A study on the sleep quality of incoming university students
Introduction
Sleep is a pivotal modulator of hormone release, cardiovascular activity and glucose regulation, and it has been demonstrated that changes in sleep quality or duration have a significant impact on morbidity (Gangwisch et al., 2006, Banks and Dinges, 2007, Hall et al., 2008, Bixler, 2009). A Finnish study found that there has been a gradual reduction in sleep duration and an increase in sleep complaints over the last 30 years (Kronholm et al., 2008), and poor sleep quality is a common issue in modern society. Additionally, sleep quality is a relevant dimension with regards to sleep–wake functioning, and poor sleep quality has been found to be associated with poor academic achievement and health, as well as increased health care costs and absenteeism from work (Trockel et al., 2000). The prevalence of poor sleep quality in the community has been reported to be 26–35% using the Pittsburgh Sleep Quality Index (PSQI) (Chung and Tang, 2006, Stein et al., 2008, Yao et al., 2008). Sleep problems are common among university students (Yang et al., 2003, Suen et al., 2008, Tsui and Wing, 2009), with the prevalence of poor sleep quality in this population having been reported as ranging from 19.17% to 57.5% (Feng et al., 2005, Suen et al., 2008).
Social support is a broad term, and includes all the supportive ways that different people behave in the social environment. It has been found that isolation or loneliness may be associated with increased incidence of depression and cardiovascular diseases (Arthur, 2006, Cacioppo et al., 2010). In addition, Hawkley et al. (2010) suggested that the same amount of sleep is less healthy when participants feel more social isolated. Therefore, it is plausible to speculate that social support may be associated with the sleep quality. However only few studies have confirmed this relationship (Yao et al., 2008).
It is well known that behavioral and lifestyle factors, such as cigarette smoking, heavy drinking, physical inactivity and excessive Internet usage, are associated with poor sleep quality (Bixler, 2009). Internet addiction is very prevalent in college students, particularly in Asian communities (Morahan-Martin and Schumacher, 2000), and has also been found to be related to mental health morbidity (Tsai et al., 2009), while Choi et al. (2009) reported that it is strongly associated with sleep problems.
Poor sleep quality/insomnia frequently occurs with mental and/or physical disorders (Stein et al., 2008). Soehner et al. (2007) reported finding a high level of neuroticism to be associated with poorer sleep, as indicated by higher PSQI scores. Van de Laar et al. (2010) proposed that personality factors may play a causal role in the development of insomnia, but may also be a consequence of the associated daytime dysfunction.
It remains to be fully determined whether impairments in sleep quality in university students are a reflection of changes in modern behavioral or lifestyle factors, or of other factors such as neuroticism or a lack of social support. The primary aim of this study is to investigate the prevalence of poor sleep in incoming university students. We hypothesize that influential factors may include not only poor lifestyle habits and the potential for psychiatric morbidity, but also a lack of social support, and these may all be elevated in those who experience poor quality sleep.
Section snippets
Subjects
A total of 5,170 incoming students at National Cheng Kung University were enrolled in 2008, having been invited to participate in this self-administered questionnaire-based study during a routine health examination performed as part of the their orientation procedure. Incoming students are newly arrived students at the university, in their first weeks, whether at undergraduate or graduate level. Prior to commencement of the study, informed consent was obtained from each study participant.
Results
A total of 4,318 incoming university students participants completed the questionnaire (response rate = 4,318/5,170 = 83.5%), 66.0% of whom were male, and there were 2,360 (54.7%) poor sleepers in total. The mean PSQI score was 6.0 ± 2.5 (Fig. 1).
The demographic differences between the poor and good sleepers are shown in Table 1, and reveal that students who were female, with a lower BMI, who were undergraduate students, who skipped breakfast, and who drank tea were significantly more likely to be
Discussion
The prevalence rates of poor sleep quality appear to vary with the study population, even when the same assessment tool, the PSQI, is employed. Kang and Chen (2009) reported that 33.8% of medical school students in Taiwan could be characterized as suffering from poor sleep quality as defined by a PSQI score higher than 5, while Feng et al. (2005) found that only 19% of medical college students reported poor sleep quality in China. These results are in contrast with the results of this study of
Acknowledgments
The authors wish to thank Mr. Chien Ting Lin and the students of National Cheng Kung University who participated in this study.
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These authors made an equal contribution to this manuscript.