Insomnia and Relationship with Anxiety in University Students: A Cross-Sectional Designed Study

Revealing inconsistencies between Epworth scores and apnea-hypopnea index when evaluating obstructive sleep apnea severity: a clinical retrospective chart review

Introduction

A common practice in clinical settings is the use of the Epworth Sleepiness Scale (ESS) and apnea-hypopnea index (AHI) to demonstrate the severity of obstructive sleep apnea (OSA). However, several instances were noted where there were discrepancies in the reported severity between Epworth scores and AHI in our patient sample, prompting an investigation into whether OSA severity as demonstrated by AHI or predicted by ESS quantification of sleepiness is primarily responsible for inconsistencies.

Methods

Discrepancies were examined between Epworth scores and AHI by categorizing patients into two categories of inconsistency: individuals with either ESS < 10 and AHI ≥ 15 events/h or ESS ≥ 10 and AHI < 15 events/h. The potential influence of sex on these categories was addressed by assessing whether a significant difference was present between mean Epworth scores and AHI values for men and women in the sample. We investigated BMI both by itself as its own respective variable and with respect to the sex of the individuals, along with a consideration into the role of anxiety. Furthermore, we tested anxiety with respect to sex.

Results

In the first category of inconsistency the average ESS of 5.27 ± 0.33 suggests a normal level of daytime sleepiness. However, this contrasts with the average AHI of 32.26 ± 1.82 events/h which is indicative of severe OSA. In the second category the average ESS of 14.29 ± 0.47 suggests severe daytime sleepiness, contradicting the average AHI of 9.16 ± 0.44 events/h which only indicates mild OSA. Sex, BMI (both as a variable by itself and with respect to sex), and anxiety (both as a variable by itself and with respect to sex) contributed to observed inconsistencies.

Conclusion

The findings of our study substantiate our hypothesis that Epworth scores should be de-emphasized in the assessment of OSA and a greater importance should be placed on measures like AHI. While Epworth scores offer insights into patients' daytime sleepiness levels and the perceived severity of their OSA, the inconsistencies highlighted in our results when compared to AHI-based OSA severity underscore their potential inaccuracy. Caution is advised when utilizing Epworth scores for evaluating OSA severity in clinical settings.

A public health view and comparison between online and on-campus learning to evaluate sleep and mental health among undergraduate students

Background

The COVID-19 pandemic changed people's lives. The majority had to adapt to working online including students. The shift to online learning caused serious sleep and mental health issues among students. This study aimed to examine the variations between the prevalence of sleep and mental health problems among undergraduate students during the periods of online learning and on-campus learning.

Method

An online survey was distributed to medical students in Saudi Arabia.

Results

A total of 110 participated in the study (age = 21 ± 1.4 years). The on-campus anxiety (8.2 ± 6.3) was significantly higher than online anxiety (5.5 ± 5.1). On-campus daytime sleepiness (8.5 ± 4) was significantly higher when compared to online daytime sleepiness (6.7 ± 4.6). Although not significant, the on-campus stress (7.7 ± 5.7) and insomnia (12 ± 7.3) were higher than online stress (6.9 ± 5.5) and insomnia (11.5 ± 6). The online depression (6.6 ± 5.7) was higher than the mean on-campus depression (5.8 ± 5.4). A significant strong positive correlation was found between on-campus anxiety and on-campus stress. A significant moderate positive correlation was detected between on-campus anxiety and on-campus daytime sleepiness. A weak but significant correlation was found between on-campus anxiety and on-campus insomnia. On-campus anxiety was significantly predicted by the following model, which included on-campus stress, insomnia, and daytime sleepiness (P < .001).

Conclusion

Medical students reported lower anxiety, daytime sleepiness, stress, and insomnia during their online learning compared to on-campus learning. Only depression was higher during online learning compared to on-campus learning.

The effect of anxiety on sleep disorders in medical students: a moderated mediation model

The relationship between anxiety and sleep disorders is a key research topic in the academic community. However, evidence on the mechanism through which anxiety influences sleep disorders remains limited. The purpose of this study was to investigate the roles of flourishing and neuroticism in the mechanism through which anxiety influences sleep disorders in medical students. We constructed a moderated mediation model and tested the mediating role of flourishing and the moderating role of neuroticism in medical college students. The results showed that: (1) anxiety was significantly and positively related to sleep disorders and significantly and negatively related to flourishing; flourishing was significantly and negatively related to sleep disorders; neuroticism was significantly and positively related to sleep disorders; (2) flourishing had a mediation effect on the relationship between anxiety and sleep disorders; (3) neuroticism moderated the process through which flourishing mediated the effect of anxiety on sleep disorders. Our research expands the literature on the mechanism underlying the effects of anxiety on sleep disorders and provides insights into the potential prevention and intervention of sleep and emotional problems in medical students.

Usability of an eHealth sleep education intervention for university students

Background

It has been estimated that more than one-third of university students suffer from insomnia. Few accessible eHealth sleep education programmes exist for university students and of the ones that do exist, fewer were developed using a user-centred approach, which allows for student input to be systematically collected and utilized to provide students with a programme that they consider to be easy to use and implement and to be effective. Better Nights, Better Days-Youth (BNBD-Youth) is a four-session eHealth sleep education programme designed for youth but previously only evaluated in younger adolescents (ages 14-18 years).

Aims

The purpose of this study is to evaluate the usability of the BNBD-Youth programme with university students using Morville's User Experience Honeycomb framework to determine if this programme would meet the needs of university students and if so what modifications would be needed.

Methods

Canadian undergraduate students (n = 46) completed the BNBD-Youth programme. Students completed online usability questionnaires based on the seven dimensions of Morville's User Experience Honeycomb (i.e. useful, usable, valuable, credible, desirable, accessible and findable) after each session and after completion of the programme. Open- and closed-ended questions were used to obtain both quantitative and qualitative responses.

Results

Average quantitative ratings were positive across user experience dimensions, ranging from 3.43 to 4.46 (out of 5). Qualitative responses indicated overall positive experiences with the programme. The only constructive feedback that met the criteria for revising the programme was to include more interactive features in Session 4.

Conclusions

This study demonstrates that university students found BNBD-Youth to be a usable programme for older youth. Demonstrating usability is an essential step in developing a programme with a user-centred design that university students will want to use in the future. Once the BNBD-Youth programme is revised to create the BNBD-University (BNBD-Uni) programme, additional usability and effectiveness testing will be conducted.

Prevalence of excessive daytime sleepiness and its association with daily life factors in Japanese first-year university students

As lifestyles have shifted to favor nighttime activities, daytime sleepiness and sleep-related problems have become increasingly common in Japan. Excessive daytime sleepiness (EDS) is an adverse consequence of sleep loss and an important public health concern. EDS may cause academic difficulties, behavioral abnormalities, and psychological dysfunction; therefore, it is a particularly important issue among university students. We conducted a cross-sectional study to investigate the prevalence of EDS and its associated lifestyle factors among Japanese university students. A questionnaire was completed by 1470 first-year university students, aged 19.0 (± 1.0) years. Using the questionnaire, we collected information on (1) demographic variables, (2) lifestyle variables, and (3) sleep habits and daytime sleepiness. Daytime sleepiness was measured using the Japanese version of the Epworth Sleepiness Scale, a frequently used subjective scale for assessing sleepiness. The overall prevalence of EDS was 57% (53% in men and 61% in women). Multivariate logistic regression analysis revealed that the following factors were associated with EDS: female sex, exercise habits, long commuting times, later wake-up times, and shorter sleep duration. Given that more than 50% of first-year university students reported having EDS, interventions should be considered to decrease its risk, including educational programs that provide strategies to extend sleep duration and delay wake-up time. Such strategies may also be valuable for students with other potential risk factors, such as exercise habits or long commute times, that are associated with EDS.

Executive functions in non-suicidal self-injury comorbid first-episode and drug-naïve depression among adolescents

Executive functions(EFs) may be associated with the emergence of non-suicidal self-injury(NSSI) due to their role as behavior controllers. EFs includes three core cognitive processes: inhibitory control, working memory, and cognitive flexibility(i.e. the ability to selectively alter cognitive strategies to generate appropriate behavior in the changing environment). This study aimed to systematically explore the three core EFs in depressed adolescents with NSSI. The data was obtained from the baseline data of the Chinese adolescent depression Cohort. The adolescents underwent cognitive assessments to yield domain-specific scores in EFs using the Digit Span Backward test(DSB), the Stroop Color-word interference test- color-word condition(Stroop-CW), and the Wisconsin Card Sorting tests(WCST). The significant differences in WCST scores were found between the NSSI group and the non-NSSI group. NSSI frequency was moderately positively correlated with total errors and negatively correlated with the number of categories completed. The number of categories completed in the "≥200″ NSSI frequency group was significantly lower than that in the "≤10″ NSSI group. The current findings suggested that depressed adolescents who had engaged in NSSI have poorer cognitive flexibility performance compared to adolescents without NSSI. As the frequency of NSSI increased, cognitive flexibility might become worse. These results provide evidence of a connection between executive dysfunctions and NSSI in depressed adolescents.

The Effect of Sleep Quality and Mental Health on Academic Performance Among the Medical Students of King Abdulaziz University

BACKGROUND

Sleep quality has an important role in brain functioning and development. Affected sleep quality and mental health can negatively affect the academic performance of college students.

OBJECTIVE

To assess the effect of sleep quality and mental health on the academic performance of medical students at King Abdulaziz University, Jeddah, Saudi Arabia.

METHODS

We conducted a cross-sectional study among medical students at King Abdulaziz University. The dependent variable was the current grade point average (GPA). For the independent variables, two validated tools were used in the study: the Pittsburgh Sleep Quality Index (PSQI) for sleep assessment; and the Depression, Anxiety and Stress Scale (DASS-21) for mental health assessment.

RESULTS

A total of 382 responses were analyzed. The majority of students (86.6%) had GPAs greater than 3.75/5, while only 1% of the sample had a GPA lower than 2.75/5. The PSQI showed a median and interquartile range of (9, 6-11). Normal DASS-21 represented the majority as follows: depression at 67%, anxiety at 63.1%, and stress at 82.2%. In the statistical analyses, sleep quality, depression, anxiety, and stress were not statistically significant with the student's GPA.

CONCLUSION

Low levels of sleep quality were found among medical students in our study. While sleep quality and mental health status did not show an effect on the GPA of the medical students, lower sleep quality was significantly correlated with increased scores of depression, anxiety, and stress. Our findings mandate interventions directed at improving sleep quality among medical students.

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.

Insomnia and multiple health outcomes: umbrella review of meta-analyses of prospective cohort studies

OBJECTIVES

To evaluate existing evidence of prospective cohort studies on associations between insomnia and multiple health outcomes.

STUDY DESIGN

An umbrella review of meta-analyses of prospective cohort studies.

METHODS

A systematic search was undertaken in Pubmed, Embase, Cochrane, and Web of Science from inception to October 2021 to find meta-analyses of prospective cohort studies investigating the association of insomnia with any health outcome. The summary relative risk (SRR) for each meta-analysis was recalculated with random-effects model. The methodological quality and the quality of evidence were assessed by the A Measurement Tool to Assess Systematic Reviews and Grading of Recommendations, Assessment, Development and Evaluation, respectively.

RESULTS

A total of 25 published meta-analyses of prospective cohort studies, reporting 63 SRRs for 29 unique outcomes were included. Insomnia was mainly related to cardiovascular outcomes and mental disorders. The former comprised atrial fibrillation (SRR: 1.30, 95% confidence interval: 1.26 to 1.35), cardiovascular diseases (1.45, 1.29 to 1.64), coronary heart disease (1.28, 1.10 to 1.50), myocardial infarction (1.42, 1.17 to 1.72), and stroke (1.55, 1.39 to 1.72). The latter involved alcohol abuse (1.35, 1.08 to 1.67), all mental disorders (2.16, 1.70 to 3.97), anxiety (3.23, 1.52 to 6.85), depression (2.31, 1.90 to 2.81), suicidal ideation (2.26, 1.79 to 2.86), suicidal attempt (1.99, 1.31 to 3.02), and suicidal death (1.72, 1.42 to 2.08). Besides, insomnia enhanced the risk of Alzheimer's disease (1.51, 1.06 to 2.14) and hyperlipidemia (1.64, 1.53 to 1.76).

CONCLUSION

Insomnia exhibits considerable adverse outcomes, primarily comprises cardiovascular outcomes and mental disorders, but further studies with robustly designed trials are needed to draw firmer conclusions.

Fear Related to COVID-19, Mental Health Issues, and Predictors of Insomnia among Female Nursing College Students during the Pandemic

Fear of infection has been sparked by the advent of the novel coronavirus disease (COVID-19). Insomnia in college students, especially its correlations and predictions with mental diseases, remains a research concern. Aim: To estimate the prevalence of fear related to COVID-19, depression, anxiety, and insomnia among female nursing college students throughout the pandemic and to determine the predictors of insomnia. Methods: A web-based cross-sectional descriptive study used 145 female nursing college students. Results: Students reported fear related to COVID-19, depression, and anxiety at rates of 79.3%, 30.2%, and 35.2%, respectively. Insomnia disturbed 24.7% of students. Anxiety predicted worsening insomnia in the student (AOR = 1.08, 95% CI: 0.92−0.97, p < 0.001). Fear related to COVID-19 was also a predictor (AOR = 0.96, 95% CI: 1.07−1.21, p < 0.05). Additionally, when depression severity declined, the chance of insomnia improved (AOR = 0.87, 95% CI: 0.85−0.91, p < 0.001). Insomnia was more common in chronically unwell students (AOR = 1.50, 95% CI = 1.01−2.24, p < 0.05). Conclusion: During the COVID-19 pandemic, university students’ mental health should be monitored, and all essential safeguards should be taken, including resource allocation, awareness raising efforts, and the building of a mental health counseling facility.

Factors associated with poor academic performance among undergraduate dental students: A cross‐sectional study

OBJECTIVE

To evaluate the factors associated with poor academic performance among undergraduate dental students enrolled at a public university in Brazil.

METHODS

A semi-structured questionnaire addressing the exploratory variables of interest (sociodemographic and economic characteristics, use of medications and drugs, dentistry as the first choice of undergraduate course, and the Pittsburgh Sleep Quality Index) was hosted on Google Forms and shared with all dental students at the Federal University of Pelotas. Academic performance was evaluated based on institutional records, access to which the participants had previously authorized; students with good (average ≥7.0 points) or poor academic performance (average <7.0 points) were considered. Adjusted logistic regressions were performed to verify the association between academic performance and the exploratory variables (p < 0.05).

RESULTS

In total, 244 students were included, of whom 18.8% had poor academic performance. Increased age (OR: 1.34; 95%CI: 1.18-1.52), non-white skin color (OR: 1.34; 95%CI: 1.18-1.52), the use of medications for anxiety and depression (OR: 1.34; 95%CI: 1.18-1.52), and poor sleep quality (OR: 1.34; 95%CI: 1.18-1.52) were factors associated with poor academic performance.

CONCLUSION

A low prevalence of poor academic performance was observed. Non-white skin color, increased age, use of anxiolytics or antidepressants, and poor or disturbed sleep may reduce dental students' academic performance.

Sleep health, its intraindividuality, and perceived stress in college students during the COVID-19 pandemic

Objective: To describe the changes in sleep health domains and examine the associations between the repeated measures and intraindividual variability (IIV) of these domains and perceived stress. Participants: A diverse racial and ethnic group of first-year college students (N = 23, 78.3% female, aged 17-18) attending in-person classes during the COVID-19 pandemic. Methods: Sleep health domains were determined using 7-day wrist actigraph and daily sleep diaries, and perceived stress scale was completed at 1-month intervals across 3 months. Results: Sleep timing, regularity, and alertness during daytime demonstrated statistically significant changes between three timepoints. Greater stress was associated with more irregularity (B = 2.25 [.87-3.62], p < .001), more dissatisfaction in sleep (B = .04 [.02-.19], p < .01), alertness during daytime (B = .18 [.05-.31], p < .001), and greater IIV (ie, fluctuations) in sleep satisfaction (B = .083 [.02, .15], p < .01). Conclusion: These findings offer insights for future researchers to facilitate intervention development to promote mental and sleep health among college students.

The impact of COVID-19 on college anxiety, optimism, gratitude, and course satisfaction

ObjectiveTo examine the relationship between college student anxiety, optimism, gratitude, and perception of the Physical Activity and Lifestyle program (PAL) instructional response/effectiveness following COVID-19. Participants: Data were collected from a southeastern, midsize university (n = 1640) during April 2020. Methods: Participants responded to a Web-based survey that included mental health factors (optimism, gratitude, anxiety) and perceptions of COVID-19 academic response. Results: The results of this study revealed a significant, negative relationship between anxiety and optimism (r = .36), gratitude (r = -.12), and perceived instruction following COVID-19 (r = -.11). There were statistically significant differences in perceived PAL instructional response/effectiveness following COVID-19 between anxiety classification, with severely anxious students expressing lower instructional response to COVID-19 when compared to moderately or mildly anxious students, [F(2,1516) = 10.60, p < .001]. Conclusions: The results inform educators on the importance of effective education and coping strategies following online transition during a pandemic.

Effects of schedule exercise therapy on chronic insomnia

Schedule exercise therapy (SET) is a novel nonpharmacological intervention for the treatment of chronic insomnia disorder (CID). The aim of this study was to explore the effects of SET on CID. Methods: One hundred and eighteen CID were recruited and randomized into medication (MED) or medication combined with SET (MSET) groups. Over 12 observational weeks, sleep and mood status were evaluated using the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Self-rating Depression Scale (SDS), and Self-rating Anxiety Scale (SAS). At the end of the observational period, the rates of clinically effective hypnotic use were calculated. At 12 weeks, the PSQI progressively decreased for all subjects combined (P < .001) as well as ISI (P < .001), ESS (P < .001), SDS (P < .001), and SAS (P < .001). The decreases in PSQI (P < .05), ISI (P < .05), SDS (P < .01), and SAS (P < .05) in the MSET group were significantly larger than those in the MED group, but not the same as those in the ESS group (P > .05). At the trial endpoint, the clinically effective rate was significantly higher (P < .05) and the hypnotic usage rate was lower (P < .05) in the MSET group than in the MED group. SET may be an effective treatment for insomnia in patients with CID.

Impact of the COVID-19 pandemic on the physical and psychological health of female college students in Japan

The spread of COVID‐19 has dramatically changed our lives. This study aimed to examine the lifestyles of female college students, focusing on physical activity, sleep status, and anxiety status during the pandemic (a state of emergency) in Japan. 184 female college students completed two questionnaires, anthropometric measurements, and daily activity log and diet record: 115 and 69 participants before and during the pandemic, respectively. Findings showed a significant decrease in physical activity: physical activity levels fell from “normal” to “low” and the daily step counts decreased by half, from 8671 to 4640. In addition, the results from the questionnaires revealed that half of the participants were at risk of having sleep disturbances, and their cycles became more nocturnal, which may have caused higher anxiety states and lower sleep quality during the pandemic. In addition, anxiety states worsened, with 100% of the participants experiencing high anxiety during the pandemic. Monitoring lifestyle disturbances during the pandemic is needed for the development of interventions to improve health among young women.

Psychological predictors of insomnia, anxiety and depression in university students: potential prevention targets

BACKGROUND

Perfectionism, low self-esteem and external locus of control are psychological constructs linked to insomnia, anxiety and depression. Examining how these constructs impact mental health and serve as risk factors for the development of clinically significant symptoms may help direct psychological support resources and preventative measures for university students.

AIMS

To longitudinally examine associations between the aforementioned psychological constructs and symptoms of insomnia, anxiety and depression in a large representative sample of first-year university students.

METHOD

Electronic surveys including validated measures of the predictors and outcomes were emailed to all first-year undergraduate students at entry to a major Canadian university, and followed up on at conclusion of the academic year.

RESULTS

Compared with healthy sleepers, students screening positive for insomnia had lower self-esteem, higher self-evaluative perfectionism and increased external locus of control (all P < 0.001). Self-evaluative perfectionism (standardised β = 0.13, P < 0.01), self-esteem (β = -0.30, P < 0.001) and external locus of control (β = 0.07, P = 0.02) measured at entry were significantly associated with insomnia symptoms at follow-up. Insomnia symptoms at entry were strong predictors of symptoms of depression (β = 0.15, P < 0.001) and anxiety (β = 0.16, P < 0.001) at follow-up, even after controlling for baseline symptoms of those disorders.

CONCLUSIONS

Perfectionism, low self-esteem and external locus of control may predispose the development of insomnia symptoms in university students. In turn, insomnia symptoms appear to be robust predictors for depressive and anxiety symptoms. Sleep may be an important prevention target in university students.

Insomnia Symptoms, Sleep Hygiene, Mental Health, and Academic Performance in Spanish University Students: A Cross-Sectional Study

Background: Insomnia has been associated with decreased academic performance and unhealthy behaviors in university students. Although many studies have analyzed sleep phenomenology among this population, only few have focused on insomnia and its related variables. In addition, such studies do not always include a clinical interview or a specific and validated instrument for measuring insomnia. This study aimed to explore the prevalence of insomnia symptoms and the relationship between insomnia and health habits, mental health, and academic performance in a large university student sample. Methods: Five hundred and eighty-two students were recruited from the University of Granada, Spain. Data were collected through an online survey with questions on sociodemographic and academic data and health habits as well as the Pittsburgh Sleep Quality Index, Insomnia Severity Index, Sleep Hygiene Index, and Sleepiness, Depression, Anxiety, and Stress Scales. A multiple regression analysis explored the relationship between academic performance, health habits, mood state, and insomnia symptoms. Results: The prevalence of students with symptoms of insomnia was high (39.7%). A multiple logistic regression analysis revealed that depression, sleep hygiene, stress and anxiety were significant predictors of insomnia symptoms. Multivariate analyses revealed that subjective insomnia symptoms, sleep efficiency, and depression were significantly correlated with academic performance in a dependent way. Conclusions: In university students, anxiety, stress, and poor sleep hygiene are risk factors for insomnia, which plays an important role in academic performance. Promoting sleep and mental health could be a potentially effective way to improve their academic performance.

The interaction between suicidal ideation, insomnia symptoms, and student status

Evidence demonstrates increased vulnerability to thoughts and behaviors related to suicide (i.e., suicidal ideation) in students. This study examined the interaction between insomnia-symptoms and student-status (students vs. non-students) on reports of suicidal thoughts of behaviors. A total of 363 (N = 363) university students and 300 (N = 300) members of the general population provided complete data on measures of insomnia-symptoms and suicidal ideation. Students indicated greater reports of both total and lifetime ideation while also considering suicidal behavior within the past year. However, no differences were observed in reports of possible future attempt(s) and the disclosure of suicidal thoughts and behaviors to another person. Moreover, students presenting concurrent symptoms of insomnia reported significantly elevated levels of suicidal ideation relative to nonstudents. These outcomes highlight the possible role of insomnia symptoms in accentuating suicidal thoughts and behaviors in the student population.

Anxiety levels and sleep quality in nursing students during the COVID-19 pandemic

PURPOSE

This study was carried out with the aim of determining the correlation between the levels of anxiety experienced by students and their sleep quality during the coronavirus disease 2019 (COVID-19) pandemic.

DESIGN AND METHODS

This descriptive and correlational type study' sample population was 283 students. The personal information form, state-trait anxiety inventory, Verran and Snyder-Halpern sleep scale were used in data collection.

FINDINGS

Study findings indicate that students' state-trait anxiety levels and sleep quality are average, 28.26% of them sleep interrupted and there is a correlation between their anxiety and sleep quality.

PRACTICE IMPLICATION

İt is recommended that teaching students how to deal with COVID-19 and interventional studies aimed at improving sleep quality by reducing anxiety levels should be conducted to further investigate the topic.

Constructs of poor sleep quality in adolescents: associated factors

This study aims to evaluate factors associated with sleep quality (overall and by domains) in adolescents. A cross-sectional study. This study was conducted with 1,296 first-year high school students from public schools in the Northern Region of the State of Pernambuco, Brazil. Demographic, socioeconomic, and behavioral data were obtained with a questionnaire. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) Body mass index (BMI) was calculated based on the ratio of weight and height squared. Multilevel linear and logistic regressions evaluated factors associated with sleep quality. We observed 53% of adolescents reported poor sleep quality. Adolescents at higher risk of clinical depression were 3.45 times more likely to have poor sleep quality (95%CI: 2.04; 5.81), and each additional unit in the social anxiety score presented 1.03 (95%CI: 1.01; 1.05) higher odds of adolescents having poor sleep quality. Adolescents with depressive symptoms had higher sleep latency, greater sleep disturbance, and greater daytime sleep dysfunction. Social anxiety was associated with sleep latency, sleep disturbance, and daytime sleep dysfunction. Higher risk of clinical depression was associated with all domains related to sleep quality. Negative health perception was associated with sleep disturbance, and physical inactivity was associated with daytime sleep dysfunction. Social anxiety and especially higher risk of clinical depression were determinants of poor sleep quality. Changes in sleep latency, sleep disturbance and daytime sleep dysfunction seems to be relevant to poor sleep quality.

The Association between Smartphone Addiction and Insomnia Incidence in Students of the Faculty of Medicine Udayana University Batch of 2020 during the Coronavirus Disease-19 Pandemic

BACKGROUND: The use of smartphones is increasing in the coronavirus disease (COVID-19) pandemic for various purposes, this encourages smartphone addiction. In addition, the incidence of insomnia has also increased in the pandemic era. AIM: This study was conducted to find an association between smartphone addiction and the incidence of insomnia, especially among students of the Faculty of Medicine, Udayana University. METHOD: This research is a descriptive-analytic study with the cross-sectional method, using two main questionnaires, Smartphone Addiction Scale-Short Version, and Insomnia Severity Index. Questionnaires were distributed using Google forms and then collected and analyzed using software SPSS version 25. RESULT: Overall the total research respondents with the inclusion criteria in this study amounted to 364 people. The results showed that 212 respondents (58.24%) had a high level of smartphone addiction and 152 respondents (41.76%) had a low level of smartphone addiction. In addition, 187 respondents (51.37%) experienced mild insomnia, 87 respondents (23.9%) experienced moderate insomnia, 13 respondents (3.57%) experienced severe insomnia, and 77 respondents (21.15%) did not experience insomnia. Based on the results of data analysis, it was found that smartphone addiction had a significant relationship (p = 0.002) with weak and positive correlation (r = 0.162) to the incidence of insomnia. CONCLUSION: It was found that the majority of respondents experienced high levels of smartphone addiction and mild insomnia. Another finding suggests the higher addiction to the smartphones, the more severe insomnia suffered.

Prevalence and Factors Associated with Insomnia Among a Representative Sample of the Lebanese Population: Results of a Cross-Sectional Study

The objectives of the study were to identify the prevalence of insomnia among a representative sample of the Lebanese population and to assess potential factors associated with insomnia among this group. A cross-sectional study was done in the Lebanese population from August 2017 to April 2018 enrolling 789 participants using a proportionate random sample from all five Lebanese governorates. Participants filled a self-administered Arabic questionnaire. The Athens Insomnia Scale was used to diagnose insomnia. The Hamilton Depression Rating Scale and the Generalized Anxiety Disorder Scale were used to measure depression and anxiety, respectively. The prevalence of insomnia was 47.1% in the population sampled. The mean age of the participants was 37 years (64% females). Death in the family [adjusted odds ratio (aORa) = 1.59], drinking caffeine before sleep more than 2 days per week compared to none (aORa = 1.57), increased stress (aORa = 1.03), increased depression (aORa = 1.14), and anxiety scores (aORa = 1.07) were associated with higher odds of insomnia. The prevalence of insomnia was very high in the Lebanese population, and it was mainly associated with modifiable, treatable risk factors. Improved knowledge and adequate screening for insomnia are needed to promote better sleep quality.

Role of perceived family support in psychological distress for pregnant women during the COVID-19 pandemic

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has caused major public panic in China. Pregnant women may be more vulnerable to stress, which may cause them to have psychological problems.

AIM

To explore the effects of perceived family support on psychological distress in pregnant women during the COVID-19 pandemic.

METHODS

A total of 2232 subjects were recruited from three cities in China. Through the online surveys, information on demographic data and health status during pregnancy were collected. Insomnia severity index, generalized anxiety disorder 7-item scale, patient health questionnaire-9, somatization subscale of the symptom check list 90 scale, and posttraumatic stress disorder checklist were used to assess the psychological distress.

RESULTS

A total of 1015 (45.4%) women reported having at least one psychological distress. The women who reported having inadequate family support were more likely to suffer from multiple psychological distress (≥ 2 psychological distress) than women who received adequate family support. Among the women who reported less family support, 41.8% reported depression, 31.1% reported anxiety, 8.2% reported insomnia, 13.3% reported somatization and 8.9% reported posttraumatic stress disorder (PTSD), which were significantly higher than those who received strong family support. Perceived family support level was negatively correlated with depressive symptoms (r = -0.118, P < 0.001), anxiety symptoms (r = -0.111, P < 0.001), and PTSD symptoms (r = -0.155, P < 0.001).

CONCLUSION

Family support plays an important part on pregnant women’s mental health during the COVID-19 pandemic. Better family support can help improve the mental health of pregnant women.

Sleep Quality Is Associated with Vitamin B12 Status in Female Arab Students

Studies have explored how vitamin B12 status affects sleep among elders and children, but this remains to be investigated among young adults. We used the Pittsburgh Sleep Quality Index (PSQI) to assess the association between serum vitamin B12 and sleep among female college students in Saudi Arabia. In this cross-sectional study, we enrolled 355 participants (age (years), 20.7 ± 1.5; body mass index, 23.6 kg/m² ± 5.2) at King Saud University, Riyadh, Saudi Arabia. Fasting blood samples were analyzed regarding the serum vitamin B12 and blood lipids. Anthropometric, socio-demographic, clinical history, stress, physical activity, and dietary data were collected. We assessed the sleep statuses of the participants using the PSQI. Around 72% of the participants were “poor” sleepers (PSQI > 5). Subgroup analysis within the tertiles showed that participants with higher vitamin B12 in the second and third tertiles reported better scores for sleep quality (B ± SE = −12.7 ± 5.6, p = 0.03; B ± SE = −32.7 ± 16.4, p = 0.05, respectively) and also reported a lower use of sleep medication (B ± SE = −21.2 ± 9.9, p = 0.03, in the second tertile only), after adjusting for the waist–hip ratio and stress. However, sleep was not found to be directly associated with either serum vitamin B12 or dietary vitamin B12. In conclusion, the serum vitamin B12 results show that the participants with higher vitamin B12 in the second and third tertiles reported better scores on the sleep quality scale and a lower use of sleep medication. However, no such associations were observed with the overall PSQI. More studies with larger sample sizes are needed to establish a direct relationship between sleep and vitamin B12.

Problematic social media use and mental health (depression, anxiety, and insomnia) among Lebanese adults: Any mediating effect of stress?

PURPOSE

To examine the association between problematic social media use with depression, anxiety, insomnia, and stress in a sample of young Lebanese adults.

METHODS

This cross-sectional study was achieved between January and May 2019; 466 out of 600 adults completed the questionnaire.

RESULTS

Higher problematic social media use was significantly associated with higher depression, anxiety, and insomnia, but not stress. Stress mediated the relation between depression, anxiety, insomnia, and problematic social media use.

PRACTICAL IMPLICATIONS

This study showed that problematic social media use was associated with psychological disorders. Additional research is needed to identify and describe the potential causality between the use of social media and various mental health issues and the interplay between the social media network and other mental health factors.

Mental burden and its risk and protective factors during the early phase of the SARS-CoV-2 pandemic: systematic review and meta-analyses

BACKGROUND

Mental burden due to the SARS-CoV-2 pandemic has been widely reported for the general public and specific risk groups like healthcare workers and different patient populations. We aimed to assess its impact on mental health during the early phase by comparing pandemic with prepandemic data and to identify potential risk and protective factors.

METHODS

For this systematic review and meta-analyses, we systematically searched PubMed, PsycINFO, and Web of Science from January 1, 2019 to May 29, 2020, and screened reference lists of included studies. In addition, we searched PubMed and PsycINFO for prepandemic comparative data. Survey studies assessing mental burden by the SARS-CoV-2 pandemic in the general population, healthcare workers, or any patients (eg, COVID-19 patients), with a broad range of eligible mental health outcomes, and matching studies evaluating prepandemic comparative data in the same population (if available) were included. We used multilevel meta-analyses for main, subgroup, and sensitivity analyses, focusing on (perceived) stress, symptoms of anxiety and depression, and sleep-related symptoms as primary outcomes.

RESULTS

Of 2429 records retrieved, 104 were included in the review (n = 208,261 participants), 43 in the meta-analysis (n = 71,613 participants). While symptoms of anxiety (standardized mean difference [SMD] 0.40; 95% CI 0.15-0.65) and depression (SMD 0.67; 95% CI 0.07-1.27) were increased in the general population during the early phase of the pandemic compared with prepandemic conditions, mental burden was not increased in patients as well as healthcare workers, irrespective of COVID-19 patient contact. Specific outcome measures (eg, Patient Health Questionnaire) and older comparative data (published ≥5 years ago) were associated with increased mental burden. Across the three population groups, existing mental disorders, female sex, and concerns about getting infected were repeatedly reported as risk factors, while older age, a good economic situation, and education were protective.

CONCLUSIONS

This meta-analysis paints a more differentiated picture of the mental health consequences in pandemic situations than previous reviews. High-quality, representative surveys, high granular longitudinal studies, and more research on protective factors are required to better understand the psychological impacts of the SARS-CoV-2 pandemic and to help design effective preventive measures and interventions that are tailored to the needs of specific population groups.

Physical Activity Level, Insomnia and Related Impact in Medical Students in Poland

BACKGROUND

Specific academic environment and time spent on learning may lead to sleep deprivation and a sedentary lifestyle. Insomnia is the most common sleep complaint. The purposes of this study were to describe the prevalence of insomnia in medical students, and to examine physical activity levels and other behavioral factors associated with insomnia in this population group.

METHODS

We included 308 medical students from Poland. The International Physical Activity Questionnaire (IPAQ) was used to assess physical activity levels and the Athens Insomnia Scale (AIS) was used to assess insomnia among students. A multifactor model of analysis was used to analyze variables related to insomnia.

RESULTS

A share of 19.2% of medical students were inactive. Insomnia was reported by 36.8% of students. In the multifactorial model, variables such as smoking cigarettes (ß = 0.21, p < 0.001), consuming energy drinks several times a month (ß = 0.21, p = 0.024), or daily stress (ß = 0.44, p < 0.001) had a negative impact on the quality of sleep of medical students.

CONCLUSIONS

Most medical students are physically active, however, approximately one-third of the medical students experience insomnia. This sleep problem is reported more often in students who experience daily stress or smoke cigarettes.

The prevalence risk of anxiety and its associated factors among university students in Malaysia: a national cross-sectional study

BACKGROUND

Anxiety disorder is one of the most common mental health problems worldwide, including Malaysia, and this issue has gained concern and attention from many, including experts and authorities globally. While average levels of stress and worry may help to motivate students to perform well in their studies, excessive feelings will increase their level of anxiety.

METHODS

A cross-sectional study was conducted at selected government and private universities throughout Malaysia. A total of 1851 students participated in this study. The students were asked to complete self-administered questionnaires, including socio-demographic, academic, and psychosocial characteristics. The Generalized Anxiety Disorder-7 (GAD-7) questionnaire was used to measure the prevalence risk of anxiety among the students. Chi-square analysis was conducted to find the relationship between the variables and anxiety, and multivariate logistic regression analysis was used to identify the predictors.

RESULTS

The response rate was 97.90%, where 1821 out of 1860 students participated in the study. The prevalence risk of anxiety in this study was recorded at 29%. The data revealed that academic year, financial support for the study, alcohol consumption, poor sleep quality, body mass index (BMI), having a good friend in the university, having doubt regarding the future, actively involved in the society, and having problems with other students and lecturer(s) were significantly associated with risk of anxiety; with the academic year as the primary predictor.

CONCLUSIONS

The findings highlight the current prevalence risk of anxiety among university students in Malaysia. The outcome of this study can serve as the evident baseline data and help with the development of specific interventions in addressing and managing the issue appropriately.

A Multi-Country Analysis of Prevalence of Anxiety-Induced Sleep Disturbance and Its Associated Factors among In-School Adolescents in Sub-Saharan Africa Using the Global School-Based Health Survey

(1) Background: Among the health problems affecting adolescents, anxiety disorders are considered among the health-compromising or debilitating outcomes that affect adolescents' mental health. We examined the prevalence and factors associated with anxiety-induced sleep disturbance among in-school adolescents in sub-Saharan Africa (SSA). (2) Methods: This study involved a cross-sectional analysis of data from the Global School-Based Health Survey (GSHS). We analyzed data on 25,454 in-school adolescents from eleven (11) countries in SSA with a dataset between 2010 and 2017. Two multivariable logistic regression models were built to determine the strength of the association between anxiety-induced sleep disturbance and the explanatory variables. The results of the regression analyses were presented using adjusted odds ratios (aOR) and their respective 95% confidence intervals (CIs). Statistical significance was set at p-value < 0.05. (3) Results: The overall prevalence of anxiety-induced sleep disturbance among in-school adolescents in SSA was 12.2%. The prevalence ranged from 5.1% in Tanzania to 20.5% in Benin. The odds of anxiety-induced sleep disturbance was higher among adolescents aged 15 and above [aOR = 1.26, 95% CI = 1.15, 1.39] compared to those aged 14 or younger. Additionally, the odds of anxiety-induced sleep disturbance was higher among adolescents who were bullied [aOR = 1.54, 95% CI = 1.42, 1.67], those that felt lonely [aOR = 3.85, 95% CI = 3.52, 4.22], those who had suicidal ideations [aOR = 1.70, 95% CI = 1.52, 1.90], those who had suicidal plan [aOR = 1.26, 95% CI = 1.13, 1.41], those who have had suicidal attempt [aOR = 1.21, 95% CI = 1.08, 1.35], those who used marijuana [aOR = 1.27, 95% CI = 1.06, 1.52], and those who were truant at school [aOR = 1.33, 95% CI = 1.22, 1.46]. However, male adolescents had lower odds of anxiety-induced sleep disturbance [aOR = 0.88, 95% CI = 0.81, 0.95], compared to their female counterparts. (4) Conclusions: We found a relatively high prevalence of anxiety-induced sleep disturbance among in-school adolescents in SSA. Higher age, being female, being bullied, loneliness, having suicidal ideations/plan/attempt, use of marijuana and truancy were risk factors for anxiety-induced sleep disturbance. The findings, therefore, highlight the urgency for policies (e.g., early school-based screening) and interventions (e.g., Rational Emotive Behavioral Education (REBE), Social Emotional Learning (SEL) that target in-school adolescents within the most at-risk populations of anxiety-induced sleep disturbance in SSA.

Insomnia May Mediate the Relationship Between Stress and Anxiety: A Cross-Sectional Study in University Students

BACKGROUND

High perceived stress and anxiety disorders are usually comorbid with each other, with stress often sequentially preceding the development of anxiety. While prior findings showed a causal role of sleep problems in anxiety, no study has assessed the role of insomnia as a mediator in the relationship between stress and anxiety.

METHODS

A cross-sectional study on university students (n = 475, age = 21.1+2.6 years) was conducted over 3 months. Participants completed self-report measures of Leeds Sleep Evaluation Questionnaire-Mizan (LSEQ-M), Perceived Stress Scale-10 (PSS-10), generalized anxiety disorder-7 scale (GAD-7), and a sociodemographic tool. The mediation effect model given by Baron and Kelly was used to determine the relationship.

RESULTS

The prevalence of insomnia and anxiety disorder was 43.6% and 21.9%, respectively. Stress was significantly associated with LSEQ-M (insomnia measure) (b = -.44, SE = 0.16, p<0.01), and high levels of anxiety (b = 0.25, SE = 0.03, p < 0.01). The indirect effect of stress on anxiety through LSEQ-M (insomnia measure) was significant (95% confidence interval [0.01, 0.04]). However, the indirect effect of anxiety on stress through LSEQ-M (insomnia measure) was non-significant (95% confidence interval [-.01, 0.04]).

CONCLUSIONS

Students having higher perceived stress levels and comorbid insomnia were also likely to have a higher anxiety level.

Insomnia is associated with worry, cognitive avoidance and low academic engagement in Argentinian university students during the COVID-19 social isolation

An increment in mental health problems related to social isolation strategies was evinced in several populations, however few investigations address this problem in students. This study aimed to analyze the relationship between insomnia, worry, coping strategies, and academic engagement in subjects pursuing a university degree in Argentina during the first month of compulsory social isolation against the COVID-19 pandemic. Self-report online questionnaires were administered to 584 participants: Insomnia Severity Index, Penn State Worry Questionnaire, Coping Responses Inventory, Utrecht Work Engagement Scale for Students. Demographic data was recorded. Statistics included bivariate and multivariate techniques. Prevalences of 45% for subthreshold insomnia, 23% for moderate insomnia, and 4% for severe insomnia were found. The severe insomnia group presented higher levels of worry and cognitive avoidance strategies. Insomnia was also associated with daytime concerns. The group without insomnia was more vigorous in their academic engagement. Being physically active was associated with lower sleep problems. Insomnia prevalence is high in socially isolated university students. Cognitive avoidance coping strategies are associated with worry, which leads to an alert state that makes sleep difficult. These findings should be taken into account by academic institutions to define their pedagogic strategies.

Impact of sleep quality on post-stroke anxiety in stroke patients

OBJECTIVE

To explore whether poor sleep is associated with post-stroke anxiety (PSA) in Chinese patients with acute ischemic stroke (AIS) and to verify whether poor sleep is a predictor of PSA.

METHODS

A total of 327 patients with AIS were enrolled and followed up for 1 month. Sleep quality within 1 month before stroke was evaluated using the Pittsburgh Sleep Quality Index (PSQI) at admission. The patients were divided into the poor sleep group (PSQI > 7, n = 76) and good sleep group (PSQI ≤ 7, n = 251). One month after stroke, patients with obvious anxiety symptoms and a Hamilton Anxiety Scale score >7 were diagnosed with PSA.

RESULTS

Eighty-seven patients (26.6%) were diagnosed with PSA. Compared to the good sleep quality group, the incidence of PSA in patients with poor sleep quality was higher (42.1% vs. 21.9%, p = .001). Poor sleep quality is more common in patients with PSA (35.6% vs. 18.8%, p = .001). A logistic regression analysis indicated that poor sleep quality was significantly associated with PSA (OR: 2.265, 95% CI: 1.262-4.067, p = .003). After adjusting for conventional and identified risk factors, poor sleep quality was found to be independently associated with PSA (OR: 2.676, 95% CI: 1.451-4.936, p = .001).

CONCLUSIONS

Poor sleep quality before stroke was associated with PSA and may be an independent risk factor of PSA 1 month after AIS onset.

Gender specificities of cardiovascular risk factors in students

Aim. To study gender differences in the prevalence of cardiovascular risk factors (RF) among higher education medical students.

Material and methods. We examined 74 men and 143 women studying at higher education medical institution. Behavioral and biological RF were evaluated. Psychoemotional status of participants was evaluated by Hospital Anxiety and Depression Scale (HADS) and Perceived Stress Scale-10 (PSS-10). Statistical analysis was carried out using the software package Statistica 10.0 (StatSoft Inc).

Results. Among men, a significantly higher percentage of patients with overweight (body mass index ≥25 kg/m2), higher blood pressure (BP), higher level of cholesterol, and smoking were recorded. Among women, a higher percentage of patients with tachycardia, a sedentary lifestyle, impaired sleep quality and falling asleep were recorded. Sleep duration in young women was significantly lower, and the level of anxiety, depression and stress were higher compared to men. Significant relationships between gender and psychological factors have been identified. Among women, correlations of psychological factors with such parameters as heart rate, total cholesterol, falling asleep and sleep quality were revealed. Among men, significant correlations of anxiety with increased BP, stress and exercise, as well as the presence of cardiovascular diseases in the father were revealed.

Conclusion. Gender specificities of RF were revealed: among men — higher frequency of metabolic disorders and higher blood pressure, and among women — psychological factors and low physical activity. It is reasonable to take they into account when developing and implementing individual diagnostic, treatment and prophylactic measures in students.

Brain mechanisms of insomnia: new perspectives on causes and consequences

While insomnia is the second most common mental disorder, progress in our understanding of underlying neurobiological mechanisms has been limited. The present review addresses the definition and prevalence of insomnia and explores its subjective and objective characteristics across the 24-hour day. Subsequently, the review extensively addresses how the vulnerability to develop insomnia is affected by genetic variants, early life stress, major life events, and brain structure and function. Further supported by the clear mental health risks conveyed by insomnia, the integrated findings suggest that the vulnerability to develop insomnia could rather be found in brain circuits regulating emotion and arousal than in circuits involved in circadian and homeostatic sleep regulation. Finally, a testable model is presented. The model proposes that in people with a vulnerability to develop insomnia, the locus coeruleus is more sensitive to-or receives more input from-the salience network and related circuits, even during rapid eye movement sleep, when it should normally be sound asleep. This vulnerability may ignite a downward spiral of insufficient overnight adaptation to distress, resulting in accumulating hyperarousal, which, in turn, impedes restful sleep and moreover increases the risk of other mental health adversity. Sensitized brain circuits are likely to be subjectively experienced as "sleeping with one eye open". The proposed model opens up the possibility for novel intervention studies and animal studies, thus accelerating the ignition of a neuroscience of insomnia, which is direly needed for better treatment.

Predictors of sleep quality among university students: the use of advanced machine learning techniques

PURPOSE

To assess the prevalence of sleep disturbances among university students and investigate potential correlated factors and their relative importance in quantifying sleep quality using advanced machine learning techniques.

METHODS

A total of 1600 university students participated in this cross-sectional study. Sociodemographic information was collected, and the Pittsburgh Sleep Quality Index (PSQI) was administered to assess sleep quality among university students. Study variables were evaluated using logistic regression and advanced machine learning techniques. Study variables that were significant in the logistic regression and had high mean decrease in model accuracy in the machine learning technique were considered important predictors of sleep quality.

RESULTS

The mean (SD) age of the sample was 26.65 (6.38) and 57% of them were females. The prevalence of poor sleep quality in our sample was 70%. The most accurate and balanced predictive model was the random forest model with a 74% accuracy and a 95% specificity. Age and number of cups of tea per day were identified as protective factors for a better sleep quality, while electronics usage hours, headache, other systematic diseases, and neck pain were found risk factors for poor sleep quality.

CONCLUSIONS

Six predictors of poor sleep quality were identified in university students in which 2 of them were protective and 3 were risk factors. The results of this study can be used to promote health and well-being in university students, improve their academic performance, and assist in developing appropriate interventions.

Associations between device use before bed, mood disturbance, and insomnia symptoms in young adults

OBJECTIVES

Young adults (YAs) are vulnerable to insomnia and mood disturbance. YAs also engage in back-lit device use which has been implicated in the development and maintenance of insomnia. This study explored the association between device use, mood disturbance, and insomnia symptoms in YAs.

PARTICIPANTS

Two thousand three hundred and ninety students at a Canadian university, aged 18-35 years.

DESIGN

Cross-sectional online survey MEASUREMENTS: Participants self-reported duration and frequency of back-lit device use before sleep and during the night. The Insomnia Severity Index and the Hospital Anxiety and Depression Scale were used to measure symptoms. Univariate and multivariate logistic regressions explored associations between device use behaviors and insomnia symptoms. A hierarchical regression analysis identified the unique contribution of back-lit device use on insomnia severity adjusting for mood disturbance, age, and sex.

RESULTS

Using a back-lit device for 1-2 hours after lights out (adjusted odds ratio [AOR] = 1.50, p < 0.001), being awakened by a device (AOR = 1.34, p = 0.002), and believing that device use negatively impacts sleep (AOR = 2.27, p < 0.001) were associated with insomnia symptoms. Depression contributed to the greatest unique variance to insomnia (11.8%), followed by anxiety (7.2%). Duration of device use after lights out, being awakened by a device and a negative perception of device use on sleep accounted for an additional 3%.

CONCLUSIONS

Device use contributed to insomnia symptoms over and above mood disturbance, age, and biological sex in YAs. Additional research is needed to determine the direction of effect and inform prevention/intervention programs specific to device use and insomnia symptomology in this population.

Sex-specific associations between sleep and mental health in university students: a large cross-sectional study

Objective: To examine the associations between sleep problems and mental health dimensions in university students, and the effect of sex on these associations. Participants: Self-reported survey data from 3,483 students aged 18-30 years was drawn from a larger web-based study (i-Share) conducted in France in the years 2013-2017. Methods: We performed logistic regression analyses stratified by sex using insufficient sleep duration, poor sleep quality, difficulty initiating sleep and excessive daytime sleepiness, in relation with stress, self-esteem, depression and anxiety. Results: All sleep problems were strongly associated with all mental health dimensions, particularly anxiety, in female students. Sleep and mental health problems were also associated in male students, with the exception of low self-esteem, but odds ratios were lower than for female students. Conclusions: Present findings warrant attention to propose early interventions targeting sleep and mental health in the university setting taking sex into account.

Impact of sleep problems on daytime function in school life: a cross-sectional study involving Japanese university students

BACKGROUND

The aims of this study were 1) to clarify the prevalence of sleep problems (insomnia, insufficient sleep, and delayed sleep-wake phase) among Japanese university students; 2) to examine sociodemographic characteristics, lifestyle, and sleep-related symptoms in each sleep problem; and 3) to evaluate the association between the above-mentioned sleep problems and daytime dysfunction in school life.

METHODS

Self-report questionnaire surveys were conducted at eight universities in Japan, and we received 1034 valid answers (78% female). The questionnaire consisted of socio-demographic characteristics, information on lifestyle, sleep pattern, sleep-related symptoms, and daytime dysfunction in school life. Groups with insomnia, behaviorally induced insufficient sleep syndrome (BIISS), delayed sleep-wake phase (DSWP), and BIISS + DSWP were defined. To identify the association between sleep problems and daytime dysfunction in school life, the generalized linear mixed effect model was conducted.

RESULTS

Sleep duration on weekdays was 5.9 ± 1.2 h, and 38.2% of the students had a sleep duration < 6.0 h. About 16% of the students were categorized as evening-type individuals. More than half of the students (56.1%) had excessive daytime sleepiness. Insomnia was associated with tardiness (aOR: 0.8, 95%CI: 0.7-0.9) and falling asleep during class (aOR: 1.6: 95%CI: 1.4-2.0). BIISS was associated with tardiness (aOR: 1.5, 95%CI: 1.1-2.2) and interference with academic achievement (aOR: 1.9, 95%CI: 1.3-2.6). DSWP and BIISS + DSWP were associated with absence (aOR: 3.4, 95%CI: 2.2-5.1 / aOR: 4.2, 95%CI: 3.2-5.6), tardiness (aOR: 2.7, 95%CI: 1.8-4.1 / aOR: 2.2, 95%CI: 1.6-2.8), falling asleep during class (aOR: 2.6, 95%CI: 1.4-4.8 / aOR: 7.6, 95%CI: 3.3-17.2), and interference with academic achievement (aOR: 2.6, 95%CI: 1.7-3.9 / aOR: 2.1, 95%CI: 1.6-2.8).

CONCLUSIONS

Students with DSWP and BIISS + DSWP were significantly associated with daytime dysfunction in school life, i.e. absence, tardiness, falling asleep during class and interference with academic achievement. Students displaying BIISS + DSWP were considered to have a relatively more serious condition compared with those with only insomnia, DSWP, or BIISS. It is therefore of utmost importance that university students aim to prevent DSWP and BIISS which were associated with daytime function in school life.

Determinants of Subjective Poor Sleep Quality in Social Media Users Among Freshman College Students

INTRODUCTION

Social media (SM) usage has increased markedly among young adults. It is linked to poor sleep quality (PSQ), a risk factor for mental and physical health concerns. This study identified the determinants of PSQ in SM users among freshman college students.

MATERIAL AND METHODS

A cross-sectional design was used and 842 students completed a self-administered questionnaire. Analyses were performed using the χ ² test to examine differences in the characteristics of poor and good sleepers and logistic regression to estimate the risk of PSQ with reference to SM usage patterns.

RESULTS

Around 75.40% (n = 635) of the participants had PSQ. There was a significant difference in the PSQ rate between males (66.3%) and females (79.3%, p < 0.001), those who were physically active (67.2%) and those who were not (82.4%, p < 0.001), those who were mentally depressed (86.5%) and those who were not (61.5%, p < 0.001), and those with anxiety (87.8%) and those without (64.3%, p < 0.001). The risk of PSQ was lower among students who used SM for education (OR = 0.65, CI = 0.42 to 0.99, p = 0.048), had higher laptop usage (OR = 0.67, CI = 0.47 to 0.96, p = 0.03), and had higher SM usage during daytime (OR = 0.46, CI = 0.32 to 0.67, p < 0.001). The risk of PSQ was higher among those who reported SM usage at bedtime (OR = 1.69, CI = 1.01 to 2.81, p = 0.046).

DISCUSSION

Among SM users, PSQ was related to sociodemographic features, lifestyle characteristics, and health-risk factors. Further research is required to confirm these findings.

Preoperative insomnia and its association with psychological factors, pain and anxiety in Chinese colorectal cancer patients

PURPOSE

Sleep disturbances are common in cancer patients, but little is known about preoperative insomnia and its associated factors in colorectal cancer (CRC) patients. The aim of this study was to clarify the relationship between preoperative insomnia and its associated factors (i.e., pain, anxiety, self-esteem, and coping styles) in CRC patients.

METHODS

A cross-sectional study was conducted in consecutive CRC inpatients (N = 434), who were required to complete the questionnaires about insomnia, pain, anxiety, self-esteem, and coping styles (acceptance/resignation, confrontation, avoidance) before the day of surgery. Hierarchical regression analyses were conducted to explore the relationships between preoperative anxiety and its associated factors.

RESULTS

Based on the cutoff value of Athens Insomnia Scale (scores ≥ 6) in Chinese cancer patients, the prevalence of insomnia was 38.2% before surgery. Pain (β = 0.087, p = 0.015) and anxiety (β = 0.372, p < 0.001) were positively associated with preoperative insomnia, while self-esteem (β = - 0.479, p < 0.001) and confrontation coping (β = - 0.124, p = 0.003) showed protective effects on preoperative insomnia when putting them together into hierarchical regression. The associated factors together accounted for an additional variance of preoperative insomnia (47.6%).

CONCLUSIONS

In line with previous findings, the detrimental effects of pain and anxiety on preoperative insomnia were also observed in our study. More importantly, our main new findings were that self-esteem and confrontation coping played important roles in alleviating preoperative insomnia among CRC patients. Clinicians should take these results into account when developing cancer care management to relieve preoperative insomnia.

Insomnia among Medical and Paramedical Students in Jordan: Impact on Academic Performance

Background

Insomnia is a problem that is common in all societies and age groups. However, its importance is increasing between students especially with the highly competitive and demanding environment surrounding them even after their graduation. In spite of the deep understanding of its health and social consequences, the frequency of insomnia among medical students in Jordan was not determined.

Aim

To determine the prevalence of sleep disturbances among college students and to look for any association between sleep disturbances and students' academic achievement.

Methods

This is a cross-sectional self-administered questionnaire-based study. The participants were college students of the medical and paramedical specialties. Insomnia Severity Index (ISI) was used and the academic performance was assessed using students' Cumulative Grade Point Average (CGPA).

Results

There were 977 responses. Prevalence of clinical insomnia was 26.0%. Students who self-reported good sleep quality had significantly lower ISI scores compared with those who self-reported bad quality of sleep. Students who slept >7 hours had significantly less ISI scores than students who slept <6 hours. Students who had a CGPA more than or equal to 3 had significantly lower ISI scores compared with those who had a CGPA less than 2.5. Self-reported sleep quality was associated with the CGPA.

Conclusion

A high prevalence of insomnia was found in this group of students. Academic performance was significantly associated with ISI scores and self-reported sleep quality. These results might be useful for future research into the development of interventional strategies to help students get enough sleep quality and quantity.

A cross-sectional survey on sleep quality, mental health, and academic performance among medical students in Saudi Arabia

Objective

Adequate sleep is integral to better mental health and facilitates students’ learning. We aimed to assess sleep quality among medical students and to see whether it was associated with their mental health (e.g., depression, anxiety, and stress) and academic performance.

Results

A total of 206 responded, and 95 of them had complete data on demography, lifestyle, academic performance, sleep quality (Pittsburgh Sleep Quality Index), and mental health (Depression Anxiety Stress Scales). The prevalence of poor sleep was 63.2%; it was higher among students who were physically inactive and had more screen time. Poor sleepers demonstrated higher academic performance than sufficient sleepers (p = 0.04). The prevalence of depression, anxiety, and stress were 42%, 53%, and 31% respectively. Sleep quality was significantly associated with depression (p = 0. 03), anxiety (p = 0.007), and stress (p = 0.01).

Impacts of socio-cultural environment and lifestyle factors on the psychological health of university students in Bangladesh: A longitudinal study

BACKGROUND

The psychological health of university students is an issue of utmost concern worldwide. Its consequences include multifaceted outcomes from complex interactions of sociocultural, environmental, and individual lifestyle factors. This research explores the impacts of socio-cultural environment and lifestyle factors on the psychological health of university students in Dhaka, Bangladesh.

METHODS

A 15-month follow-up was carried out among 1140 university students from April 2016 to November 2017. Data were collected by using a pre-developed questionnaire, consisting of socio-demographic information, comprehensive lifestyle information, and psychological health information including a nine-item scale, the Patient Health Questionnaire-9 (PHQ-9) for assessing the level of depression, and a 7-item scale, the Generalized Anxiety Disorder-7 (GAD-7) for assessing the level of anxiety. The collected data were analyzed by using the Statistical Package for Social Sciences (SPSS) software, version 22.

RESULTS

With time, there was a 22.5% increase in the prevalence of provisional depression and a 27.1% increase in the prevalence of anxiety. In terms of demographic factors, findings revealed that students dissatisfied with university culture were significantly more likely to experience depression (B = 5.13, p<0.01, β=0.33) and anxiety (B = 4.69, p<0.01, β=0.34). 'Being female', 'being students of social sciences faculty', 'dissatisfaction with current education, financial condition and future career' were found to be significant predictors of students' psychological disorders. In terms of lifestyle factors, participants with high and excessive recreational screen time were significantly more vulnerable to depression (B = 1.25, p<0.01, β=0.097 and B = 1.75, p<0.01, β=0.12) and anxiety (B = 0.86, p = 0.02, β=0.08 and B = 1.22, p<0.01, β=0.096). Additionally, 'weekly physical inactivity', 'dissatisfaction with daily sleep', 'short and long sleep duration', 'low and high daily meal intake frequency' and 'alcohol consumption' were inextricably linked with students' depression and anxiety.

CONCLUSION

The prevalence of provisional as well as major depressive and anxiety disorders among university students in Bangladesh is significantly high and augmented in nature. This study provides significant information about the adverse impacts of university socio-cultural environment and students' lifestyle factors on their psychological health conditions.

Impact of Sleep Disorders and Other Factors on the Quality of Life in General Population: A Cross-Sectional Study

The study objective was to assess if insomnia, along with other factors, can impact the physical and mental quality of life (QOL) of the Lebanese general population. This cross-sectional study, conducted between November 2017 and March 2018, enrolled 756 community-dwelling participants. A first linear regression, using the SF-12 PCS score as the dependent variable, showed that having a family history of insomnia problems (β = 1.107, p = 0.026) was significantly associated with higher physical QOL (higher SF-12 PCS score), whereas increased stress (β = 0.048, p = 0.015) was significantly associated with lower physical QOL. A second linear regression, using the SF-12 MCS score as dependent variable, showed that having increased age (β = -0.079, p < 0.001) was significantly associated with lower mental QOL. Despite its cross-sectional design and the modest sample size, this study adds to the evidence that insomnia, along with other factors (including sociodemographic and psychological factors), can have a detrimental impact on both physical and mental QOL of participants.

Time to think: Subjective sleep quality, trait anxiety and university start time

Poor quality sleep is related to mental health and there is increasing interest in student wellbeing and mental health. The aim of the current study was to evaluate sleep quality, daytime dozing, anxiety proneness, chronotype and preferred start time in a sample of university students. A total of 546 university students (age range, 18-55) from two university located in South East England were included and completed an online survey. Participants' self-reported age, gender, year and field of study. Sleep quality, anxiety, daytime dozing, coffee/caffeine/tobacco use (coded as binary variables), preferred start time and chronotype were also recorded. Data were analysed using independent samples t-tests, chi-square, simple mediation-analyses and Analysis of Variance. Across the entire sample 46% percent of participants rated their sleep as fairly bad or very bad. Poor quality sleep was associated with significantly higher levels of anxiety which was not mediated by chronotype. Poor quality sleep is more prevalent in the first year of university and our sample endorsed a start time for university activities approximately 2 h later than currently timetabled. The current findings demonstrate that a large proportion of students are chronically sleep deprived, obtaining, on average, less than 7 h sleep per night on week days and this was more marked in first year students. In addition, we show that poor sleep is associated with increased anxiety. Based on the current evidence the authors suggest a review of current university timetabling and examination scheduling merits immediate consideration by policy makers and educators.