Effects of an irregular bedtime schedule on sleep quality, daytime sleepiness, and fatigue among university students in Taiwan

Sleep patterns and quality during summer and academic year among female university students

OBJECTIVES

To measure sleep patterns and quality during summer vacation and weeks 1-4 of the academic year among female university students.

METHODS

This retrospective prospective cohort study included female students at a university in Riyadh, Saudi Arabia. Participants were recruited with convenience sampling and completed questionnaires online. The questionnaire asked about 5 occasions using the Sleep Quality Scale (SQS) and about their sleep schedule during summer vacation and weeks 1-4 of the academic year.

RESULTS

There were 385 participants. The number of students who slept before midnight increased over time from n=127 (32.9%) students during vacation to n=172 (44.6%) students in week 4 (p<0.001). The average sleep hours decreased from 8.97 (standard deviation (SD)=2.6) hours during summer to 7.01 (p<0.001, SD=2.7) hours in week 4. Students reported poorer sleep quality during the academic year, particularly in week 1 (p=0.023), than summer. Students reported higher satisfaction with sleep during summer vacation (n=97; 25.2%) than week 1 (n=38; 9.9%) and week 4 (n=36; 9.4%) (p<0.001). Students experienced daytime fatigue and tiredness (n=79; 20.5%; p=0.002) and low concentration in week 4 (n=79; 20.5%; p<0.001) compared to summer.

CONCLUSION

In the studied population, multiple sclerosis was the most prevalent cause of ON. Women were more likely to have ON. The prognosis for eyesight was substantially connected with the length of ON.

Insomnia symptoms as long-term predictors of anxiety symptoms in middle-aged and older adults from the English Longitudinal Study of Ageing (ELSA), and the role of systemic inflammation

Insomnia, i.e., difficulties in sleep onset and sleep maintenance, may increase the risk of anxiety symptoms, although long-term follow-up studies are rarely reported. Here, we examined whether insomnia symptoms may predict anxiety symptoms in a 9-year follow-up, and whether inflammation may play a mediating role. Data from 1355 participants (63.44 ± 7.47 years, 55.1 % females) from the English Longitudinal Study of Ageing (ELSA) were analysed. Insomnia symptoms were assessed in 2012/13. High-sensitivity C-reactive protein (hs-CRP), a marker of systemic inflammation, was measured in 2016/17. Anxiety symptoms were assessed in 2020/21. After adjusting for confounders and baseline levels, structural equation modelling (SEM) revealed that insomnia symptoms significantly predicted anxiety symptoms (β = 0.357, p < .001) but not hs-CRP (β = -0.016, p = .634). Similarly, hs-CRP was not related to anxiety symptoms (β = -0.024, p = .453). The hs-CRP mediation hypothesis was therefore rejected (β = 0.0004; 95 % BCI -0.001 to 0.005), and multi-group SEM showed that sex did not moderate these paths. However, baseline diagnoses of anxiety disorders prospectively predicted higher hs-CRP (B = 0.083, p = .030). Results of the current study suggest that individuals with baseline anxiety disorders may be at higher risk of developing low-grade chronic inflammation. Several alternative psychophysiological mechanisms linking insomnia and anxiety symptoms should be explored, including autonomic and cortical pre-sleep arousal, cortisol reactivity, and pro-inflammatory cytokines. Finally, insomnia symptoms may be a treatment target to lower the risk of anxiety symptoms in elderly.

The Prevalence and Predictors of Sleep Disorders and Their Impact on Academic Performance Among Saudi University Students: A Cross-Sectional Study

BACKGROUND

University students encounter a variety of sleep problems that have an impact on their health and academic performance. Therefore, the aim of this study was to evaluate the prevalence of sleep disorders and their impact on academic performance among Saudi university students.

METHODS

This is an online cross-sectional study that involved university students and was conducted between November 2022 and February 2023 in Saudi Arabia. Sleep disorders were examined among undergraduate students through online screening surveys including the Epworth Sleepiness Scale (ESS) to assess excessive daytime sleepiness, the Insomnia Severity Index (ISI) to measure insomnia, and the Berlin questionnaire to examine obstructive sleep apnea (OSA). Restless leg syndrome (RLS) was measured using the RLS rating. SPSS version 29.0 (IBM Corp., Armonk, NY, USA) was used for all statistical analyses. Binary logistic regression analysis was used to identify predictors of having excessive daytime sleepiness, insomnia, sleep-disordered breathing, and RLS.

RESULTS

The sample included 449 participants. According to the ESS, 56.6% (n=254) of students reported excessive daytime sleepiness. Using the ISI, 78.4% (n=352) of students were found to have insomnia. The Berlin questionnaire indicated that 6.7% (n=30) of students had sleep-disordered breathing. Additionally, 13.6% (n=61) of students reported having RLS. Male students had higher odds of sleep-disordered breathing compared to females (p<0.01), while marital status showed that married students had higher odds of sleep-disordered breathing (p<0.05). Students who reported nighttime sleeping had lower odds of insomnia and restless leg syndrome (p<0.05). Having regular sleeping times was associated with higher odds of insomnia (p<0.05). Napping sometimes was associated with higher odds of excessive daytime sleepiness and sleep-disordered breathing (p<0.05). Students working day and night shifts had higher odds of sleep-disordered breathing (p<0.01). Interestingly, students with comorbidities had lower odds of RLS (p<0.01).

CONCLUSION

This study established that sleep disturbances among students significantly reduce grade point averages (GPAs), where the most affected were male students and those who were married. The government should implement sleep education programs, provide resources for the management of sleep, encourage consistent sleep schedules, and come up with targeted interventions for at-risk groups. More research is also recommended on effective sleep interventions.

Prevalence and related factors of sleep quality among Chinese undergraduates in Jiangsu Province: multiple models' analysis

Background and aims

In China, a significant number of undergraduates are experiencing poor sleep quality. This study was designed to investigate the prevalence of poor sleep quality and identify associated factors among undergraduates in Jiangsu Province, China.

Methods

A total of 8,457 participants were collected in 2022 using whole-group convenience sampling. The factors studied included basic demographics, family and social support, personal lifestyles, physical and mental health, mobile phone addiction index (MPAI), and the Connor-Davidson resilience scale (CD-RISC). The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. Four models, including weighted multiple linear regression, binary logistic regression, weighted linear mixed model, and logistic regression with random effects, were applied to identify associated factors for sleep quality.

Results

Of the 8,457 participants analyzed, 26.64% (2,253) were classified into the poor sleep quality group with a PSQI score >7. No significant relationship was found between sleep quality and gender, native place, economic level of family, physical exercise, dormitory light, dormitory hygiene, and amativeness matter. Risk factors for sleep quality identified by the four models included lower CD-RISC, higher MPAI, fourth grade or above, smoking, drinking, greater academic pressure, greater employment pressure, roommate sleeping late, noisy dormitory, poorer physical health status, poorer mental health status, and psychological counseling.

Conclusions

These findings provide valuable insights for university administrators, enabling them to better understand the risk factors associated with poor sleep quality in undergraduates. By identifying these factors, administrators can provide targeted intervention measures and counseling programs to improve students' sleep quality.

Assessing the daily association of sleep hygiene behaviours with sleep: A between and within persons approach

Sleep hygiene behaviours are recommendations given to both clinical and non-clinical populations with a focus on modifying behaviours to maximise sleep outcomes. However, methodological issues present in sleep hygiene research make it difficult to conclusively determine the impact of each behaviour. This study aimed to address these issues by adopting a two-week, repeated measures design which incorporated objective sleep measures and used linear mixed effect modelling to assess the daily association of a wide range of sleep hygiene behaviours on sleep in a non-clinical, university sample. Between-persons effects revealed that bedtime and frequency of daytime napping, alcohol use, and social media use were negatively related to sleep duration while waketime and frequency of too much water consumption were positively related to sleep duration. Within-person effects revealed that later than usual bedtime, earlier than usual waketime, no sunlight exposure, poor ventilation, having an unpleasant conversation before bed were negatively associated with sleep duration whereas using alcohol to deliberately help full asleep was positively related to sleep duration. In contrast, disproportionately more behaviours were not significantly related to either sleep outcome, only some of which could be explained by individual differences, which suggests that more research is needed to determine the conditions under which these behaviours affect sleep, if at all.

Sleep Quality and its Daytime Effects among University Students in the UAE

Objectives

To determine the irregularity in the sleep schedule among university students in the UAE and determine its correlation with poor sleep quality, daytime sleepiness, and fatigue.

Methods

This observational cross-sectional survey was electronically conducted among undergraduate students of Ajman University during the academic year 2022-2023. The participants were selected using a simple random sampling method. The instruments for data collection comprised of sleep schedule questionnaire, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Fatigue Severity Scale. Data was subjected to chi-square analysis, Mann-Whitney U test, Wilcoxon rank-sum test, and Spearman's correlation.

Results

Of the 537 participants, 353 (65.7%) were female. The majority (57.2%) kept highly irregular bedtimes. The cohort's mean global PSQI score was 8.9±3.0 indicating poor sleep quality. There was a positive correlation between the irregular bedtime frequency and the global PSQI score (r = 0.311; p < 0.010). Most (70.8%) participants had a total high Fatigue Severity Scale score of ≥ 36. The scores of women (41.0±10.5) were significantly higher than those of men (38.5±11.0) (p =0.006). Around 53.0% of the participants had high ESS scores indicating excessive daytime sleepiness. There was also a significant correlation between ESS score and irregular bedtime frequency (r = 0.113; p =0.009).

Conclusions

The students at Ajman University had a high prevalence of irregular bedtime and inadequate sleeping hours. This was affecting their sleep quality and causing excessive daytime sleepiness. The students, especially women, were suffering from fatigue, potentially affecting their normal functionality. It is crucial to encourage students to establish regular sleep patterns and improve sleep habits to promote their productivity and general well-being.

The importance of sleep regularity: a consensus statement of the National Sleep Foundation sleep timing and variability panel

OBJECTIVE

To develop and present consensus findings of the National Sleep Foundation sleep timing and variability panel regarding the impact of sleep timing variability on health and performance.

METHODS

The National Sleep Foundation assembled a panel of sleep and circadian experts to evaluate the scientific evidence and conduct a formal consensus and voting procedure. A systematic literature review was conducted using the NIH National Library of Medicine PubMed database, and panelists voted on the appropriateness of 3 questions using a modified Delphi RAND/UCLA Appropriateness Method with 2 rounds of voting.

RESULTS

The literature search and panel review identified 63 full text publications to inform consensus voting. Panelists achieved consensus on each question: (1) is daily regularity in sleep timing important for (a) health or (b) performance? and (2) when sleep is of insufficient duration during the week (or work days), is catch-up sleep on weekends (or non-work days) important for health? Based on the evidence currently available, panelists agreed to an affirmative response to all 3 questions.

CONCLUSIONS

Consistency of sleep onset and offset timing is important for health, safety, and performance. Nonetheless, when insufficient sleep is obtained during the week/work days, weekend/non-work day catch-up sleep may be beneficial.

The effect of smartphone addiction on the relationship between psychological stress reaction and bedtime procrastination in young adults during the COVID-19 pandemic

BACKGROUND

Previous studies on bedtime procrastination mainly focused on the influencing factors of stress and draw less attention on the role of family environment.

AIM

This study aimed to explore the effect of psychological stress reaction on bedtime procrastination in young adults, with considering the mediating effect of smartphone addiction, and the moderating effect of family cohesion during the COVID-19 pandemic.

METHODS

A sample of 1217 young adults completed psychological stress reaction scale, Smartphone addiction tendency scale for young adults, bedtime procrastination scale and family cohesion scale. A moderated mediation model was conducted to clarify the effect of psychological stress reaction on bad bedtime procrastination in young adults.

RESULTS

The findings showed that: (1) The individual level of psychological stress reaction was positively associated with bedtime procrastination; (2) Smartphone addiction mediated the effect of psychological stress reaction on bedtime procrastination; (3) Family cohesion moderated the relationship among psychological stress reaction, smartphone addiction and bedtime procrastination.

CONCLUSIONS

This study revealed the effect of smartphone addiction on the relationship between psychological stress reaction and bedtime procrastination during the COVID-19 pandemic, and these findings could provide novel evidence that family cohesion may serve as a protective factor against the negative consequences of smartphone addiction on bad bedtime procrastination.

Exposure to secondhand smoke is associated with poor sleep quality among non-smoking university students in Bangladesh: a cross-sectional survey

Although secondhand smoke (SHS) exposure is predominant in Bangladesh, the adverse effect of SHS exposure on health-related behaviors, such as sleep quality, have remained an under-investigated area of the country's public health landscape. Therefore, the purpose of this study was to examine the association between SHS exposure and poor sleep quality among non-smoking university students in Bangladesh. A cross-sectional survey was carried out between May and September 2022. SHS exposure (main predictor variable) and other covariates (e.g., age, sex, etc.) were measured using a self-reported questionnaire and sleep quality (outcome variable) was measured via the Pittsburgh Sleep Quality Index. Multiple logistic regression models investigated the association between SHS exposure and poor sleep quality. The study included 390 students (mean age: 22 years, 53.8% male). Approximately 41.8% of the participants reported SHS exposure, and 50.5% had poor sleep quality. Students exposed to SHS were more likely to have poor sleep quality compared to their counterparts (AOR = 1.61; 95% CI 1.01, 2.58). Subgroup analysis revealed poor sleep quality was 2-times higher among male students exposed to SHS than those male students without SHS exposure (AOR = 2.03; 95% CI 1.05, 3.93). No association was found in female students. Findings from this study warrant increased awareness and public health initiatives on the implications of SHS on health behaviors, such as sleep quality, in non-smoking Bangladeshi university students.

The Worldwide Prevalence of Sleep Problems Among Medical Students by Problem, Country, and COVID-19 Status: a Systematic Review, Meta-analysis, and Meta-regression of 109 Studies Involving 59427 Participants

Abstract

Purpose of Review

Several studies have found that medical students have a significant prevalence of sleep issues, such as poor sleep quality, excessive daytime sleepiness, and inadequate sleep duration. The purpose of this review is to carefully evaluate the current research on sleep problems among medical students and, as a result, estimate the prevalence of these disturbances. The EMBASE, PsychINFO, PubMed/MEDLINE, ScienceDirect, Scopus, and Web of Science and retrieved article reference lists were rigorously searched and rated for quality. Random effects meta-analysis was performed to compute estimates.

Recent Findings

The current meta-analysis revealed an alarming estimated pooled prevalence of poor sleep quality (K = 95, N = 54894) of 55.64% [95%CI 51.45%; 59.74%]. A total of 33.32% [95%CI 26.52%; 40.91%] of the students (K = 28, N = 10122) experienced excessive sleepiness during the day. The average sleep duration for medical students (K = 35, N = 18052) is only 6.5 h per night [95%CI 6.24; 6.64], which suggests that at least 30% of them get less sleep than the recommended 7-9 h per night.

Summary

Sleep issues are common among medical students, making them a genuine problem. Future research should focus on prevention and intervention initiatives aimed at these groups.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40675-023-00258-5.

A latent profile analysis of sleep disturbance in relation to mental health among college students in China

Aims

This study aimed to examine the subtype classification characteristics of sleep disturbance (SD) in college students and their associations with sample characteristic factors and mental health outcomes.

Methods

The sample comprised 4,302 college students (Mean age = 19.92 ± 1.42 years, 58.6% females). The Youth Self-Rating Insomnia Scale, Beck Depression Inventory, 8-item Positive Subscale of the Community Assessment of Psychic Experiences, and 10-item Connor-Davidson Resilience Scale were used to assess adolescents' sleep disturbance, depressive symptoms, psychotic-like experiences (PLEs), and resilience. Latent profile analysis, logistic regression, and liner regression analysis were used to analyze the data.

Results

Three subtypes of SD in college students were identified: the high SD profile (10.6%), the mild SD profile (37.5%), and the no SD profile (51.9%). Compared with college students in the "no SD" profile, risk factors for "high SD" include being male and poor parental marital status. Sophomores were found to predict the "high SD" profile or "mild SD" profile relative to the "no SD" profile. College students in the "mild SD" profile or "high SD" profile were more likely to have a higher level of depressive symptoms and PLEs, while a lower level of resilience.

Conclusion

The findings highlighted that target intervention is urgently needed for male college students, sophomores, and those with poor parental marital status in the "mild SD" profile or "high SD" profile.

The effect of wearable-delivered sleep interventions on sleep outcomes among adults: A systematic review and meta-analysis of randomized controlled trials

The aims of the review were to (i) evaluate the effectiveness of wearable-delivered sleep interventions on sleep outcomes among adults, and (ii) explore the effect of factors affecting total sleep time. Eight databases were searched to identify relevant studies in English from inception until December 23, 2021. The Cochrane Risk of Bias tool version 2.0 and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria were used to assess the risk of bias and certainty of the evidence, respectively. Twenty randomized controlled trials (RCTs) were included, involving 1608 adults across nine countries. Wearable-delivered sleep interventions elicited significant improvement of 1.96 events/h for the oxygen desaturation index and 3.13 events/h for the respiratory distress index. Meta-analyses found that wearable-delivered sleep interventions significantly decreased sleep disturbance (Hedges' g [g] = -0.37, 95% confidence interval [CI]: -0.59, -0.15) and sleep-related impairment (g = -1.06, 95% CI: -1.99, -0.13) versus the comparators. The wearable-delivered sleep interventions may complement usual care to improve sleep outcomes. More rigorous RCTs with a long-term assessment in a wide range of populations are warranted.

Factors that influence morningness-eveningness and daytime sleepiness: A cross-cultural comparison of Iranian and Brazilian adolescents

As adolescents get older, they become more evening oriented and, because they are usually expected to wake early to attend school, they often present daytime sleepiness, which is associated with negative outcomes. It is still unclear if this is similar cross-culturally. Here, we studied morningness-eveningness and daytime sleepiness in early adolescence from two different developing nations (Brazil and Iran). A total sample of 697 Iranian and Brazilian early adolescents (9- to 15-year-old; 358 boys) from Tehran, Iran, and São Paulo, Brazil, varying in age and parental schooling (a proxy of socioeconomic status: SES) completed the Morningness-Eveningness Scale for Children (MESC) and the Pediatric Daytime Sleepiness Scale (PDSS) and reported their total sleep time on school nights. They also filled in the Pubertal Developmental Scale to determine their pubertal status. A negligible cross-cultural difference in morningness-eveningness was found, indicating that Brazilians showed a slight circadian-phase delay compared with Iranians throughout all tested ages. There was also seen a very slight increase in phase delay as early adolescents aged, indicative of more eveningness. However, there were no country differences in daytime sleepiness once total sleep time during school nights was controlled for, which was the only factor that affects PDSS scores.

The Effects of Objective Push-Type Sleep Feedback on Habitual Sleep Behavior and Momentary Symptoms in Daily Life: mHealth Intervention Trial Using a Health Care Internet of Things System

BACKGROUND

Sleep is beneficial for physical and mental health. Several mobile and wearable sleep-tracking devices have been developed, and personalized sleep feedback is the most common functionality among these devices. To date, no study has implemented an objective push-type feedback message and investigated the characteristics of habitual sleep behavior and diurnal symptoms when receiving sleep feedback.

OBJECTIVE

We conducted a mobile health intervention trial to examine whether sending objective push-type sleep feedback changes the self-reported mood, physical symptoms, and sleep behavior of Japanese office workers.

METHODS

In total, 31 office workers (mean age 42.3, SD 7.9 years; male-to-female ratio 21:10) participated in a 2-arm intervention trial from November 30 to December 19, 2020. The participants were instructed to indicate their momentary mood and physical symptoms (depressive mood, anxiety, stress, sleepiness, fatigue, and neck and shoulder stiffness) 5 times a day using a smartphone app. In addition, daily work performance was rated once a day after work. They were randomly assigned to either a feedback or control group, wherein they did or did not receive messages about their sleep status on the app every morning, respectively. All participants wore activity monitors on their nondominant wrists, through which objective sleep data were registered on the web on a server. On the basis of the estimated sleep data on the server, personalized sleep feedback messages were generated and sent to the participants in the feedback group using the app. These processes were fully automated.

RESULTS

Using hierarchical statistical models, we examined the differences in the statistical properties of sleep variables (sleep duration and midpoint of sleep) and daily work performance over the trial period. Group differences in the diurnal slopes for mood and physical symptoms were examined using a linear mixed effect model. We found a significant group difference among within-individual residuals at the midpoint of sleep (expected a posteriori for the difference: -15, 95% credible interval -26 to -4 min), suggesting more stable sleep timing in the feedback group. However, there were no significant group differences in daily work performance. We also found significant group differences in the diurnal slopes for sleepiness (P<.001), fatigue (P=.002), and neck and shoulder stiffness (P<.001), which was largely due to better scores in the feedback group at wake-up time relative to those in the control group.

CONCLUSIONS

This is the first mobile health study to demonstrate that objective push-type sleep feedback improves sleep timing of and physical symptoms in healthy office workers. Future research should incorporate specific behavioral instructions intended to improve sleep habits and examine the effectiveness of these instructions.

Study of factors leading to poor sleep among management students

Sleep is the most important but often neglected element of an individual’s overall health and well-being. Lack of sleep or poor sleep can adversely affect health in an individual and lead to various diseases. At the same time, sleep problems are not uncommon among students. The factors leading to poor sleep among management students who have a comparatively tight schedule are still unclear. The paper aims to understand the factors leading to poor sleep among management students. The study has been focused on the management students (MBA’s) studying in the different management colleges of the state of Maharashtra. A total of 297 management students were surveyed. Apart from factor analysis, the Kessler distress scale was used for Measuring Psychological distress.52% of the respondents fell in the category of likely to have a mental disorder. Managements can draw inference from this and implement strategies to make sure this number reduces.

Positive Orientation and Fatigue Experienced by Polish Nursing Students during the COVID-19 Pandemic: The Mediatory Role of Emotional Control

This study aimed to investigate the mediatory role of emotional control with respect to the control of anger, depression, and anxiety in the relationship between positive orientation and tiredness/fatigue occurring in a group of Polish nursing students during the COVID-19 pandemic. The study included 894 nursing students from six universities in Poland. A diagnostic survey was applied as the research method, and the data were collected using the Fatigue Severity Scale (FSS), the Courtauld Emotional Control Scale (CECS) and the Positive Orientation Scale (SOP). The mean participant age was 20.73 years (SD = 1.81). More than half of the students in the study showed a low level of positive orientation. Correlational analyses revealed a significant negative correlation between positive orientation and tiredness/fatigue experienced by the students participating in the study (r = −0.336; p < 0.001), and correlation between positive orientation and the overall emotional control index (r = −0.317; p < 0.001), and the indices of control of anger (r = −0.154; p < 0.01), depression (r = −0.376; p < 0.001), and anxiety (r = −0.236; p < 0.01). Analysis of the results also revealed the occurrence of significant, positive links between the controlled emotions and their components and the tiredness/fatigue experienced by nursing students. It is important to take action associated with the prevention of tiredness/fatigue among students and to reinforce a positive orientation and the capacity to control emotions to effectively minimize the effects of the COVID-19 pandemic on nursing students.

Effects of Socio-Familial Behavior on Sleep Quality Predictive Risk Factors in Individuals under Social Isolation

Social confinement involves a series of temporary changes in the habits and lifestyles of individuals, severely affecting their regular activities and schedules and substantially modifying socio-familial behavior (SFB) and sleep quality (SQ). There is no literature reporting the effects of SFB changes on SQ during social confinement due to the COVID-19 outbreak. An observational transversal research design, with group comparison and correlation methods, was used to perform the present study. The results were analyzed as follows: (1) An exploratory factor analysis (EFA); (2) A description of the sample was determined by proportions comparisons of sleep habits between the different variables of interest; and (3) A linear regression model was analyzed to explore the predictive association of the negative effects of social isolation during the COVID-19 pandemic on SFB and SQ. In addition to the global SFB score, two SFB factors were identified as predictors affecting the SQ, SF-Habits, and SF-Emotional scores, suggesting a close balance between daily life activities and sleep health during critical social changes. Furthermore, two main risk factors resulted from the regression analysis: economic concerns and increased alcohol consumption. Therefore, the predictive capacity of economic concerns showed statistical significance in anticipating negative sleep quality scores. Overall, this suggests that sleep quality, economic concerns, schedules, and substance use were associated with the self-perception of coping skills, elucidating the importance of fostering habits related to schedules within the home and ensuring that all family members participate.

Daytime Sleepiness among Medical Colleges’ Students in Jordan: Impact on Academic Performance

Introduction

Sleep disorders are extremely prevalent in the general population. College students are more susceptible to sleep problems. This is due to the increased competition in getting a job position and the current alterations in the labor market. Poor sleep is prevalent and has deleterious effects on college students, but its frequency among college students has not been documented in Jordan. So, the aims of this study are to assess the prevalence of daytime sleepiness among medical college students in Jordan and to look for any links between daytime sleepiness and academic performance.

Methods

A cross-sectional study performed on medical and paramedical specialties students and Epworth sleepiness Sscale (ESS) was used. To assess the students' academic performance, the cumulative grade point average was utilized.

Results

977 students from five medical colleges participated in the study. ESS scores were abnormal in 34.4% of students and were considered to have daytime sleepiness. Significant lower ESS scores were associated with students who reported good sleep quality than students who reported poor sleep quality. Significant lower ESS scores were reported by students who slept more than 7 hours compared with students who slept less than 6 hours. The ESS scores were not significantly associated with students' CPGA.

Conclusion

Daytime sleepiness is highly prevalent among medical students in Jordan. The data of this study might be very helpful to assess the academic policy makers to develop intervention strategies that resolve the sleep disturbances in college students and reduce its impact on the academic achievements.

Sleep characteristics of Iranian people and their effects on daytime functioning: a population-based study

Sleep characteristics vary between populations. Detrimental sleep habits have cognitive consequences leading to daytime functioning debilitation. Until now no study has been done to investigate sleep characteristics in Iran thoroughly. In this study, we aimed to evaluate Iranians’ sleep characteristics and their association with daytime functioning. We conducted a population-based study from January 2017 to May 2019 on people more than 18 years old who lived in 11 urban destricts and 3 rural areas of Tehran, Iran. We randomly selected the participants using a multistage random stratified clustered sampling method. We obtained the participants’ demographic and anthropometric characteristics and details of bedtime, sleep duration, sleep onset latency, wake-up time and sleep impact on daytime functioning. Logistic regression model was used to assess the relationship between sleep characteristics) and daytime functioning. In total, 1830 people with a mean age of 40.83 years participated in the study. The gender distribution of the participants was even, and 70.98% of them were married. After adjusting for age and sex, the following three factors had a significant impact on daytime functioning: bedtime, sleep onset latency, and sleep duration. (OR = 1.12, P < 0.038, OR = 1.01, P < 0.011, and OR = 0.99, P = 0.01, respectively). We also found that longer sleep onset latency (P = 0.004) and shorter sleep durations (P = 0.029) significantly interfere with daytime functioning. Iranians’ sleep characteristics, especially their sleep duration and sleep onset latency, are associated with their daytime function. Interventions on people’s sleep hygiene are warranted to promote healthier sleep behaviors among Iranians, considering the high impact of current sleep characteristics on their daily lives.

Effect of Hibiscus syriacus Linnaeus extract and its active constituent, saponarin, in animal models of stress-induced sleep disturbances and pentobarbital-induced sleep

Treatment of sleep disorders promotes the long-term use of commercially available sleep inducers that have several adverse effects, including addiction, systemic fatigue, weakness, loss of concentration, headache, and digestive problems. Therefore, we aimed to limit these adverse effects by investigating a natural product, the extract of the Hibiscus syriacus Linnaeus flower (HSF), as an alternative treatment. In the electric footshock model, we measured anxiety and assessed the degree of sleep improvement after administering HSF extract. In the restraint model, we studied the sleep rate using PiezoSleep, a noninvasive assessment system. In the pentobarbital model, we measured sleep improvement and changes in sleep-related factors. Our first model confirmed the desirable effects of HSF extract and its active constituent, saponarin, on anxiolysis and Wake times. HSF extract also increased REM sleep time. Furthermore, HSF extract and saponarin increased the expression of cortical GABAA receptor α1 (GABAAR α1) and c-Fos in the ventrolateral preoptic nucleus (VLPO). In the second model, HSF extract and saponarin restored the sleep rate and the sleep bout duration. In the third model, HSF extract and saponarin increased sleep maintenance time. Moreover, HSF extract and saponarin increased cortical cholecystokinin (CCK) mRNA levels and the expression of VLPO c-Fos. HSF extract also increased GABAAR α1 mRNA level. Our results suggest that HSF extract and saponarin are effective in maintaining sleep and may be used as a novel treatment for sleep disorder. Eventually, we hope to introduce HSF and saponarin as a clinical treatment for sleep disorders in humans.

Bedtime Procrastination Partially Mediates the Impact of Personality Characteristics on Daytime Fatigue Resulting From Sleep Deficiency

Getting good and sufficiently long sleep at night is important for health, effective functioning, and well-being. However, insufficient or delayed sleep are important and growing social problems that can lead to fatigue, poor performance, deterioration of well-being, circadian rhythm disturbances, and health problems. One of the significant determinants of sleep deprivation is bedtime procrastination, which is understood as the individual tendency to postpone going to bed in the absence of any external circumstances that force one to do so. Nowadays, this phenomenon is widespread in various social groups, especially among students. Despite the high prevalence of bedtime procrastination, its relationship with personality characteristics has not yet been thoroughly studied. The presented research aimed to identify the possible impact of the basic dispositional personality traits and trait-like personality characteristics on bedtime procrastination and daytime fatigue resulting from a deficiency of sleep at night. The responses from 399 university students who voluntarily took part in an internet survey were analyzed. The severity of bedtime procrastination was assessed using the Bedtime Procrastination Scale. Five basic dispositional personality traits (extraversion, neuroticism, conscientiousness, agreeableness, and openness/intellect) and their components (aspects) were measured using the International Personality Item Pool - Big Five Aspects Scale. Self-esteem and general self-efficacy were assessed using the Rosenberg Self-Esteem Scale and the General Self-Efficacy Scale. Perceived locus of control was measured using the Delta Questionnaire. The direct and indirect relationships between personality variables and daytime fatigue were investigated using linear regression models with bedtime procrastination as a mediator variable. Industriousness and orderliness, both of which are aspects of conscientiousness, were found to be indirectly associated with daytime fatigue as a consequence of their impact on bedtime procrastination. Volatility and withdrawal, both of which are aspects of neuroticism, were found to be directly related to daytime fatigue without the intermediary impact of bedtime procrastination. Self-esteem was shown to be associated with experiencing daytime fatigue, both directly and indirectly through bedtime procrastination. General self-efficacy and external locus of control were associated with daytime fatigue only directly, without the intermediary role of bedtime procrastination. The results of our research indicate that personality factors may not only play an important role in shaping sleep-related health behaviors, but they also affect well-being during the day.

Occipital sleep spindles predict sequence learning in a visuo-motor task

STUDY OBJECTIVES

The brain appears to use internal models to successfully interact with its environment via active predictions of future events. Both internal models and the predictions derived from them are based on previous experience. However, it remains unclear how previously encoded information is maintained to support this function, especially in the visual domain. In the present study, we hypothesized that sleep consolidates newly encoded spatio-temporal regularities to improve predictions afterwards.

METHODS

We tested this hypothesis using a novel sequence-learning paradigm that aimed to dissociate perceptual from motor learning. We recorded behavioral performance and high-density electroencephalography (EEG) in male human participants during initial training and during testing two days later, following an experimental night of sleep (n = 16, including high-density EEG recordings) or wakefulness (n = 17).

RESULTS

Our results show sleep-dependent behavioral improvements correlated with sleep-spindle activity specifically over occipital cortices. Moreover, event-related potential (ERP) responses indicate a shift of attention away from predictable to unpredictable sequences after sleep, consistent with enhanced automaticity in the processing of predictable sequences.

CONCLUSIONS

These findings suggest a sleep-dependent improvement in the prediction of visual sequences, likely related to visual cortex reactivation during sleep spindles. Considering that controls in our experiments did not fully exclude oculomotor contributions, future studies will need to address the extent to which these effects depend on purely perceptual versus oculomotor sequence learning.

Temperament, sleep quality, and insomnia severity in university students: Examining the mediating and moderating role of sleep hygiene

University students commonly experience sleep problems which have implications for daily functioning and academic achievement. For this reason, research is needed to identify modifiable individual difference variables that may contribute to better sleep in this population. Temperament and sleep hygiene may be two such factors. As part of a larger study, 167 university students (61.7% female) completed online questionnaires that inquired about temperament (the Adult Temperament Questionnaire; ATQ), sleep hygiene behavior (the Sleep Hygiene Index; SHI), global sleep quality (the Pittsburgh Sleep Quality Index; PSQI), and insomnia severity (the Insomnia Severity Index; ISI). Correlations amongst the included measures were in the predicted direction: effortful control was negatively associated with the SHI composite, PSQI global scores, and ISI scores; extraversion was negatively related to PSQI global scores; and negative affect was positively associated with the SHI composite and ISI scores. In addition, the SHI composite mediated the association between effortful control and the PSQI global scores as well as the association between negative affect and PSQI global scores; similar patterns of mediation were found when considering ISI scores, although the direct effects differed. That is, negative affect was directly associated with ISI scores but not PSQI global scores. These findings suggest that interventions designed enhance effortful control, reduce negative affect, and improve sleep hygiene may contribute to better global sleep quality and decrease insomnia in university students.

The Effect of Four Weeks Dietary Intervention with 8-Hour Time-Restricted Eating on Body Composition and Cardiometabolic Risk Factors in Young Adults

Recently, intermittent fasting, also known as time-restricted eating (TRE), has become a popular diet trend. Compared to animal studies, there have been few studies and inconclusive findings investigating the effects of TRE in humans. In this study, we examined the effects of 8 h TRE on body weight and cardiometabolic risk factors in young adults who were mainly active at night. A total of 33 young adults completed the 8 h TRE for 4 weeks. Body composition was measured by bioelectrical impedance analysis at baseline and every 2 weeks, and blood samples were collected at baseline and week 4. Daily dietary records were logged throughout the intervention period. Participants experienced significant changes in body weight (−1.0 ± 1.4 kg), body mass index (−0.4 ± 0.5 kg/m²), and body fat (−0.4 ± 1.9%) after 4 weeks of TRE. When participants were divided into weight loss/gain groups based on their weight change in week 4, fat mass reduction was significantly higher in the weight loss group than in the weight gain group. Regarding cardiometabolic risk factors, levels of fasting insulin and insulin resistance improved in the weight loss group after intervention, but not in the weight gain group. All subjects showed late-shifted sleeping patterns, but no significant differences in sleep duration, sleep quality, or psychological measures between the two groups. When meal frequency and energy proportion were evaluated, the average meal frequency was 2.8 ± 0.5 and energy proportions of breakfast, lunch, dinner, and snacks were 4.5, 39.2, 37.6, and 18.5%, respectively; there were no significant differences between the two groups. However, the saturated fat intake at dinner was lower in the weight loss group (3.1 ± 3.2%, 6.0 ± 2.5% respectively). In conclusion, 8 h TRE can be applied as a lifestyle strategy to manage body weight and cardiometabolic risk factors among young adults with late chronotypes.

COVID-19: Sleep, Circadian Rhythms and Immunity - Repurposing Drugs and Chronotherapeutics for SARS-CoV-2

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has affected nearly 28 million people in the United States and has caused more than five hundred thousand deaths as of February 21, 2021. As the novel coronavirus continues to take its toll in the United States and all across the globe, particularly among the elderly (>65 years), clinicians and translational researchers are taking a closer look at the nexus of sleep, circadian rhythms and immunity that may contribute toward a more severe coronavirus disease-19 (COVID-19). SARS-CoV-2-induced multi-organ failure affects both central and peripheral organs, causing increased mortality in the elderly. However, whether differences in sleep, circadian rhythms, and immunity between older and younger individuals contribute to the age-related differences in systemic dysregulation of target organs observed in SARS-CoV-2 infection remain largely unknown. Current literature demonstrates the emerging role of sleep, circadian rhythms, and immunity in the development of chronic pulmonary diseases and respiratory infections in human and mouse models. The exact mechanism underlying acute respiratory distress syndrome (ARDS) and other cardiopulmonary complications in elderly patients in combination with associated comorbidities remain unclear. Nevertheless, understanding the critical role of sleep, circadian clock dysfunction in target organs, and immune status of patients with SARS-CoV-2 may provide novel insights into possible therapies. Chronotherapy is an emerging concept that is gaining attention in sleep medicine. Accumulating evidence suggests that nearly half of all physiological functions follow a strict daily rhythm. However, healthcare professionals rarely take implementing timed-administration of drugs into consideration. In this review, we summarize recent findings directly relating to the contributing roles of sleep, circadian rhythms and immune response in modulating infectious disease processes, and integrate chronotherapy in the discussion of the potential drugs that can be repurposed to improve the treatment and management of COVID-19.

Sleep quality mediates the effect of chronotype on resilience in the time of COVID-19

This study aimed to explore the relationship between chronotype and resilience, sleep quality, and post-traumatic stress reactions during the first COVID-19 lockdown in Italy. An online survey was distributed through social networks during forced home confinement, collecting data from1298 participants of 19 different Italian regions. Chronotype was evaluated using the reduced version of the Morningness/Eveningness Questionnaire (rMEQ); sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI); resilience levels were measured by the 10-item version of the Connor-Davidson Resilience Scale (CD-RISC10); post-traumatic stress reactions were assessed by the 6-item version of the Impact of Event Scale (IES6). Resilience and sleep quality were significantly lower in the evening compared to non-evening types, as well as in females as compared to males. Moreover, resilience was negatively correlated with post-traumatic stress reactions and positively correlated with sleep quality. A negative correlation was also reported between sleep quality and post-traumatic stress reactions. Sleep quality was identified as a possible mediator between chronotype and resilience, and between resilience and post-traumatic stress reactions, after controlling for age and sex. These findings provide new insights into the role of chronotype in adapting to continuous stressful situations. Sleep quality seems to mediate the causal path between the antecedents of resilience and the development of trauma. Further research is needed to explore the suitability of primary interventions based on chronobiology and sleep hygiene to mitigate the impact of pandemic-related home confinement measures on mental health among the general population.

Social media (Facebook) improper use and the influence of sleeping quality in Taiwan's university students

This study examines the relationship between Facebook (FB) usage and addiction level, and sleep quality of university students. A Google Forms questionnaire was prepared and disseminated via the authors' FB profile for university students to fill out. A total of 277, including two studying overseas, took part in this research. Among the survey respondents, over 60% (n = 144) were medical students (p = 0.000); over 30% (n = 84) were always logged into FB; the average and daily usage time of most was 5 to 60 min at a time (p = 0.009), and 3 to 5 h a day (p = 0.040), respectively. The respondents' average sleep time was 7.11 h, but over 61% categorized their sleep quality as poor. It was also found that students from financial and management school were 4.23 times more at risk of FB addiction than the medical counterparts and were likely to be already addicted to FB as well as have a sleep disorder. Based on these results, it is suggested that university students, who fall in the high-risk category, be screened early to prevent them from developing social media addiction and sleep disorders. For improving youths' health and sleep quality, future research should attach the importance to early screening for sleep disturbances caused by the internet and social media addiction.

Psychological correlates of poor sleep quality among U.S. young adults during the COVID-19 pandemic

OBJECTIVE

Uncertainty due to the COVID-19 pandemic may result in problematic sleep that can lead to negative effects on overall health. This unprecedented and stressful time can be even more detrimental for young adults with pre-existing mental health conditions. The purpose of this study is to investigate potential risk factors (i.e., current mental health symptoms, and COVID-19-related grief and worry) on sleep quality of U.S. young adults during the initial months of the global pandemic.

METHOD

This cross-sectional study examined 908 young adults in the weeks following the declaration of the coronavirus pandemic as a national emergency by the United States. A series of hierarchical multiple regression analyses examined depression, anxiety, and PTSD, as well as COVID-19-related grief and worry as predictors of young adults' sleep quality.

RESULTS

Young adults experienced high rates of sleep problems during the first two months (April to May 2020) of the pandemic. Depressive and anxiety symptoms appear to be predictors of sleep quality regardless of any pre-existing diagnosis. Furthermore, high levels of PTSD symptoms and COVID-19-related worry were associated with young adults' poor sleep.

CONCLUSIONS

Our findings point to possible psychological factors that uniquely explain young adults' poor sleep quality during the COVID-19 pandemic in the U.S. This study shed new light on how the COVID-19 pandemic might affect the sleep behaviors of young adults without a pre-existing mental health diagnosis. Implications for supporting young adults sleep and well-being during the pandemic are addressed.

Epidemic Rumination and Resilience on College Students' Depressive Symptoms During the COVID-19 Pandemic: The Mediating Role of Fatigue

The restriction of numerous sectors of society and the uncertainty surrounding the development of the COVID-19 pandemic have resulted in adverse psychological states to college students isolated at home. In this study, we explored the mediating role of fatigue in the effects of epidemic rumination and resilience on depressive symptoms as well as how epidemic rumination and resilience may interact with one another. A large sample of Chinese college students (N = 1,293) completed measures on epidemic rumination, resilience, fatigue, and depressive symptoms. Results indicated depressive symptomology was positively predicted by epidemic rumination while negatively predicted by resilience. In both cases, fatigue partially mediated these effects and positively predicted depressive symptoms. Unexpectedly, epidemic rumination and resilience interacted in a manner where the effect of rumination on fatigue became stronger as resiliency increased. Theoretical and practical implications are provided to further interpret the results.

Sleep Quality in Pamukkale University Students and its relationship with smartphone addiction

Objective:

Research shows that poor sleep quality and smartphone addiction are common problems among university students. This study was planned to evaluate the quality of sleep in students at Pamukkale University and to investigate its relationship with smartphone addiction.

Methods:

This cross-sectional study was carried out at the university campus in 2017-2018. Its dependent variable was low sleep quality. Independent variables were smartphone addiction, features related to smartphone addiction, socio-demographic features and other questioned features. The total number of students attending normal education in seven faculties and two colleges for four years was 20862. The minimum sample size of the study was calculated as 1088. Smartphone Addiction Scale-Short Version (SAS-SV) and Pittsburgh Sleep Quality Index (PSQI) were used. The data were analyzed with the SPSS program.

Results:

The mean age was of the participants 21.39 ± 2.21. The sleep quality of students with a PSQI total score of more than five was defined as ‘poor’. The frequency of poor sleep quality was 52.4%. The frequency of smartphone addiction was 34.6% according to the SAS-SV scale. It was found that the frequency of poor sleep quality was significantly higher in students with smartphone addiction compared to others.

Conclusion:

Smartphone addiction was found as one of the risk factors for poor sleep quality.

Subjective Happiness and Sleep in University Students with High Myopia

Purpose: Recent investigations described a host of disadvantageous myopia comorbidities including decreased QOL, depression, and sleep problems. The present study evaluated mental status and habitual sleep in young subjects with myopia based on the reported association between myopic error and psychiatric profiles. Methods: This cross-sectional study surveyed 153 university students using a questionnaire containing the Pittsburgh Sleep Quality Index (PSQI), Subjective Happiness Scale (SHS), short morningness/eveningness questionnaire, and Hospital Anxiety and Depression Scale (HADS). Results: Participants were classified as having high myopia (n = 44), mild myopia (n = 86), or no myopia (n = 23). The SHS and HADS scores in this cohort were significantly worse in the high myopia group than in the other two groups (p < 0.05, t-test). PSQI values were not significantly different among the three groups. Regression analysis correlated myopic error with poor SHS (p = 0.003), eveningness chronotype (p = 0.032), late wake-up time (p = 0.024), and late bedtime (p = 0.019). Conclusions: University students with myopia tended to be unhappy, have an eveningness chronotype, wake up late, and go to bed late compared to less myopic subjects. Optimal correction might, therefore, be beneficial to myopic students in addition to preventing progression to high myopia in early childhood to potentially avoid related negative effects on mental health and sleep habits in adolescence.

Determinants of sleep quality in college students: A literature review

PURPOSE

To review the various determinants of sleep quality among college students.

METHODS

The PubMed, Web of Science and Cochrane Library databases were searched with the search string "sleep quality" AND "college students" for articles published between January 2007 and October 2017. Articles were excluded if they (1) examined sleep quality as a risk factor for other outcomes or (2) involved inpatients or participants under medical care.

RESULTS

The 112 identified studies were classified into categories according to the investigated determinants and their effect on sleep quality. Physical activity and healthy social relations improved sleep quality, while caffeine intake, stress and irregular sleep-wake patterns decreased sleep quality. Less consistent results were reported regarding eating habits and sleep knowledge, while proper napping during the day might improve overall sleep quality.

CONCLUSIONS

College students are vulnerable to different risk factors for sleep quality. When designing interventions to improve sleep quality among college students, the main determinants need to be taken into consideration.

Isolating the role of time in bed restriction in the treatment of insomnia: a randomized, controlled, dismantling trial comparing sleep restriction therapy with time in bed regularization

Study Objectives

Sleep restriction therapy (SRT) is one of the most effective treatments for insomnia. Restriction of time in bed (TIB) is assumed to be the central mechanism through which SRT improves sleep consolidation and reduces insomnia symptoms. This hypothesis has never been directly tested. We designed a randomized, controlled, dismantling trial in order to isolate the role of TIB restriction in driving both clinical and polysomnographic sleep outcomes.

Methods

Participants aged 25–55 who met diagnostic criteria for insomnia disorder were block-randomized (1:1) to 4 weeks of SRT or time in bed regularization (TBR), a treatment that involves the prescription of a regular but not reduced TIB. The primary outcome was assessed with the insomnia severity index (ISI) at baseline, 4-, and 12-weeks post-randomization. Secondary outcomes included sleep continuity (assessed via polysomnography, actigraphy, and diary) and quality of life. We performed intention-to-treat analyses using linear mixed models.

Results

Fifty-six participants (39 females, mean age = 40.78 ± 9.08) were assigned to SRT (n = 27) or TBR (n = 29). Daily monitoring of sleep via diaries and actigraphy confirmed large group differences in TIB (d range = 1.63–1.98). At 4-weeks post-randomization, the adjusted mean difference for the ISI was −4.49 (d = −1.40) and −4.35 at 12 weeks (d = −1.36), indicating that the SRT group reported reduced insomnia severity relative to TBR. Robust treatment effects in favor of SRT were also found for objective and self-reported sleep continuity variables (d range = 0.40–0.92) and sleep-related quality of life (d = 1.29).

Conclusions

For the first time, we demonstrate that TIB restriction is superior to the regularization of TIB on its own. Our results underscore the centrality of the restriction component in reducing insomnia symptoms and consolidating sleep.

Prevalence and correlates of poor sleep quality among college students: a cross-sectional survey

Background

Sleep problems are widespread among college students around the globe, especially in China. This study was designed to investigate the prevalence of poor sleep quality and identify associated factors among college students in Jilin Province, China.

Methods

A total of 6284 participants were completely collected by stratified cluster sampling in 2016. Information on basic demographics, lifestyles, social and family support, and subjective sleep quality was collected by questionnaire. The Pittsburgh Sleep Quality Index (PSQI) is a self-administered questionnaire used to assess sleep for one month.

Results

1951 (31.0%) participants were classified into poor sleep quality group, as defined by a PSQI score > 5. Males scored significantly higher than females on sleep duration and use of sleep medication, while females scored significantly higher than males on PSQI total and sleep disturbances. The results of the multivariate logistic regression show the following factors to be significant predictors of poor sleep quality: freshman (OR = 1.523, 95% CI: 1.168–1.987), alcohol use (OR = 1.634, 1.425–1.874), gambling behaviors (OR = 1.167, 95% CI: 1.005–1.356), exercised for more than 30 min a week on less than one day (OR = 1.234, 95% CI: 1.016–1.498), the feelings of satisfied with parental love (OR = 1.849, 95% CI: 1.244–2.749), and harmonious/neutral relationship with classmates (OR = 2.206, 95% CI: 1.312–3.708; OR = 1.700, 95% CI: 1.414–2.045),. No study pressure of this academic year (OR = 0.210, 95% CI: 0.159–0.276), no truancy in the past month (OR = 0.510, 95% CI: 0.354–0.735), never had self-injurious behaviors (OR = 0.413, 95% CI: 0.245–0.698), very harmonious family relationship (OR = 0.377, 95% CI: 0.219–0.650), frequent communication with parents (OR = 0.524, 95% CI: 0.312–0.880), the feelings of satisfied with maternal love (OR = 0.432, 95% CI: 0.257–0.725), and frequent excursions to gymnasium (OR = 0.770, 95% CI: 0.659–0.899) were the protective factors.

Conclusions

The implication of the present study may be that college students must be made aware of the consequences of inadequate sleep quality and risk factors could be improved if students tried to change their behavior and subjective consciousness.

Does the Proximity of Meals to Bedtime Influence the Sleep of Young Adults? A Cross-Sectional Survey of University Students

Avoiding food before bedtime is a widely accepted sleep hygiene practice, yet few studies have assessed meal timing as a risk factor for disrupted sleep. This study examined the relationship between evening meal timing and sleep quality in young adults. A total of N = 793 participants (26% male) aged between 18 and 29 years responded to an online survey, which captured sociodemographic information, lifestyle variables, and sleep characteristics. Meal timing was defined as meals more than 3 h before or within 3 h of bedtime. The outcomes were as follows: one or more nocturnal awakenings, sleep onset latency of >30 min, and sleep duration of ≤6 h. Logistic regression analyses showed that eating within 3 h of bedtime was positively associated with nocturnal awakening (OR = 1.61, 95% CI = 1.15–2.27) but not long sleep onset latency (1.24; 0.89–1.73) or short sleep duration (0.79; 0.49–1.26). The relationship remained significant after adjusting for potential confounders of ethnicity and body mass index (OR = 1.43, 95% CI = 1.00–2.04). Meal timing appears to be a modifiable risk factor for nocturnal awakenings and disrupted sleep. However, this is a preliminary cross-sectional study and highlights the need for additional research on the influence of the timing of food intake on sleep.

Chawla N. Deviations from normal bedtimes are associated with short-term increases in resting heart rate

Despite proper sleep hygiene being critical to our health, guidelines for improving sleep habits often focus on only a single component, namely, sleep duration. Recent works, however, have brought to light the importance of another aspect of sleep: bedtime regularity, given its ties to cognitive and metabolic health outcomes. To further our understanding of this often-neglected component of sleep, the objective of this work was to investigate the association between bedtime regularity and resting heart rate (RHR): an important biomarker for cardiovascular health. Utilizing Fitbit Charge HRs to measure bedtimes, sleep and RHR, 255,736 nights of data were collected from a cohort of 557 college students. We observed that going to bed even 30 minutes later than one's normal bedtime was associated with a significantly higher RHR throughout sleep (Coeff +0.18; 95% CI: +0.11, +0.26 bpm), persisting into the following day and converging with one's normal RHR in the early evening. Bedtimes of at least 1 hour earlier were also associated with significantly higher RHRs throughout sleep; however, they converged with one's normal rate by the end of the sleep session, not extending into the following day. These observations stress the importance of maintaining proper sleep habits, beyond sleep duration, as high variability in bedtimes may be detrimental to one's cardiovascular health.

The Mediating Role of Visual Stimuli From Media Use at Bedtime on Psychological Distress and Fatigue in College Students: Cross-Sectional Study

BACKGROUND

Empirical research has linked psychological distress with fatigue. However, few studies have analyzed the factors (eg, stimuli from bedtime media use) that affect the relationship between psychological distress and fatigue.

OBJECTIVE

The aim of this study was to examine whether visual stimuli from bedtime media use mediate the relationship between psychological distress and fatigue among college students.

METHODS

The sample included 394 participants (92 males, 302 females) with a mean age of 19.98 years (SD 1.43 years), all of whom were Chinese college students at an occupational university in Sichuan Province, China. Data were collected using a paper-based questionnaire that addressed psychological distress, stimuli from bedtime media use, and fatigue. Mediation analysis was conducted using the PROCESS macro version 2.16.2 for SPSS 22, which provided the 95% CIs.

RESULTS

Both psychological distress (r=.43, P<.001) and visual stimuli from bedtime media use (r=.16, P<.001) were positively related to fatigue. The association between auditory stimuli from bedtime media use and fatigue was not significant (r=.09, P=.08). The relationship between psychological distress and fatigue was partially mediated by visual stimuli from bedtime media use (beta=.01, SE 0.01, 95% CI 0.0023-0.0253).

CONCLUSIONS

The findings imply that psychological distress has an indirect effect on fatigue via visual stimuli from bedtime media use. In contrast, auditory stimuli from bedtime media use did not have the same effect. We suggest that college students should reduce bedtime media use, and this could be achieved as part of an overall strategy to improve health. Mobile health apps could be an option to improving young students' health in daily life.

Sleep quality in medical students: a comprehensive meta-analysis of observational studies

PURPOSE

Poor sleep quality is common in medical students and is associated with a number of negative health outcomes. However, the prevalence estimates of poor sleep quality in medical students vary widely across studies. We thus conducted a meta-analysis of the prevalence of poor sleep quality and its mediating factors in medical students.

METHODS

A systematic literature search of PubMed, EMBASE, Web of Science, PsycINFO, and Medline Complete was performed. The random-effects model was used to analyze the pooled prevalence of poor sleep quality and its 95% confidence intervals (CIs).

RESULTS

A total of 57 studies with 25,735 medical students were included. The pooled prevalence of poor sleep quality was 52.7% (95% CI: 45.3% to 60.1%) using the Pittsburgh Sleep Quality Index (PSQI). The pooled mean total PSQI score across 41 studies with available data was 6.1 (95% CI: 5.6 to 6.5). Subgroup analyses found that PSQI cutoff value and study region were associated with the prevalence of poor sleep quality (P = 0.0003 VS. P = 0.005). Across the continents, poor sleep quality was most common in Europe, followed by the Americas, Africa, Asia, and Oceania. Meta-regression analyses found that smaller sample size (slope = - 0.0001, P = 0.009) was significantly associated with higher prevalence of poor sleep quality.

CONCLUSIONS

Poor sleep quality is common among medical students, especially in Europe and the Americas continets. Due to the negative health outcomes, regular screening of poor sleep quality and effective interventions are needed for medical students.

Multidimensional sleep quality of dependent self-employment workers

Background

The number of workers in non-standard employment (NSE) is increasing due to industrial change and technological development. Dependent self-employment (DSE), a type of NSE, was created decades ago. Despite the problems associated with this new type of employment, few studies have been conducted on the effects by DSE on health, especially sleep quality. This study aims to determine the relationship between DSE and sleep quality.

Methods

This study analyzed data of 50,250 wage workers from the fifth Korean Working Conditions Survey. Workers that did not respond or refused to answer any questions related to variables were excluded, and finally 36,709 participants were included in this study. A total of 2,287 workers (6.2%) were compared with non-DSE (34,422; 93.8%) workers, and multiple logistic regression analyses were applied.

Results

DSE status had a significant association with difficulty falling asleep (odds ratio [OR]: 1.331, 95% confidence interval [CI]: 1.178–1.504), difficulty maintaining sleep (OR: 1.279; 95% CI: 1.125–1.455), and extreme fatigue after waking up (OR: 1.331; 95% CI: 1.184–1.496). A multiple logistic regression of the variables for sleep quality in DSE showed a significant association with exposure to physical factors for all types of poor sleep quality as well as shift work for difficulty maintaining sleep with extreme fatigue after waking up. Long working hours and emotional labor were also associated with extreme fatigue after waking up.

Conclusions

This study shows a significant association between DSE and poor sleep quality, especially when workers were exposed to physical risk factors (noise, vibration, abnormal temperature, etc.) and shift work.

Perception of Sleep Disturbances due to Bedtime Use of Blue Light-Emitting Devices and Its Impact on Habits and Sleep Quality among Young Medical Students

Introduction

The use of blue light-emitting devices (smartphones, tablets, and laptops) at bedtime has negative effects on sleep due to light stimulation and/or problematic excessive use. We aimed to evaluate, among young medical students, if the perception of sleep disturbances due to bedtime use of these devices is consistent with healthier habits and a better sleep quality.

Materials and methods

294 medical students in medicine and pharmacy from the Faculty of Medicine and Pharmacy of Rabat, Morocco, took part in this anonymous and voluntary cross-sectional study and answered an electronic questionnaire. Student and Mann–Whitney U tests were used to compare variables between 2 groups based on their perception of sleep disturbances. The level of significance was p ≤ 0.05.

Results

286 students (97.3%) used a blue light-emitting smart device at bedtime before sleep, and sleep quality was poor (Pittsburgh Sleep Quality Index, PSQI > 5) in 101 students (35.3%). The perception of sleep disturbances due to this night usage was reported by 188 of them (65.7%). In this group, 154 (81.9%) used their device with all the lights turned off in the room (p=0.02), 34 (18.1%) put devices under pillows (p=0.04), 114 (60.6%) interrupted sleep to check messages (p < 0.001), and the mean duration use of these technologies at bedtime was 2 h ± 23 min per night (p=0.02). Also, the mean sleep duration was 6.3 hours ± 1.25 (p=0.04), 119 (63.3%) presented fatigue on waking more than one time per week (p=0.04), and 76 (40.4%) presented poor sleep quality (75.2% of the students with PSQI > 5) (p=0.005).

Conclusions

Despite the perception of sleep disturbances due to bedtime use of blue light-emitting devices, unhealthy sleep habits tend to be frequent in young medical students and worrying because it is associated to significant poor sleep quality.

Reciprocal Longitudinal Associations Between Adolescents' Media Consumption and Sleep

Background/Objective: Associations between adolescents' sleep and their media consumption have been shown in several cross-sectional studies. However, longitudinal investigations are still sparse and have mainly investigated associations between sleep duration and the usage of TV or computer games. The present study explored reciprocal longitudinal relationships between the consumption of different screen-based media and sleep-related problems in German adolescents. Participants: Four hundred sixty-seven 10- to 17-year-old adolescents participated in the LIFE Child Study in Leipzig, Germany. Methods: The consumption of screen-based media (TV or video, computer and Internet, mobile phones) as well as sleep-related problems (problems at bedtime, sleep behavior problems, daytime sleepiness) were assessed at two time points, 12 months apart. Reciprocal longitudinal relations were assessed by multiple regression analyses. All associations were controlled for age, gender, socioeconomic status, and dependent variables at baseline. Results: The consumption times of the different screen-based media were significantly related. Similarly, the different sleep-related problems showed significant interrelations. Most importantly, the analyses revealed significant associations between a high baseline consumption of computer and Internet with more problems at bedtime, as well as more daytime sleepiness at follow-up. Furthermore, baseline daytime sleepiness was associated with a higher consumption of TV or video at follow-up. Conclusions: These results indicate a mutual dependency of media consumption and sleep over time.

Sleep Hygiene Mediates, but Does Not Moderate, Associations Between Temperament and Sleep Quality in University Students

Although there are theoretical reasons to expect associations among temperament, sleep hygiene behaviors (SHB), and global sleep quality (GSQ), these relations have not yet been examined despite their potential impact on undergraduate student well-being. The present study was conducted to (1) examine relations between temperament and GSQ in university students broadly recruited, (2) document associations between SHB and temperament in this sample, and (3) to determine whether associations among temperament, SHB, and GSQ were best explained by mediation or moderation models. One hundred fifty-two university students completed questionnaires that inquired about temperament, SHB, and GSQ. Correlations revealed that poorer SHB and GSQ were associated reduced effortful control; poorer SHB was also associated with increased negative affect (SHB and GSQ were unrelated to extraversion and orienting sensitivity). Mediation models assessing relations amongst temperament, SHB, and GSQ indicated that negative affect and effortful control may predispose university students to engage in fewer SHB, negatively impacting GSQ; variability in SHB did not moderate the impact of temperament on GSQ. Additional research is needed to confirm and extend these findings, with the ultimate goal of improving undergraduate GSQ (a) by reducing negative affect and increasing effortful control or (b) by improving SHB that are uniquely associated with these temperament profiles.

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

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

A Correlational Analysis of the Relationships among Intolerance of Uncertainty, Anxiety Sensitivity, Subjective Sleep Quality, and Insomnia Symptoms

In this study, we used structural equation modeling to investigate the interplay among Intolerance of Uncertainty (IU), Anxiety Sensitivity (AS), and sleep problems. Three hundred undergraduate students completed the Intolerance of Uncertainty Scale, the Intolerance of Uncertainty Inventory, the Anxiety Sensitivity Index, the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Pittsburgh Sleep Quality Index and the Insomnia Severity Index. 68% and 40% of the students reported poor sleep quality or sub-threshold insomnia problems, respectively. Depression and anxiety levels were above the cut-off for about one-fourth of the participants. Structural equation modeling revealed that IU was strongly associated with AS, in turn influencing both insomnia severity and sleep quality via depression and anxiety. Significant indirect effects revealed that an anxious pathway was more strongly associated with insomnia severity, while a depression pathway was more relevant for worsening the quality of sleep. We discussed the results in the frameworks of cognitive models of insomnia. Viewing AS and IU as antecedents of sleep problems and assigning to AS a pivotal role, our study suggested indications for clinical interventions on a population at risk for sleep disorders.

Effects of gender, medical school class year, and majors on sleep quality in Chinese medical students: a systematic review and meta-analysis

BACKGROUND

Sleep problems are common in the general population, and medical students are one subgroup of the general population who appear to be especially vulnerable to poor sleep. This systematic review and meta-analysis examined the effects of gender, medical school class year, and majors on sleep quality among Chinese medical students.

METHODS

Electronic databases, including PubMed, EMBASE, SCOPUS, Web of Science, Cochrane Library, WanFang, Chinese National Knowledge Infrastructure, and VIP Database were systematically searched from inception to 26 March 2019.

RESULTS

Thirteen studies with 18,740 participants were included in the analysis. Among them, 25% of medical students exhibited poor sleep quality. No significant differences were found between male and female students in the prevalence of poor sleep quality (odds ratio = 0.87, 95% confidence interval 0.72, 1.04; Chi² = 3.88, I² = 0%) or Pittsburgh Sleep Quality Index scores (mean difference = - 0.06, 95% confidence interval - 0.15, 0.02; Chi² = 9.70, I² = 28%). No significant differences were found in the prevalence of poor sleep quality between students in lower and higher medical school class year (odds ratio = 0.98, 95% confidence interval 0.66, 1.45; Chi² = 38.84, I² = 83%). No significant differences were found in the prevalence of poor sleep quality (mean difference = 1.02, 95% confidence interval 0.77, 1.36; Chi² = 0.18, I² = 0%) or Pittsburgh Sleep Quality Index scores (mean difference = - 0.16, 95% confidence interval - 0.57, 0.26; Chi² = 0.99, I² = 0%) between students majoring in Clinical Medicine and Medical Imaging.

CONCLUSIONS

More detail is warranted in future studies in order to reveal subgroups of medical students who suffer from poor sleep quality.

The Relationship Between Sleep Quality and Internet Addiction Among Female College Students

BACKGROUND

Over 40% of Taiwanese College students experience sleep problems that not only impair their quality of life but also contribute to psychosomatic disorders. Of all the factors affecting the sleep quality, internet surfing is among one of the most prevalent. Female college students are more vulnerable to internet-associated sleep disorders than their male counterparts. Therefore, this study aims to investigate (1) the relationship between internet addiction and sleep quality, and (2) whether significant variations in sleep quality exist among students with different degrees of internet use.

METHODS

This structured questionnaire-based cross-sectional study enrolled students from a technical institute in southern Taiwan. The questionnaire collected information on the following three aspects: (1) demography, (2) sleep quality with Pittsburgh Sleep Quality Index (PSQI), and (3) severity of internet addiction using a 20-item Internet Addiction Test (IAT). Multiple regression analysis was performed to examine the correlation between PSQI and IAT scores among the participants. Logistic analysis was used to determine the significance of association between PSQI and IAT scores.

RESULTS

In total, 503 female students were recruited (mean age 17.05 ± 1.34). After controlling for age, body mass index, smoking and drinking habits, religion, and habitual use of smartphone before sleep, internet addiction was found to be significantly associated with subjective sleep quality, sleep latency, sleep duration, sleep disturbance, use of sleep medication, and daytime dysfunction. Worse quality of sleep as reflected by PSQI was noted in students with moderate and severe degrees of internet addiction compared to those with mild or no internet addiction. Logistic regression analysis of the association between scores on IAT and sleep quality, demonstrated significant correlations between quality of sleep and total IAT scores (odds ratio = 1.05:1.03 ∼ 1.06, p < 0.01).

CONCLUSION

The results of this study demonstrated significant negative association between the degree of internet addiction and sleep quality, providing reference for educational institutes to minimize adverse effects associated with internet use and improve students' sleep quality.