Abstract
The association between sleep problems and quality of life has been well documented and the COVID-19 pandemic seemingly had an impact on both sleep quality and health-related quality of life (HRQoL). However, recent evidence about this relationship among university students is limited. The aims of this study are to investigate the prevalence of poor sleep quality and insomnia and to explore the associations between these outcomes, perceived stress, and HRQoL among Italian university students. An anonymous questionnaire comprising the Pittsburgh Sleep Quality Index, the Insomnia Severity Index, the Short Form-12 health survey, and the Perceived Stress Scale was administered to a convenience sample of 1279 students (1119 females and 160 males, mean age: 23.4 ± 2.5 years) attending one of the largest Italian universities. A total of 65% of the participants showed poor sleep quality, whereas 55% reported insomnia symptoms. Students reporting poor sleep quality and insomnia obtained higher perceived stress scores and lower physical and mental HRQoL scores. Controlling for health-related variables and perceived stress, hierarchical regression analyses showed that sleep quality components added a significant contribution to the prediction of both physical (ΔR2 = 0.1) and mental (ΔR2 = 0.02) HRQoL. As a whole, these findings confirm the relevance of sleep for university students’ well-being and might inform the development of health promotion interventions for this population.
Highlights
Poor sleep quality, reduced sleep duration, and sleep disorders, such as insomnia and obstructive sleep apnea, have been widely shown to be associated with adverse outcomes for both physical and mental health, including cardiovascular and metabolic diseases [1–4], anxiety and depression [5–7], and reduced cognitive functioning [8], consistently with the acknowledged role of sleep in the regulation of biological processes pivotal for health [9].Sleep quality has been conceptualized as a construct comprising both quantitativeobjective and subjective aspects of sleep [10,11]
Sleep disorders are highly prevalent among young adults [12] and poor sleep quality seems to be common among university students, with large studies conducted across different socio-cultural contexts [13–17]
With respect to the sleep quality and insomnia severity, 64.5% (n = 825; 95% CI: 61.9–67.1%) of the sample obtained a score above 5 on the Pittsburgh Sleep Quality Index (PSQI), indicating poor sleep quality, and 54.8% (n = 701; 95% CI: 52.1–57.5%) scored above the cut-off of 7 on the Insomnia Severity Index (ISI), with 41.2% of the participants (n = 527; 95% CI: 38.5–44%) reporting subthreshold insomnia symptoms, 12.4% (n = 159; 95% CI: 10.7–14.4%) reporting moderate insomnia symptoms, and 1.2% (n = 15; 95% CI: 0.68–2%) reporting severe insomnia symptoms
Summary
Poor sleep quality, reduced sleep duration, and sleep disorders, such as insomnia and obstructive sleep apnea, have been widely shown to be associated with adverse outcomes for both physical and mental health, including cardiovascular and metabolic diseases [1–4], anxiety and depression [5–7], and reduced cognitive functioning [8], consistently with the acknowledged role of sleep in the regulation of biological processes pivotal for health [9].Sleep quality has been conceptualized as a construct comprising both quantitativeobjective and subjective aspects of sleep [10,11]. Sleep disorders are highly prevalent among young adults [12] and poor sleep quality seems to be common among university students, with large studies conducted across different socio-cultural contexts [13–17]. Reporting prevalence rates between 50% and 70% for poor sleep quality assessed with the Pittsburgh Sleep Quality Index [18]. In this population, significant associations have been reported between poor sleep, mental health problems [19], and academic performance [20]. Given the well-established bidirectional nature of the relationship between poor sleep and distress [5,6,21,22], improving sleep quality should be a primary objective of preventive mental health interventions for young adults.
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