Sleep-wake rhythm and its association with lifestyle, health-related quality of life and academic performance among Japanese nursing students: a cross-sectional study

Association between chronotype, social jetlag, sleep quality, and academic burnout among nursing students: A cross-sectional study

Academic burnout in nursing students is a serious problem worldwide that results in emotional exhaustion, cynicism and low professional efficacy. The aim of the current study was to examine the association between sleep quality and circadian rhythm indicators and academic burnout among Iranian nursing students. This cross-sectional study was conducted on 325 undergraduate nursing students studying at Qazvin University of Medical Sciences between November and February 2023. Data collection was carried out using self-report questionnaires including demographic characteristics, The Pittsburgh Sleep Quality Index (PSQI), reduced-Morningness-Eveningness Questionnaire (r-MEQ), and the Maslach Burnout Inventory-Student Survey (MBI-SS). Social jetlag (SJL) was defined as the absolute value of the difference between the midpoint of sleep on free days (MSF) and the midpoint of sleep on workdays (MSW). Data were analyzed using univariate and multivariate linear regression models. About 31.4% of participants had evening chronotype and almost half of them suffered from poor sleep quality. About 47.7% of the participants had SJL ≥ 2 h. In the multivariate linear regression model, students with evening chronotype compared to morning chronotype experienced more academic burnout in emotional exhaustion, cynicism and professional efficacy. PSQI score was only correlated with emotional exhaustion and cynicism subscales. Increased SJL was a predictor on all three subscales of academic burnout. The findings suggested that evening chronotype, poor sleep quality, and high SJL were associated with increased likelihood of academic burnout in nursing students. Assessment of circadian preference and sleep quality is beneficial for timely identification and prevention of academic burnout in nursing students.

Effectiveness of a guided digital self-help intervention to improve sleep and the biological clock in university students - Study protocol for a randomized controlled trial

Background

Sleep problems occur in many university students which affects their mental health and daily functioning. Cognitive behavioural therapy for insomnia (CBT-I) has been proven effective in adults but research in university students, who struggle to maintain a 24-hour rhythm, is still limited. We hypothesize that a guided digital CBT-I intervention, enriched with components on the biological clock ('i-Sleep & BioClock') will be effective in reducing insomnia severity and improving mental health outcomes for students with sleep problems.

Objectives

We aim to evaluate the effectiveness of a guided online sleep and biological clock self-help intervention in improving sleep, depression symptoms, anxiety symptoms, functioning, academic performance, and quality of life in university students at 6 weeks and 18 weeks.

Methods

This is a two-arm parallel-group superiority randomized controlled trial, comparing a 5-week guided online 'i-Sleep & BioClock' intervention to online psychoeducation (PE). We aim to include 192 university students (Bachelor, Master, and PhD) with at least subthreshold insomnia (Insomnia Severity Index ≥10), aged ≥16, who can speak Dutch or English. We are excluding students with current risk for suicide or night shifts. The primary outcome is insomnia severity. Secondary outcomes include sleep estimates (sleep and light exposure diary), depression, anxiety, functioning, quality of life, and academic performance. The effectiveness of the intervention compared to online PE will be evaluated using linear mixed models.

Discussion

The current study tests the effectiveness of an online self-help intervention for university students who suffer from sleep problems. This trial builds upon an open feasibility study and will provide evidence of an online guided self-help program for students. The findings of this study will determine the potential wider dissemination of the intervention to address the high need for available and accessible help for students experiencing insomnia.

Trial registration

ClinicalTrials.Gov (NCT06023693), registered on August 3rd, 2023.

Evaluation of Student Academic Performance After Curricular Content Reduction

OBJECTIVE

To evaluate the effect of curricular content reduction in an integrated course sequence spanning 3 years of a Doctor of Pharmacy curriculum on student examination scores and course grades.

METHODS

This 2-year, prepost study compared student overall average and final examination scores and overall course grades after the transition from a 5-day to a 4-day week of an integrated learning experience (ILE) course sequence. In addition, an anonymous, optional 23-item survey was distributed to first to third year pharmacy students asking about the 4-day week change, how they utilized the non-ILE day, and additional demographic and social characteristics to identify factors influencing success on examination and course performance during the 4-day week.

RESULTS

There were 533 students included in the overall analysis, with no significant differences in overall course grades in the 5-day vs 4-day week. Examination scores were not significantly different after the transition, except in 2 of 12 courses where scores were higher and final examination scores were not significantly different, except for higher final examination scores in 1 course during the 5-day week. Significant positive influencers of top quartile of examination performance included prepharmacy grade point average ≥ 3.5, age 25 to 29 years, and prepharmacy coursework at the parent institution, whereas using the non-ILE day primarily to sleep negatively influenced outcomes.

CONCLUSION

Curricular density is a prevalent problem and addressing it at a program level is essential. Reducing curricular content and hours at our institution did not adversely impact student examination and course performance and slight improvement was noted in some areas.

Chronotypes and their association with sleep quality among Chinese college students of Anhui Province: a cross-sectional study

OBJECTIVES

To describe the prevalence of chronotype and sleep quality among Chinese college students and explore the relationship between chronotype and sleep quality.

DESIGN

A cross-sectional study.

SETTING

Four colleges and universities in Anhui, China, between November and December 2020.

PARTICIPANTS

A total of 4768 college students were recruited using a stratified, multistage, cluster sampling survey.

OUTCOME MEASURES

Morningness-Eveningness Questionnaire 19 was used to determine the chronotype of the students and the Pittsburgh Sleep Quality Index (PSQI) was used to measure their sleep quality. The multiple logistic regression model was used to explore the potential association between chronotype and sleep quality.

RESULTS

The self-reported proportions of evening-type (E-type), neutral-type and morning-type among college students were 51.17%, 45.14% and 3.69%, respectively. The mean PSQI score was 4.97±2.82 and the prevalence of poor sleep quality was 18.2%. After adjusting the covariates by multiple logistic regression analysis, E-type was positively associated with subjective sleep quality (OR=1.671, 95% CI 1.414 to 1.975), sleep latency (OR=1.436, 95% CI 1.252 to 1.647), sleep duration (OR=2.149, 95% CI 1.506 to 3.067), habitual sleep efficiency (OR=1.702, 95% CI 1.329 to 2.180), daytime dysfunction (OR=1.602, 95% CI 1.412 to 1.818) and overall poor sleep quality (OR=1.866, 95% CI 1.586 to 2.196).

CONCLUSIONS

College students mainly exhibited E-type, and an elevated prevalence of poor sleep quality existed among these students. The E-type was positively associated with poor sleep quality.

Latent profile analysis for health-related quality of life, sleep quality, morning and evening type, and internet addiction among medical students

Health-related quality of life, sleep quality, morning and evening types, and internet addiction are of significant importance to the development of medical students, yet they have rarely been studied. Taking this into consideration, the study aimed to confirm latent profiles in health-related quality of life, sleep quality, morning and evening types, and internet addiction in medical students and investigate the characteristics of participants in each profile to provide suggestions for students' health. This was an observational cross-sectional study including 1221 medical student subjects at China Medical University in 2019. Multiple correspondence analysis was the initial step to verify the correspondence, dispersion, and approximation of variable categories. Latent profile analysis was used to identify the multiple correspondences between the levels of variables. Three profiles were found, including: (1) The Low sleep quality profile was characterized by the lowest sleep quality among the three existing profiles. (2) The High health-related quality of life and Low internet addiction profile was characterized by the highest level of health-related quality of life but the lowest level of internet addiction. (3) The Low health-related quality of life and High internet addiction profile was characterized by the highest standardized values of internet addiction but the lowest standardized values of health-related quality of life. This study had important implications for improving student health and supported the medical universities and hospitals in implementing targeted policies based on distinctive student characteristics.

Delayed sleep-wake rhythm due to staying at home during the COVID-19 pandemic and sleep debt after returning to campus among Japanese nursing university students: A longitudinal study

This study aimed to investigate sleep problems during staying at home due to the coronavirus disease 2019 (COVID-19) pandemic and after returning to campus among university nursing students. We analyzed data from self-reported sleep surveys conducted during a nursing course at a university in Tokyo between 2019 and 2021. During staying at home due to COVID-19, we observed delayed sleep-wake rhythm, prolonged sleep duration on weekdays, a decreased sleep debt, improved daytime sleepiness, and worsened insomnia, especially in terms of difficulty initiating sleep (Study 1; 18 paired data). After returning to campus, we found advanced wake-up time, shortened sleep duration, increased sleep debt, worsened insomnia, and increased daytime sleepiness (Study 2; 91 paired data). The association between advanced midpoint of sleep and commute time over an hour (aOR, 3.29; 95%CI: 1.24-8.72) was confirmed. Furthermore, sleep paralysis and nightmares were more prevalent among nursing students with an advanced midpoint of sleep, whereas nursing students whose midpoint of sleep was delayed had higher daytime sleepiness after returning to campus. To maintain regular sleep-wake rhythms and sufficient sleep duration, the educational environment surrounding nursing university students (e.g., curriculum, class schedule, style of class) should be established considering their age-dependent biological rhythm in addition to sleep hygiene education for students.

The impact of sleep–wake problems on health-related quality of life among Japanese nursing college students: a cross sectional survey

Aim

This study was conducted to examine the impact of sleep–wake problems on health-related quality of life of Japanese nursing college students. 

Methods

This cross-sectional study was conducted in 2019 on 150 third and fourth-year nursing college students from two locations in Japan. Insomnia severity was assessed using the Insomnia Severity Index (ISI) and health-related quality of life using the SF-8 questionnaire. The total sleep time (TST) was divided into 3 groups: < 6 h, 6–7 h (reference), and ≥ 7 h. The total ISI score was divided into 2 groups: ≥ 8 points and < 8 points (reference). Logistic regression analysis was performed to evaluate sleep–wake problems related to decline in mental health.

Results

The median mental health indicated in the SF-8 questionnaire was divided into two groups, and the factors causing decline in mental health were investigated. The odds ratios (95% confidence interval) for adjusted ISI ≥ 8 and TST on weekdays < 6 h was 6.51 (2.96–14.30) and 3.38 (1.40–8.17), respectively. Mental health status was significantly lower when ISI ≥ 8 and even lower when TST < 6 h.

Conclusion

Insomnia and short sleep duration are associated with decreased mental health status in nursing college students. Many tended to lack sleep on weekdays. Sleep–wake problems identified while in university should be comprehensively dealt with.

Predictors of positive mental health in higher education students. A cross-sectional predictive study

PURPOSE

To describe positive mental health (PMH) psychological vulnerability (PV) and identify predictors of PMH in higher education students (HES).

DESIGN AND METHODS

A cross-sectional, predictive study was performed with a convenience sample of 3322 students, using an online questionnaire with sociodemographic information, the PMH Questionnaire, and the PV Scale.

FINDINGS

The majority scored a flourishing level, and 67.7% of the participants scored high levels of PV. The Regression Model found a significant predictive variable for PMH.

PRACTICE IMPLICATIONS

Gender, age, regular exercise, healthy diet, number of meals per day, and leisure activities are significant positive predictors of PMH. PV is the sole significant negative predictor. Therefore, improving mental health literacy can be a strategy to support HES.

A Cross-Sectional Study of Mental Health, Lifestyle, and Anxiety in Japanese Nursing Students by Year of College

For students in nursing colleges to develop necessary competencies as health care professionals and prevent post-graduation “reality shock” deterioration in the quality of care they provide, appropriate measures are needed in response to changes that occur as college years progress. In this study, mental health status, lifestyle, and various types of anxiety were investigated in 448 nursing college students during a four-year program in Japan. Students from each year of the program were surveyed with the K10 scale to measure mental health, and the Student Life Questionnaire to assess dietary habits, sleep duration, and exercise. Mean K10 scores for first-year students was 13.1, with 30% having anxiety about college life. Similarly, for second-year students the K10 score was 13.7, and compared to first-year students, rates of meal skipping and sleeping less increased. For third-year students, the K10 score (15.9) was higher than for other groups, as were their percentages of all items. Fourth-year students had a mean K10 score of 14.6, with a higher rate of meal skipping and feeling anxious about the future than other groups. These results suggest the need for support tailored to the characteristics of each year in the bachelor’s program in nursing.