the unmarried (2.8 (1-7.8)), those in good health (2.3 (1.1-4.5)), and nonkhat chewers (4.9 (1.4-17.1)). Nonsmokers were less likely to have good quality sleep compared to occasional smokers (0.185 (0.071-.485)). Stress (30%) and academic workload (21%) were the most commonly reported causes of poor sleep quality. Almost two-thirds of the students (65%) mentioned that disturbed sleep undermined their academic performance.

Conclusions

Poor sleep quality is common among Sana'a medical students and impacts their academic performance. Specific stress management and sleep hygiene promoting programs should be incorporated early on in medical education.

Prevalence and Correlates of Sleep Quality Among Jordanian University Students: A Cross-Sectional National Study

Poor sleep quality affects university students' life and increases their risk of long-term health consequences. This study aimed to describe the quality of sleep among Jordanian university students, examine differences in sleep quality according to selected variables, and identify predictors of sleep quality. A cross-sectional correlational design and a multi-strategic sampling technique were used to select a sample of 1,308 university students. The Pittsburgh Sleep Quality Index, the Perceived Stress Scale, and the Sleep Hygiene Instrument were administered to the subjects. T-test, ANOVA, and multiple regressions were used to analyze the data. The results showed that most students were classified as poor sleepers (87.1%), and only (12.8%) reported having a good sleep quality. Among the components of sleep quality, subjective sleep quality (m = 1.90, SD = 0.89) and daytime dysfunction (m = 1.72, SD = 0.67) had the highest mean scores, while sleep efficiency (m = 0.50, SD = 0.91) and the use of sleep medications (m = 0.23, SD = 0.73) had the lowest mean scores. There were statistically significant differences in sleep quality in relation to residency, academic level, academic achievement, and family income. Significant predictors of sleep quality were gender, marital status, employment status, sleep hygiene, and stress.

Sleep Quality and Associated Factors Among Diabetes Mellitus Patients in a Follow-Up Clinic at the University of Gondar Comprehensive Specialized Hospital in Gondar, Northwest Ethiopia: A Cross-Sectional Study

INTRODUCTION

Diabetic mellitus has a negative impact on the quality of sleep. It is one of the leading public health conditions which can result in poor sleep quality. Poor sleep quality is an unreported and unrecognized problem which can affect the prognosis of diabetes patients.

OBJECTIVE

The aim of this study is to assess the prevalence of poor sleep quality and its associated factors among patients with diabetes mellitus attending follow-up clinics at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2019.

METHODS

An institution-based cross-sectional study was conducted among 430 diabetes mellitus patients at the University of Gondar Comprehensive Specialized Hospital from February 1, 2020 to March 28, 2020. A systematic random sampling method was used to reach the study subjects. An interviewer-administered questionnaire was used for data collection. Pittsburgh sleep quality index was used for assessing sleep quality. To explain study variables, frequency tables and percentages were used. A binary logistic regression was conducted to see the relation between dependent and independent variables.

RESULTS

A total of 430 diabetes mellitus patients participated in the study with a response rate of 100%. The overall prevalence of poor sleep quality was 47.2%. Drinking alcohol (AOR = 2.45, 95% CI: 1.28-4.69), smokers (AOR = 6.26, 95% CI: 2.04-19.21), comorbidity (AOR = 1.80, 95% CI: 1.10-2.96), BMI ≥ 30 (AOR = 4.87, 95% CI: 1.07-22.09), having type 2 diabetes mellitus (AOR = 2.16, 95% CI: 1.04-4.50), poor glycemic control (AOR = 2.61, 95% CI: 1.81-4.81) and having depression (AOR = 9.95, 95% CI: 4.85-20.38) were associated with poor sleep quality.

CONCLUSION

In this study, nearly half of the patients had poor sleep quality. Drinking alcohol, smoking, comorbidities, higher BMI, type 2 diabetes mellitus, poor glycemic control and having depression were factors in poor sleep quality. Creating awareness of the need for weight reduction, minimizing alcohol intake, cessation of smoking, and improving sleep hygiene for DM patients would be effective management for improving poor sleep quality.

The impact of protective psychosocial factors on khat chewing among male medical and dental future health-care providers in Yemen

BACKGROUND/PURPOSE

Khat chewing, a green leaf with amphetamine effects, is a public health concern. Yet, it is prevalent and evident, in the khat belt region, among male students in health faculties. This study aimed to examine whether psychosocial factors have a protective impact on khat chewing among male dental and medical students.

MATERIALS AND METHODS

A cross-sectional study included all students (1457) in second year and above at a Yemeni university. A self-administered questionnaire was used to obtain sociodemographic data and to assess students' psychosocial characteristics namely, depression, resilience and social support (perceived or received [living with or away from family]). Data analysis included descriptive statistics and multivariable logistic regression modelling.

RESULTS

The response rate was 61% (male = 334, female = 547) and the responding students' mean ± SD age was 22.95 ± 1.56 years. Of the respondents 185 (21% [95%CI = 18%-24%]) were current khat chewers (7 [4%] females and 178 [96%] males respectively). In the adjusted model, among male students living away from family was significantly associated with khat chewing (adjusted odd ratio [AOR] = 3.15,95%CI = 1.96-5.07, p < 0.001) and perceived social support was inversely significantly related to khat chewing (AOR = 0.98; 95%CI = 0.96-1.00; p = 0.019).

CONCLUSION

Within the limitation of the study of a single institute, social support whether received (living with family) or perceived appeared to be a protective factor from khat chewing among male medical and dental students. Social support should be enhanced and targeted to discourage khat chewing during the preparation of this future health care force.

Exploring the relationship of sleep quality with drug use and substance abuse among university students: a cross-cultural study

Background

There is a growing interest in studying the area of drugs and college students due to the negative effects that drugs have on a student’s social life, academics, psychology, finances, and health. So, this study aims to identify the relationship between drug/substance abuse and quality of sleep among university students in Yemen and Saudi Arabia.

The sample size was 935 (43.21% N = 404 female, 56.79% N = 531 male, 55.40% N = 518 Yemeni, and 44.60% N = 417 Saudi). Students responded to the Drug Abuse Screening Test (DAST-10), the Pittsburgh Sleep Quality Index (PSQI), and the Substance Abuse Questionnaire.

Results

The results showed a high prevalence of drug use: 43.1% of respondents (27.27% N = 219 Yemenis and 15.83% N = 148 Saudis) abuse drugs, 29.41% were in the low level of drug use, 10.48% were in the moderate level of drug use, 2.46% were in the substantial level of drug, and 0.75% were in the severe level of drug use as per the DAST-10. The differences between both countries in terms of drug use were significant (X2 19.394, P < 0.001). The prevalence rate of inhalants was 16.36% and of sedatives was 12.09%, and the differences between countries were significant. The prevalence of poor sleep quality was 24.81%; a total of 7.91% of respondents had very poor sleep quality, while 16.90% had poor sleep quality. The differences between countries were not significant.

The relationship between sleep quality and drug use, smoking, and substance abuse was significant. The quality of sleep decreased consistently with a high level of drug use or substance abuse.

Conclusions

Poor sleep quality is significantly associated with drug use and substance abuse, and it is important to recognize the factors affecting drug and substance abuse among university students. A significant contribution can make for the protection of university students by guaranteeing that psychological interventions for high-risk groups are planned in advance.

Sleep quality, sleep latency, and sleep duration: a national comparative study of university students in Jordan

BACKGROUND

Sleep problems have significant negative health consequences on university students.

STUDY AIM

To assess subjective sleep quality, sleep latency, and sleep duration in a national sample of university students and investigate differences in these components with selected variables.

METHODS

A cross-sectional analysis and multi-stage sampling were conducted to select a sample of 1308 students from three major areas in Jordan. Sleep quality, sleep latency, and sleep duration were measured by an Arabic version of the Pittsburgh Sleep Quality Index (PSQI). Data were analyzed using measures of frequency and central tendency and Kruskal-Wallis tests.

RESULTS

Two-thirds of university students described their sleep quality as fairly bad and very bad and 20 reported sleep latency of more than 30 min during the past month. There was a significant difference in subjective sleep quality according to the student's place of residence. Sleep latency differed according to students' income, physical activity, use of media devices before sleep, smoking status, and academic achievement. Significant differences were also found in sleep duration with students' academic achievement, academic level, and body mass index.

CONCLUSIONS

University students suffer from poor sleep quality, delayed sleep phase, and sleep deprivation. Lower-income, smoking, physical inactivity, and using media devices before sleep contributed to students' sleeping problems.

IMPLICATIONS

Interventional programs that focus on improving physical activity, controlling tobacco use, healthy sleep education, and reducing screen time are essential public health interventions to reduce sleep problems among youth.

Associations of physical activity and screen time with suboptimal health status and sleep quality among Chinese college freshmen: A cross-sectional study

This study aimed to investigate the associations of physical activity (PA) and screen time (ST) with physiological, psychological, and social health-particularly regarding effects on sleep quality-among Chinese college freshmen. A cross-sectional survey was conducted at Renmin University of China, in Beijing. A total of 5,233 students were surveyed in September 2015. Participants completed a self-report questionnaire on their demographic characteristics, tobacco and alcohol use, PA, ST, sleep quality, and health status. Multivariate logistic regression was performed to examine the independent and interactive associations between PA and ST with sleep quality and suboptimal health status. In total, 10.43%, 13.18%, and 13.26% of the 5,233 students had physiological, psychological, and social suboptimal health status, respectively. The prevalence of poor sleep quality was 37.94%. High ST and high PA were significantly associated with physiological suboptimal health status (aOR = 1.39, 95% CI: 1.16-1.68, and aOR = 0.55, 95% CI: 0.45-0.71), psychological suboptimal health status (aOR = 1.43, 95% CI: 1.21-1.69, and aOR = 0.57, 95% CI: 0.47-0.69), social suboptimal health status (aOR = 1.27, 95% CI: 1.08-1.50, and aOR = 0.63, 95% CI: 0.52-0.77), and poor sleep quality (aOR = 1.20, 95% CI: 1.03-1.39, and aOR = 0.64, 95% CI: 0.55-0.76). Additionally, low ST and high PA were interactively negatively associated with poor sleep quality (aOR = 0.56, 95% CI: 0.45-0.70), physiological suboptimal health status (aOR = 0.49, 95% CI: 0.40-0.59), psychological suboptimal health status (aOR = 0.48, 95% CI: 0.39-0.58), and social suboptimal health status (aOR = 0.49, 95% CI: 0.40-0.59). These findings suggested there are independent and interactive associations of low ST and high PA with poor sleep quality and suboptimal health status among Chinese college freshmen.

Excessive daytime sleepiness and its predictors among medical and health science students of University of Gondar, Northwest Ethiopia: institution-based cross-sectional study

Background

Excessive daytime sleepiness (EDS) is a condition of sleepiness when a person would not be expected to sleep. University students are prone to EDS due to the competitive learning environment and fragmented night sleep. No study was conducted in Ethiopia on EDS. Therefore, this study aimed to determine EDS and its predictors among University of Gondar (UoG) Medical and Health Science students.

Methods

Institution-based cross-sectional study was carried out on 383 Medical and Health Science students of UoG who were recruited using a computer-generated simple random sampling technique. We used a validated Epworth daytime sleepiness tool to collect data. Epi-Info™ 7 and Stata 14 were used for data entry and analysis, respectively. Bivariable and multivariable binary logistic regression analyses were performed to find out predictors. Odds ratio with 95% uncertainty interval were computed. In the final model, a variable with a p < 0.05 was declared as a predictor of EDS.

Results

Three hundred and eighty-three students completed the questionnaire. Males were 69.97% and the mean age of participants was 20.79 (±1.83) years. In the current study, the prevalence of EDS was 31.07% (95% UI: 26.62–35.91). The odds of getting EDS was 1.83 (AOR = 1.83, 95% UI: 1.14–2.96) and 1.84 (AOR = 1.84, 95% UI: 1.13–3.00) higher among students who reported night sleep behaviour disorders and depression, respectively.

Conclusion

This study revealed that EDS is high and predicted by depression and night sleep behaviour disorders. These findings suggest the need to set preventive strategies such as counselling of students to reduce depression and night sleep behaviour disorders. Further studies particularly qualitative studies are required to find out more factors affecting EDS.

Prevalence and differences in habitual sleep efficiency, sleep disturbances, and using sleep medication: a national study of university students in Jordan

BACKGROUND

Sleep quality has a significant impact on the physical and mental health of the young population.

STUDY AIM

To evaluate sleep efficiency, sleep disturbances, and use of sleep medication among university students in Jordan and to examine differences in these problems in relation to selected demographic and health-risk behaviors.

METHODS

The study used a cross-sectional design and a multi-stage sampling technique. Three public universities were randomly selected from three major governorates in Jordan. The Arabic version of the Pittsburgh Sleep Quality Index was used to measure sleep efficiency, sleep disturbances, and the use of sleep medication. Descriptive statistics and Kruskal-Wallis tests were used to analyze the data.

RESULTS

Of 1308 students who participated in the study, 27% reported sleep efficiency less than 85%, 45% of the students reported nocturnal awakening, 30% reported getting up to use the bathroom, and 9% reported using medication to help sleep. Differences in sleep efficiency, sleep disturbances, and use of sleep medication were found in relation to students' gender, income, marital status, smoking status, and academic achievement.

CONCLUSIONS

Poor sleep efficiency, sleep disturbances, and the use of sleep medications are significant problems affecting sleep quality among university students. Students' gender, marital status, income, smoking status, and academic achievement are important factors associated with sleep quality.

IMPLICATIONS

Sleep screening among university students is required to identify and provide treatment for sleep problems. Furthermore, educating university students about the effects of smoking on health in general and on sleep in particular should be mandated.

Poor sleep quality and associated factors among prisoners of the Diredawa correctional facility in eastern Ethiopia

BACKGROUND

Impaired sleep quality affects judgment, psychomotor skills, memory, decision-making, concentration, and attention. It might also contribute to the development of new physical health problems, as well as exacerbating already existing physical problems. Despite this, there is a scarcity of research done in Africa including Ethiopia that addressed this issue. So this study assessed the quality of sleep and related factors among prisoners of the Diredawa correctional facility, Diredawa, eastern Ethiopia.

METHODS

A cross-sectional study was done using a simple random sampling technique to recruit 421 participants from May 21 to June 21; 2017. A semi-structured questionnaire, Pittsburgh Sleeps Quality Index (PSFIG), Patient Health Questionnaire-9 (PQ-9), and Sleep Hygiene Index (SHI) were used to assess participants' socio-demographic data, sleep quality, depression, and sleep hygiene, respectively. The collected data were entered into EPA-data 3.1 and analyzed by using SPAS-20. Descriptive and analytical statistics were used. Bivariate and multivariable logistic regression with odds ratio and 95% CI were employed. The statistical significance was declared at p value < 0.05.

RESULTS

A total of 421 out of 423 prisoners were interviewed, resulting in a response rate of 99.5%. The prevalence of poor sleep quality was 227 (53.9%) with 95% CI (49.2, 58.7). Having co-morbidity of depression (adjusted odds ratio; OAR = 3.47, 95% CI 1.38,8.76), lifetime use of cigarette (OAR = 2.16, 95% CI 1.21,5.58), marijuana and hashish (OAR = 5.02, 95% CI 1.63,15.46), current use of coffee (OAR = 2.75, CI 1.37, 7.05), poor sleep hygiene (OAR = 3.19, CI 1.32,7.69), committing assault crime (OAR = 4.12, CI 1.29,10.63) and crime of rape (OAR = 5.57, CI (1.45, 13.89) were the associated factors for poor sleep quality in this study.

CONCLUSION

More than half of the participants (53.9%) have poor sleep quality. Depression, lifetime use of cigarettes, using cannabis and hashish, current use of coffee, poor sleep hygiene, and crime types were the associated factors that should be taken into consideration and evaluated early to minimize poor sleep quality.

Effects of Nocturnal Sleep Quality on Diurnal Cortisol Profiles and Attention in Nurses: A Cross-Sectional Study

Objective:

Low sleep quality (LSQ) activates the hypothalamic–pituitary–adrenal (HPA) axis and is related to arousal. Nursing staff, who work in shifts, tend to exhibit LSQ, which affects the level of vigor after awakening. This study investigated the effects of nocturnal sleep quality on diurnal cortisol profiles and sustained attention in day-shift nurses.

Method:

This study adopted a prospective cross-sectional design. Participants were recruited from a university-affiliated hospital in northern Taiwan. In the initial stage of this study, the Chinese Pittsburgh Sleep Quality Index (PSQI) Questionnaire was administered to 199 participants to categorize them as either LSQ (PSQI > 5) or high sleep quality (HSQ; PSQI ≤ 5). Participants were then randomly sampled from the two groups. Nocturnal sleep data and four diurnal saliva samples were collected for each participant. Sustained attention was measured before they started work. A total of 32 and 29 participants in the HSQ and LSQ groups, respectively, completed the data collection process.

Results:

Compared with the HSQ group, the LSQ group exhibited earlier wake-up times ( p = .02), a flatter cortisol awakening response (CAR) slope ( p < .01), a flatter morning-to-evening slope ( p < .01), and prolonged reaction speed and mean reaction time before starting work ( p < .01).

Conclusion:

Compared with the HSQ group, the LSQ group exhibited impaired HPA-axis regulation, with a flatter CAR and diurnal cortisol slope and poor sustained attention in the morning. Nursing staff are advised to achieve HSQ to improve attention and performance levels and maintain optimum work safety.

Prevalence of poor sleep quality in the Ethiopian population: a systematic review and meta-analysis

BACKGROUND

Only a limited amount of data is available from lower-income countries regarding the prevalence of poor quality of sleep. This meta-analysis of the scientific literature was performed to estimate the pooled prevalence of poor sleep quality in the Ethiopian population.

METHODS

The study protocol followed was the Preferred Reporting of Items for Systematic Review and meta-analysis (PRISMA) statement.

RESULTS

The nine studies which met the inclusion criteria provided data based on a total of 9103 participants who were studied at various health and academic institutions. The incidences of self-reported poor sleep quality ranged from 26 to 66.2%. The pooled estimate of poor sleep quality was 53%.There was a high prevalence of reported poor quality of sleep among younger subjects and among those who were studied in community (noninstitutional) settings.

CONCLUSION

The pooled prevalence of poor sleep quality is quite high among Ethiopians.

Insomnia among Town Residents in Ethiopia: A Community-Based Cross-Sectional Survey

Background

Insomnia is one of the most common sleep problems throughout the world and a major public health concern among adults in the general population. The aim of this study was to assess the prevalence of insomnia and its associated factors among town adult residents in Ethiopia.

Methods

Community-based cross-sectional study was done among 840 randomly selected adult participants by using standardized and pretested Athens insomnia scale (AIS) to assess insomnia. Systematic random sampling technique was used to get samples of the study participants. Data were entered into Epi-Info and analyzed using SPSS version 20. Descriptive, bivariate, and multivariate logistic regression models were used for analysis. Adjusted odds ratio (AOR) with 95% Confidence Interval (CI) was used to show the odds, and P value < 0.05 was considered as statistically significant.

Results

The prevalence of insomnia was found to be 42.9%. Sleep problems were associated with female sex [AOR =2.74, 95% CI; (1.77, 4.24)], age above 48 years [AOR=4.67, 95% CI: (2.32, 9.40)], being single [AOR=2.81, 95% CI (1.59, 4.95)] and widowed [AOR=4.20, 95% CI; (1.60, 11.01)], khat chewing [AOR=1.76,95% CI; (1.19, 2.60)], current tobacco smoking [AOR=3.13, 95% CI; (1.64, 5.95)], caffeinated beverage use [AOR=1.67, 95% CI; (1.12, 2.49)], comorbid medical-surgical disorders [AOR=2.03, 95% CI; (1.18, 3.48)], common mental disorders [AOR=8.92, 95% CI; (5.93,13.44)], and noise at bed time [AOR=2.13 95% CI; (1.20, 3.78)].

Conclusion

The prevalence of insomnia has to be found high and associated with many area related factors. It is important to pay attention in urban settings and large scale studies recommended.

Consumption of Energy Drinks and Their Effects on Sleep Quality among Students at the Copperbelt University School of Medicine in Zambia

Background. Good sleep quality is cardinal to good health, and research has shown that it plays a fundamental role in immunity, learning, metabolism, and other biological functions. Energy drink consumption is a popular practice among college students in the United States. There has been little research done on the consumption of energy drinks and its effects in Zambian universities. The main objective was to determine the effects of energy drinks on sleep quality among students at the Copperbelt University School of Medicine. A self-administered questionnaire was administered to 195 undergraduate students at the Copperbelt University School of Medicine in their second- and third-year of study. Energy drink consumption and sleep quality were assessed by univariate, bivariate, and multivariate analyses. 157 students were enrolled into the study. The prevalence of energy drink consumption was 27.4% among participants. Studying for an exam was the most common reason for drinking energy drinks (83.7% of energy drink users). The majority of participants were found to be have poor sleep quality (59.6%). There was a statistically significant association between energy drink consumption and poor sleep quality (p value < 0.01). The findings of our study show that energy drink consumption is not a common practice in the Zambian university setting as the prevalence was 27.4%. Furthermore, the prevalence of poor sleep quality among Zambian university students is high and is significantly associated with energy drink consumption, and there is a need to better understand the patterns of energy drink use as well as their effects on various aspects of health including sleep quality in the Zambian setting. Further research should assess the knowledge of nonmedical students on the effects of energy drinks.

Prevalence and Associated Factors of Sleep Quality among Adults in Jimma Town, Southwest Ethiopia: A Community-Based Cross-Sectional Study

Background

An estimated 150 million people worldwide and nearly 17% of the populations in the developing nations are currently suffering from sleep problems. The aim of the present study was to determine the prevalence and associated factors of sleep quality among adults in Ethiopia.

Method

A cross-sectional study was conducted on 422 randomly selected adults using validated and pretested Pittsburgh Sleep Quality Index. Data were entered into EpiData and analyzed using SPSS version 20 considering bivariable (P value < 0.25) and multivariable (P < 0.05) logistic regression procedures at 95% confidence interval.

Result

The overall prevalence of poor sleep quality (PSQI score > 5) was 65.4% with higher proportion among males (79 (63.0%)) and age group of 40-49 years (174 (28.6%)). A multivariable logistic regression analysis indicated that age category of 40-49 years (AOR = 2 [95% CI (1.1, 3.6)]) (P = 0.03), monthly income ≤ 1000 ETB (AOR = 2.2 [95% CI (14, 3.5)]) (P = 0.01), current khat chewing (AOR = 1.8 [95% CI (1.1, 3.1)]) (P = 0.03), daily khat chewing (AOR = 3.4 [95% CI (1.2, 11.1)]) (P = 0.04), and obesity (AOR = 1.2 [95% CI (1.3, 2.5)]) (P = 0.03) were identified as risk factors of poor sleep quality.

Conclusion

The current study is informative for government to work on poverty reduction, create awareness for weight reduction, and develop legislation for khat control to prevent poor sleep quality.

Sleep quality and anxiety level in employees

OBJECTIVE:

The aim of this study was to measure the sleep quality and anxiety level of a group of employees, as well as determine the relationship between sleep quality and anxiety and other factors.

METHODS:

A total of 130 of 185 employees at a university campus were enrolled in this cross-sectional study. A descriptive questionnaire, the Pittsburgh Sleep Quality Index, and the Beck Anxiety Inventory were the data collection instruments. In addition to univariate analysis, the relationship between the 2 scales was examined with Spearman correlation analysis.

RESULTS:

Of the participants, 38.9% had poor sleep quality. Gender, income level, presence of a chronic disease, regular medication use, and relationship with family and the social environment were found to affect both sleep quality and anxiety. A decrease in sleep quality was associated with an increase in the level of anxiety.

CONCLUSION:

Poor sleep quality and a high anxiety level are common in this country, as in the rest of the world. Socioeconomic interventions and psychosocial support to improve the status of individuals with risk factors, such as chronic disease, will reduce anxiety and improve sleep quality and overall psychosocial health. Further prospective studies should be conducted with different groups of participants and with larger samples to expand knowledge of the relationship between sleep quality and anxiety.

Validation of the adapted Leeds sleep evaluation questionnaire in Ethiopian university students

Background

Current evidence supports the applicability of the Leeds Sleep Evaluation Questionnaire (LSEQ) in screening for insomnia. The psychometric properties of the LSEQ have never been investigated in an African population. Therefore, this study aimed to validate the adapted version of the LSEQ-Mizan (LSEQ-M) in Ethiopian university students.

Methods

Of a preliminary sample of 750 (random sampling), 424 students (age = 21.87 ± 4.13 years and body mass index = 20.84 ± 3.18 kg/m²) from Mizan-Tepi University, Mizan-Aman, South-west Ethiopia completed the LSEQ-M, the General Anxiety Disorder Scale-7 and a semi-structured questionnaire for socio-demographics. Insomnia was screened in accordance with the International Classification of Sleep Disorders as a measure of concurrent validity.

Results

Although, individual items showed ceiling and floor effect, the LSEQ-M as a scale did not have these effects. Good internal consistency (Cronbach’s alpha of 0.84) and strong internal homogeneity as measured by the correlation coefficient between items scores and the LSEQ-M global score was found. The LSEQ-M showed excellent screening applicability for insomnia with optimal cut-off scores of 52.6 (sensitivity 94%, specificity 80%), and the area under the curve, 0.95 (p < 0.0001). The original 4-Factor model was valid in Ethiopian university students for screening for insomnia.

Conclusion

The LSEQ-M has excellent psychometric validity in screening for insomnia among Ethiopian university students.

Electronic supplementary material

The online version of this article (10.1186/s12955-018-0876-0) contains supplementary material, which is available to authorized users.

Poor sleep in concurrent users of alcohol, khat, and tobacco smoking in community-dwelling Ethiopian adults

BACKGROUND:

Polysubstance dependence, stress, and sleep disturbances are inter-related by shared physiological pathways. No study has investigated the relationship between sleep and concurrent use of alcohol and khat.

OBJECTIVES:

The aim of the study was to assess the effect of the concurrent use of alcohol and khat as well as concurrent alcohol, khat, and tobacco smoking on sleep patterns.

METHODS:

A sample of community-dwelling adults (n = 339, age = 25.5 ± 5.7 years, body mass index = 22.0 ± 2.2 kg/m²) from Mizan-Aman, Ethiopia, participated in a cross-sectional study. Semi-structured tool for sociodemographics, substance use habit, and the Pittsburgh Sleep Quality Index (PSQI) were used. The difference in sleep patterns among substance use groups, i.e., nonusers, alcohol use only, concurrent alcohol and khat use, and concurrent alcohol, khat and tobacco smoking was assessed.

RESULTS:

The poorest sleep quality was found among concurrent users of alcohol, khat, and tobacco smoking (PSQI global score = 8.2 ± 2.4), followed by concurrent users of alcohol and khat (PSQI global score = 7.3 ± 2.9) (F (3.335) = 23.64, P < 0.001). There were significant differences in the PSQI component score of sleep quality χ²(3) =159.09, P < 0.001, the PSQI component score of sleep latency χ²(3) = 128.09, P < 0.001, and the PSQI component score of sleep disturbances χ²(3) = 37.69, P < 0.001 between substance use groups.

CONCLUSION:

Concurrent use of alcohol, khat as well as alcohol, khat, and tobacco smoking was associated with poor sleep. Sleep disturbances in this group need management to avoid the prospective development of psychosocial disturbances in polysubstance users.

Assessment of sleep quality and its predictors among patients with diabetes in Jazan, Saudi Arabia

BACKGROUND

Poor sleep quality is common among patients with diabetes. It is associated with negative physical, psychological, and functional consequences. However, the implicated risk factors of poor sleep quality remain uncertain.

OBJECTIVES

This study aimed to determine the prevalence of poor sleep quality among patients with diabetes and to investigate the factors associated with the poor sleep quality.

PATIENTS AND METHODS

An analytical cross-sectional study of 307 diabetic patients in Jazan, Saudi Arabia was conducted in 2018. A multistage cluster random sampling was used to select the study participants. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Data on patient's characteristics were gathered via patients' interviews, and medical data were collected based on the patients' files. Logistic regression analysis was used to identify the predictors of poor sleep quality.

RESULTS

The mean score of PSQI was 5.29±2.73. The prevalence of poor sleep quality was 55.4% (95% CI 49.7-60.8). Sociodemographic and clinical factors were significantly associated with poor sleep quality, such as being elderly, female, illiterate, smoker, complications of diabetes, comorbidity, or psychological symptoms. However, female gender was the strongest predictor of reporting poor quality of sleep, OR= 3.69, 95% CI 1.65-8.28 (P<0.001).

CONCLUSION

Poor sleep quality among diabetic patients is a prevalent health problem. Many factors can affect sleep quality. Health care providers may consider routine screening for and address sleep problems among diabetic patients.

Research on Sleep Quality and the Factors Affecting the Sleep Quality of the Nursing Students

Purpose: This research has been conducted in order to examine the quality of sleep and the factors affecting the sleep quality.Material/Methods: The sample of this descriptive research is comprised of 223 volunteer students studying at Uludağ University Faculty of Health Sciences Department of Nursing. Research datas have been collected through personal features survey and Pittsburg Sleep Quality Index(PSQI). Results: The average result derived from the sample is 6.52±3.17. To briefly explain the average of the component scores: subjective sleep quality 1.29±0.76, sleep latency 1,55±0.94, sleep duration 0.78±0.99, habitual sleep activity 0.47±0.90, sleep disturbances 0.99±0.09, use of sleeping medication 0.12±0.48, daytime dysfunction 1.29±0.90. It has been observed that there is a meaningful discrepancies between average PSQI results and smoking habits of the students, total daily sleeping hours, efficient waking up times, average daily coffee consumption(p<0.05). According to the analyses there is no meaningful discrepancies between the age,gender, where the students live,snoozing during the morning classes, the existence of chronic diseases and daily average tea consumption.(p>0.05)Conclusions: According to the findings in the light of this research; nursing students have low sleep quality.

Sleep correlates of substance use in community-dwelling Ethiopian adults

PURPOSE

The relationship between sleep disturbances and substance use can have harmful effects. Evidence shows widespread use of substances, including khat, in the Ethiopian population. However, to the best of our knowledge, no study has investigated the sleep correlates of substance use in community-dwelling Ethiopian adults.

MATERIALS AND METHODS

A cross-sectional study using simple random sampling was performed on community-dwelling adults (n = 371, age = 25.5 ± 5.7 years, body mass index = 22.0 ± 2.2 kg/m²) in Mizan-Aman, Ethiopia. Dichotomized sleep measures (sleep quality and sleep latency) assessed by the Pittsburgh Sleep Quality Index (PSQI) were used in association analysis using binary logistic regression with substance use (khat, smoking, and alcohol).

RESULT

Sleep latency was associated with khat chewing (adjusted odds ratio (AOR) = 2.8, 95% confidence interval (CI) 1.7-4.4) and tobacco smoking (AOR = 2.1, 95% CI 1.4-3.0). Sleep quality was associated with khat chewing (AOR = 3.1, 95% CI 1.8-5.2), tobacco smoking (AOR = 1.7, 95% CI 1.2-2.5), and alcohol intake (AOR = 1.9, 95% CI 1.1-3.1).

CONCLUSION

Sleep correlates of substance use were found in community-dwelling Ethiopians. These findings may aid in the development of targeted strategies to manage substance use-related sleep disturbances.

Insomnia and Its Temporal Association with Academic Performance among University Students: A Cross-Sectional Study

INTRODUCTION

Studies show that 9.4% to 38.2% of university students are suffering from insomnia. However, research data in developing countries is limited. Thus, the aim of the study was to assess insomnia and its temporal association with academic performance.

METHODS AND MATERIALS

Institution based cross-sectional study was conducted with 388 students at Debre Berhan University. Data were collected at the nine colleges. Logistic and linear regression analysis was performed for modeling insomnia and academic performance with a p value threshold of 0.05, respectively. Data were entered using EPI-data version 3.1 and analyzed using SPSS version 20.

RESULTS

The prevalence of insomnia was 61.6%. Field of study (p value = 0.01), worshiping frequency (p value = 0.048), marital status (p value = 0.03), and common mental disorder (p value < 0.001) were identified associated factors of insomnia. There was no significant association between insomnia and academic performance (p value = 0.53, β = -0.04). Insomnia explained 1.2% (r² = 0.012) of the difference in academic performance between students.

CONCLUSIONS

Nearly 3 out of 5 students had insomnia. We recommended that universities would endorse sleep quality and mental health illness screening programs for students.

The prevalence and association of stress with sleep quality among medical students

Introduction: Medical students tend to reduce their sleep, in an effort to adjust and cope with their workload and stressful environment. This study estimated the prevalence of and the relationship between poor sleep quality and stress among medical students.

Methods: This cross-sectional study was conducted using a stratified random sample of male and female medical students in King Saud bin Abdulaziz University for Health Sciences in Riyadh, Saudi Arabia. A self-administered questionnaire was distributed to assess sleep quality using the Pittsburgh Sleep Quality Index, and the stress level by using the Kessler Psychological Distress Scale.

Results: A high prevalence of poor sleep quality (76%) and stress (53%) were found, with a statistically significant association (p < 0.001). Logistic regression indicated that students who are not suffering from stress are less likely to have poor sleep quality (OR = 0.28, p < 0.001), and the risk of having poor sleep quality is almost four times higher in students whose cumulative grade point average (GPA) is less than 4.25 (OR = 3.83, p = 0.01).

Conclusion: The study documents a statistically significant association between stress and poor sleep quality. A recommendation for the management of medical college is to establish academic counseling centers focusing in promoting good sleep hygiene and strengthening students’ study skills and coping with their stressful environment.

Validation of the Pittsburgh sleep quality index in community dwelling Ethiopian adults

Background

The applicability of the Pittsburgh Sleep Quality Index (PSQI) in screening of insomnia is demonstrated in various populations. But, the tool has not been validated in a sample of Ethiopians. Therefore, this study aimed to assess its psychometric properties in community dwelling Ethiopian adults.

Material and methods

Participants (n = 311, age = 25.5 ± 6.0 years and body mass index = 22.1 ± 2.3 kg/m²) from Mizan-Aman town, Southwest Ethiopia completed the PSQI and a semi-structured questionnaire for socio-demographics. Clinical interview for screening of insomnia according to the International Classification of Sleep Disorders was carried out as a concurrent validation measure.

Results

Overall, the PSQI scale did not have floor effect and ceiling effects. Moderate internal consistency (Cronbach’s alpha was 0.59) and sufficient internal homogeneity as indicated by correlation coefficient between component scores and the global PSQI score was found. The PSQI was of good value for screening insomnia with optimal cut-off scores of 5.5 (sensitivity 82%, specificity 56.2%) and the area under the curve, 0.78 (p < 0.0001). The PSQI has unidimensional factor structure in the Ethiopian community adults for screening insomnia.

Conclusion

The PSQI has good psychometric validity in screening for insomnia among Ethiopians adults.

Electronic supplementary material

The online version of this article (doi:10.1186/s12955-017-0637-5) contains supplementary material, which is available to authorized users.

Prevalence of khat chewing and its effect on academic performance in Sidama zone, Southern Ethiopia

BACKGROUND

Khat use is a well-established public health problem in Yemen, Arabian Peninsula, and Ethiopia. Along with its large scale production, the magnitude of khat use is increasing among students.

OBJECTIVE

This study was intended to assess the prevalence, determinants, and effect of khat use on academic performance of high school students in Sidama Ethiopia.

METHODOLOGY

A cross-sectional study was conducted from April to June 2015. We used a stratified sampling technique to draw a total of 1,577 students. The data was collected using self-administered questionnaires and analyzed using SPSS version 20. Descriptive statistics and logistic regression models were used to determine the prevalence, effects, and predictors of khat use.

RESULT

The life time and current prevalence of khat use were 14.6% and 13%, respectively. Smoking cigarette (AOR=5.1, 95% C.I: 2.3-14.3), drinking alcohol (AOR=3.0, 95% C.I: 1.4-6.3), having a family growing khat (AOR=2.0, 95% C.I: 1.1-2.5), having friend chewing khat (AOR=3. 95% C.I: 2.0-4.6), were some of factors that increased the odds of students' khat use. Student's khat use increased the odds of student's poor academic performance (AOR=2.1, 95% C.I: 1.1-3.9).

CONCLUSION

The prevalence of khat use in high khat producing districts of Sidama and its contribution to poor academic performance demand prompt intervention.

Association of suicidal ideation with poor sleep quality among Ethiopian adults

OBJECTIVE

The objective of this study was to examine the extent to which poor sleep quality is associated with suicidal ideation among Ethiopian adults.

METHODS

A cross-sectional study was conducted among 1054 adults attending outpatient clinical facilities in Ethiopia. Standardized questionnaires were utilized to collect data on demographics, sleep quality, lifestyle, and depression status. Depression and suicidal ideation were assessed using the Patient Health Questionnaire-9 (PHQ-9), while the Pittsburgh Sleep Quality Index (PSQI) questionnaire was utilized to assess sleep quality. Multivariate logistic regression models were fit to estimate adjusted odds ratio (AOR) and 95 % confidence intervals (95 % CI).

RESULTS

The prevalence of suicidal ideation was 24.3 % while poor sleep quality (PSQI global score of >5 vs. ≤5) was endorsed by 60.2 % of participants. After adjustment for confounders including depression, poor sleep quality was associated with more than 3-fold increased odds of suicidal ideation (AOR = 3.59; 95 % CI 2.34-5.51). When assessed as a continuous variable, each 1-unit increase in the global PSQI score resulted in a 20 % increased odds for suicidal ideation, even after adjusting for depression (AOR = 1.20; 95 % CI 1.14-1.27). Participants with both poor sleep quality and depression had much higher odds (AOR = 23.22, 95 % CI 14.10-38.28) of suicidal ideation as compared with those who had good sleep quality and no depression although inferences from this analysis are limited due to the wide 95 % CI.

CONCLUSION

Suicidal ideation and poor sleep quality are highly prevalent. Individuals with poor sleep quality have higher odds of suicidal ideation. If confirmed, mental health services need to address sleep disturbances seriously to prevent suicidal episodes.

Mediator Effect of Sleep Hygiene Practices on Relationships Between Sleep Quality and Other Sleep-Related Factors in Chinese Mainland University Students

This study examined the mediator effect of sleep hygiene practices (SHP) on relationships between sleep quality and other sleep-related factors in Chinese mainland university students using structural equation modeling analysis. Of the 413 students, 41.4% had poor sleep quality. Gender, academic stress, relaxed psychological status, good physical status, and SHP had significant direct effects on sleep quality; relaxed psychological status had significant direct effect on SHP and indirect effect on sleep quality via SHP. The direct, indirect, and total effects of gender, academic stress, relaxed psychological status, good physical status, and SHP explained 25% of the variance in sleep quality. The Chinese mainland university students had relative poor sleep quality. SHP was a mediator between sleep quality and relaxed psychological status.

Risk of Common Mental Disorders in Relation to Symptoms of Obstructive Sleep Apnea Syndrome among Ethiopian College Students

BACKGROUND

The Berlin and Epworth Sleepiness Scale (ESS) are simple, validated, and widely used questionnaires designed to assess symptoms of obstructive sleep apnea syndrome (OSAS) a common but often unrecognized cause of morbidity and mortality.

METHODS

A cross-sectional study was conducted among 2,639 college students to examine the extent to which symptoms of OSAS are associated with the odds of common mental disorders (CMDs). The General Health Questionnaire (GHQ-12) was used to evaluate the presence of CMDs while the Berlin and ESS were used to assess high-risk for obstructive sleep apnea (OSA) and excessive daytime sleepiness, respectively. Logistic regression procedures were used to derive odds ratios (OR) and 95% confidence intervals (CI) assessing the independent and joint associations of high-risk for OSA and excessive daytime sleepiness with odds of CMDs.

RESULTS

Approximately 19% of students had high-risk for OSA while 26.4% had excessive daytime sleepiness. Compared to students without high-risk for OSA and without excessive daytime sleepiness (referent group), students with excessive daytime sleepiness only (OR=2.01; 95%CI: 1.60-2.52) had increased odds of CMDs. The odds of CMDs for students with high-risk OSA only was 1.26 (OR=1.26; 95%CI 0.94-1.68). Students with both high-risk for OSA and excessive daytime sleepiness, compared to the referent group, had the highest odds of CMDs (OR=2.45; 95%CI: 1.69-3.56).

CONCLUSION

Our findings indicate that symptoms of OSAS are associated with increased risk of CMDs. These findings emphasize the comorbidity of sleep disorders and CMDs and suggest that there may be benefits to investing in educational programs that extend the knowledge of sleep disorders in young adults.

Psychometric properties and factor structure of the General Health Questionnaire as a screening tool for anxiety and depressive symptoms in a multi-national study of young adults

BACKGROUND

Globally, common psychiatric disorders such as depression and anxiety are among the leading causes of morbidity and mortality. The 12-item General Health Questionnaire (GHQ-12) is a widely used questionnaire for screening or detecting common psychiatric disorders. The purpose of this study was to examine the reliability, construct validity and factor structure of the GHQ-12 in a large sample of African, Asian and South American young adults.

METHODS

A cross-sectional study was conducted among 9077 undergraduate students from Chile, Ethiopia, Peru and Thailand. Students aged 18-35 years were invited to complete a self-administered questionnaire that collected information about lifestyle, demographics, and GHQ-12. In each country, the construct validity and factorial structures of the GHQ-12 questionnaire were tested through exploratory and confirmatory factor analyses (EFA and CFA).

RESULTS

Overall the GHQ-12 items showed good internal consistency across all countries as reflected by the Cronbach's alpha: Chile (0.86), Ethiopia (0.83), Peru (0.85), and Thailand (0.82). Results from EFA showed that the GHQ-12 had a two-factor solution in Chile, Ethiopia and Thailand, although a three-factor solution was found in Peru. These findings were corroborated by CFA. Indicators of goodness of fit, comparative fit index (CFI), root mean square error of approximation (RMSEA), and standardized root mean squared residual, were all in acceptable ranges across study sites. The CFI values for Chile, Ethiopia, Peru and Thailand were 0.964, 0.951, 0.949, and 0.931, respectively. The corresponding RMSEA values were 0.051, 0.050, 0.059, and 0.059.

CONCLUSION

Overall, we documented cross-cultural comparability of the GHQ-12 for assessing common psychiatric disorders such as symptoms of depressive and anxiety disorders among young adults. Although the GHQ-12 is typically used as single-factor questionnaire, the results of our EFA and CFA revealed the multi- dimensionality of the scale. Future studies are needed to further evaluate the specific cut points for assessing each component within the multiple factors.

Sleep Quality and Emotional Correlates in Taiwanese Coronary Artery Bypass Graft Patients 1 Week and 1 Month after Hospital Discharge: A Repeated Descriptive Correlational Study

Background

Poor sleep quality is a common health problem for coronary artery bypass graft patients, however few studies have evaluated sleep quality during the period immediately following hospital discharge.

Purpose

The aim of this study was to investigate changes in sleep quality and emotional correlates in coronary artery bypass graft patients in Taiwan at 1 week and 1 month after hospital discharge.

Methods

We used a descriptive correlational design for this study. One week after discharge, 87 patients who had undergone coronary artery bypass surgery completed two structured questionnaires: the Pittsburgh Sleep Quality Index and the Hospital Anxiety and Depression Scale. Three weeks later (1 month after discharge) the patients completed the surveys again. Pearson correlations, t-tests, ANOVA and linear multiple regression analysis were used to analyze the data.

Results

A majority of the participants had poor sleep quality at 1 week (82.8%) and 1 month (66.7%) post-hospitalization, based on the global score of the Pittsburgh Sleep Quality Index. Despite poor sleep quality at both time-points the sleep quality at 1 month was significantly better than at 1-week post hospitalization. Poorer sleep quality correlated with older age, poorer heart function, anxiety and depression. The majority of participants had normal levels of anxiety at 1 week (69.0%) and 1 month (88.5%) as measured by the Hospital Anxiety and Depression Scale. However, some level of depression was seen at 1 week (78.1%) and 1 month (59.7%). Depression was a significant predictor of sleep quality at 1 week; at 1 month after hospital discharge both anxiety and depression were significant predictors of sleep quality.

Conclusion

Sleep quality, anxiety and depression all significantly improved 1 month after hospital discharge. However, more than half of the participants continued to have poor sleep quality and some level of depression. Health care personnel should be encouraged to assess sleep and emotional status in patients after coronary artery bypass surgery and offer them appropriate management strategies to improve sleep and reduce anxiety and depression.

The Epidemiology of Tobacco Use among Khat Users: A Systematic Review

Khat, an "amphetamine-like green leaf," may influence the consumption of tobacco. This study reviews the epidemiology of tobacco use among khat users. Electronic database searches using appropriate keywords/terms were conducted to identify observational studies of khat use. Assessment of quality and risk of bias of all included studies was conducted, and the results were synthesised descriptively. Nine eligible cross-sectional studies were identified. All assessed self-reported tobacco among khat users and were carried out in Africa and the Middle East. Eight reported cigarettes and one reported waterpipes as the mode of use. Methods of tobacco use prevalence assessment varied. Prevalence of "current" tobacco use among students and university teachers ranged from 29 to 37%; "lifetime" tobacco use in university teachers was 58% and "undefined" tobacco use in nonspecific adults and students ranged from 17 to 78%. Daily tobacco use among adults was reported as 17% whilst simultaneous tobacco and khat use was reported as between 14 and 30% in students. In conclusion, tobacco prevalence among khat users appears significant. Findings should be interpreted cautiously due to self-reported tobacco use, diversity in questions assessing tobacco use, and type of tobacco consumption. Future research should address the methodological shortcomings identified in this review before appropriate policy interventions can be developed.

Construct validity and factor structure of the pittsburgh sleep quality index and epworth sleepiness scale in a multi-national study of African, South East Asian and South American college students

BACKGROUND

The Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) are questionnaires used to assess sleep quality and excessive daytime sleepiness in clinical and population-based studies. The present study aimed to evaluate the construct validity and factor structure of the PSQI and ESS questionnaires among young adults in four countries (Chile, Ethiopia, Peru and Thailand).

METHODS

A cross-sectional study was conducted among 8,481 undergraduate students. Students were invited to complete a self-administered questionnaire that collected information about lifestyle, demographic, and sleep characteristics. In each country, the construct validity and factorial structures of PSQI and ESS questionnaires were tested through exploratory and confirmatory factor analyses (EFA and CFA).

RESULTS

The largest component-total correlation coefficient for sleep quality as assessed using PSQI was noted in Chile (r = 0.71) while the smallest component-total correlation coefficient was noted for sleep medication use in Peru (r = 0.28). The largest component-total correlation coefficient for excessive daytime sleepiness as assessed using ESS was found for item 1 (sitting/reading) in Chile (r = 0.65) while the lowest item-total correlation was observed for item 6 (sitting and talking to someone) in Thailand (r = 0.35). Using both EFA and CFA a two-factor model was found for PSQI questionnaire in Chile, Ethiopia and Thailand while a three-factor model was found for Peru. For the ESS questionnaire, we noted two factors for all four countries.

CONCLUSION

Overall, we documented cross-cultural comparability of sleep quality and excessive daytime sleepiness measures using the PSQI and ESS questionnaires among Asian, South American and African young adults. Although both the PSQI and ESS were originally developed as single-factor questionnaires, the results of our EFA and CFA revealed the multi- dimensionality of the scales suggesting limited usefulness of the global PSQI and ESS scores to assess sleep quality and excessive daytime sleepiness.