Background
Sleep is a pivotal modulator of neuroendocrine function, glucose regulation, and cardiovascular activity. The consequences of sufficient restorative sleep deprivation are severe, impacting human health, wellbeing, and functioning [
1]. Poor sleep quality may have a negative impact on social, physical, and mental health, as well as the living quality of individuals
. According to the cut-off (Pittsburgh Sleep Quality Index (PSQI) score > 5), a German community study indicated that the prevalence of poor sleep quality among people aged 18–80 years was 36% [
2]. In a cross-sectional study conducted in Hong Kong, China, the prevalence of poor sleep quality among 5001 adults was 39.4% [
3].
As is well-known, college students in the transition period from home to college, from adolescence to adulthood are one of the most sleep-deprived age groups [
4]. College students usually face numerous challenges, such as greater academic pressures, social obligations, internet distraction, being responsible for themselves, and erratic schedules. Carskadon and Davis [
5] found that students entering the college had less sleep time and delayed sleep onset. Sleep problems can trigger negative health outcomes, such as mood disturbance, fatigue, impaired concentration, and poor academic performance. Sleep problems are widespread among college students around the globe, especially in China. Problems of poor sleep quality and lack of sleep are common among college students in Hong Kong [
6]. Li et al. included 82,055 Chinese college students for meta-analysis, with an average sleep time of 7.08 h/day. The proportion of students who slept less than 6 h/day and 7 h/day (short sleep) was 8.4 and 43.9%, respectively. The average bedtime is 12:51 a.m. The proportion of students with large sleep latency (time taken to fall asleep) of more than 30 min was 25.5% [
7,
8]. Short sleep duration and unhealthy sleep patterns are common among Chinese university students [
9]. Previous studies revealed that a considerable prevalence of poor sleep quality among this population ranged from 19.17 to 57.5% depending on the definition and measure used [
10,
11].
Poor sleep quality is associated with a number of factors, including demographic characteristics, behavioral and lifestyle factors, physical activity, psychological factors, and chronic diseases. With age, sleep changes, such as shorter sleep time and increased sleep fragmentation [
12]. Zhang et al. found that diseases and increased chronic diseases within 2 weeks in middle-aged and elderly patients were the main physiological health-related factors leading to poor sleep. Physical health may be a major determinant of sleep quality [
13]. Wang et al. showed that advanced age, smoking, irregular diet, lack of physical exercise, poor mental health, chronic diseases, or multiple diseases were positively correlated with sleep deprivation [
14]. Internet addiction is very prevalent in college students, particularly in Asian communities [
15], and is closely associated with sleep problems [
16]. In addition, poor sleep quality is also associated with stress levels and education levels [
17].
Since the differences in social and cultural background between the East and the West cannot be neglected, the findings may not completely reflect the overall sleep characteristics of the Chinese population, including college students. Many studies on the prevalence of poor sleep quality and associated factors of college students were conducted in China, but other factors such as the family and social support have been overlooked, resulting in failing to obtain complete results.
The purpose of this study was to investigate the prevalence of poor sleep among college students in Jilin Province, China. We looked at factors that influence sleep quality, including demographics and lifestyle, as well as family and social support. Understanding these factors may help improve sleep quality, thereby promoting the development of strategies and raising the quality of life.
Results
A total of 6284 eligible questionnaires from undergraduate university student participants were completed in the study. The sample included 52.7% male and 47.3% female. The age of the students ranged from 15 to 25 years, and the mean age was 19.76 years (SD = 1.45). The number of students ≤20 years old and > 20 years old was 4550 and 1734 respectively. There were 2586 freshmen, 1966 sophomores, 1072 juniors, and 660 senior and senior five.
Table
1 shows the basic demographic differences between students with poor and good sleep quality. There were 4233 (69.0%) and 1951 (31.0%) with good and poor sleep quality, respectively. The difference in age groups and BMI was non-significant between subjects with good and poor sleep quality (. Students in lower grades had a higher prevalence of poor sleep quality than students in higher grades (
p<0.05).
Table 1
Basic demographic characteristics and sleep quality
Age |
≤ 20 | 4550 | 72.4% | 3106(68.3) | 1444(31.7) | 1.000 | | |
> 20 | 1734 | 27.6% | 1227(70.8) | 507(29.2) | 1.044 | 0.871–1.252 | 0.638 |
Gender |
Male | 3310 | 52.7% | 2284(69.0) | 1026(31.0) | 1.000 | | |
Female | 2974 | 47.3% | 2049(68.9) | 925(31.1) | 1.017 | 0.888–1.166 | 0.804 |
Ethnicity |
Han | 5737 | 91.3% | 3955(68.9) | 1782(31.1) | 1.000 | | |
Minority | 547 | 8.7% | 378(69.1) | 169(30.9) | 0.999 | 0.815–1.225 | 0.993 |
BMI (kg/m2) |
< 18.5 | 1158 | 18.5% | 813(70.2) | 345(29.8) | 1.000 | | 0.228 |
18.5–23.9 | 4054 | 64.5% | 2785(68.7) | 1269(31.3) | 0.769 | 0.588–1.005 | 0.055 |
24–27.9 | 774 | 12.3% | 543(70.2) | 231(29.8) | 0.825 | 0.645–1.056 | 0.127 |
≥ 28 | 298 | 4.7% | 192(64.4) | 106(35.6) | 0.771 | 0.581–1.022 | 0.071 |
Grade |
Freshman | 2586 | 41.2% | 1755(67.9) | 831(32.1) | 1.000 | | 0.002 |
Sophomore | 1966 | 31.3% | 1337(68.0) | 629(32.0) | 0.873 | 0.760–1.002 | 0.054 |
Junior | 1072 | 17.0% | 759(70.8) | 313(29.2) | 0.677 | 0.550–0.834 | < 0.001 |
Senior and senior five | 660 | 10.5% | 482(73.0) | 178(27.0) | 0.663 | 0.508–0.866 | 0.003 |
Monthly family income per capita (¥) |
< 3000 | 2909 | 46.3% | 1974(67.9) | 1974(32.1) | 1.000 | | 0.901 |
3000–4999 | 1916 | 30.5% | 1343(70.1) | 1343(29.9) | 1.029 | 0.891–1.188 | 0.695 |
5000–6999 | 842 | 13.4% | 589(70.0) | 589(30.0) | 1.005 | 0.830–1.217 | 0.961 |
≥ 7000 | 617 | 9.8% | 427(69.2) | 427(30.8) | 1.085 | 0.864–1.362 | 0.481 |
Monthly living expenses (¥) |
< 1000 | 2036 | 32.4% | 1367(67.1) | 669(32.9) | 1.000 | | 0.087 |
1000–2000 | 3646 | 58.0% | 2537(69.6) | 1109(30.4) | 0.874 | 0.762–1.004 | 0.057 |
2001–3000 | 467 | 7.4% | 338(72.4) | 129(27.6) | 0.829 | 0.636–1.082 | 0.168 |
> 3000 | 135 | 2.1% | 91(67.4) | 44(32.6) | 1.245 | 0.796–1.947 | 0.336 |
Table
2 provides for differences in lifestyle factors and subgroups with good or poor sleep quality. Among students who drank alcohol (p<0.001), had higher academic pressure (p<0.001), more days of school absenteeism (p<0.001), had often self-injurious behaviors (p<0.05), gambled (p<0.05), and regularly exercised less than one day a week (p<0.05), there was a higher prevalence of poor sleep quality.
Table 2
Univariate logistic regression analysis of lifestyle factors with sleep quality
Tobacco use |
yes | 354 | 5.6% | 232(65.5) | 122(34.5) | 1.000 | | |
no | 5930 | 94.4% | 4101(69.2) | 1829(30.8) | 0.927 | 0.716–1.200 | 0.564 |
Alcohol use | | | | | | |
yes | 4394 | 69.9% | 2880(65.5) | 1514(34.5) | 1.000 | | |
no | 1890 | 30.1% | 1453(76.9) | 437(23.1) | 0.607 | 0.528–0.697 | < 0.001 |
Study pressure of this academic year |
no | 887 | 14.1% | 733(82.6) | 154(17.4) | 1.000 | | < 0.001 |
smaller | 903 | 14.4% | 676(74.9) | 227(25.1) | 1.381 | 1.082–1.762 | 0.009 |
general | 2611 | 41.5% | 1894(72.5) | 717(27.5) | 1.535 | 1.245–1.893 | < 0.001 |
larger | 1488 | 23.7% | 846(56.9) | 642(43.1) | 3.032 | 2.437–3.772 | < 0.001 |
great | 395 | 6.3% | 184(46.6) | 211(53.4) | 4.848 | 3.672–6.401 | < 0.001 |
Days off from school(/month) | | | | | < 0.001 |
0 | 5049 | 80.3% | 3591(71.1) | 1458(28.9) | 1.000 | | < 0.001 |
< 1 | 574 | 9.1% | 348(60.6) | 226(39.4) | 1.587 | 1.307–1.926 | < 0.001 |
1–2 | 395 | 6.3% | 260(65.8) | 135(34.2) | 1.371 | 1.067–1.762 | 0.014 |
3–4 | 110 | 1.8% | 57(51.8) | 53(48.2) | 2.076 | 1.366–3.157 | < 0.001 |
≥ 5 | 156 | 2.5% | 77(49.4) | 79(50.6) | 1.914 | 1.326–2.764 | < 0.001 |
Self-injurious behaviors |
never | 5929 | 94.4% | 4134(69.7) | 1795(30.3) | 1.000 | | 0.002 |
Occasionally | 196 | 3.1% | 106(54.1) | 90(45.9) | 1.575 | 1.141–2.175 | 0.006 |
sometimes | 75 | 1.2% | 52(69.3) | 23(30.7) | 0.798 | 0.444–1.435 | 0.452 |
often | 84 | 1.3% | 41(48.8) | 43(51.2) | 2.018 | 1.165–3.495 | 0.012 |
Suicidal ideation in the past 12 months |
yes | 576 | 9.20% | 338(58.7) | 238(41.3) | 1.219 | 0.989–1.503 | 0.064 |
no | 5708 | 90.80% | 3995(70.0) | 1713(30.0) | 1.000 | | |
Gambling behaviors |
yes | 1137 | 18.1% | 734(64.6) | 403(35.4) | 1.000 | | |
no | 5147 | 81.9% | 3599(69.9) | 1548(30.1) | 0.852 | 0.732–0.990 | 0.037 |
Exercise for more than 30 min (days/week) |
0 | 1526 | 24.3% | 961(63) | 565(37) | 1.000 | | 0.002 |
1–2 | 2687 | 42.8% | 1893(70.5) | 794(29.5) | 0.768 | 0.663–0.888 | < 0.001 |
3–4 | 1128 | 18.0% | 807(71.5) | 321(28.5) | 0.737 | 0.612–0.886 | 0.001 |
5–7 | 943 | 15.0% | 672(71.3) | 271(28.7) | 0.822 | 0.676–0.999 | 0.049 |
Table
3 shows the family and social support and subgroups with good or poor sleep quality and reveals that students who lacked communication with parents (p<0.05), were dissatisfied with their parental love (p<0.05), and had disharmonious family relationships (p<0.05), were significantly more likely to be poor sleepers. As for social support related factors, often go to Bar/Karaoke hall/Song and dance hall with friends (p<0.05) were also significantly associated with poor sleep quality.
Table 3
Univariate logistic regression analysis of family and social support with sleep quality
Family relationship |
Very harmonious | 3884 | 61.8% | 2870(73.9) | 1014(26.1) | 1.000 | | < 0.001 |
Harmonious | 1822 | 29.0% | 1142(62.7) | 680(37.3) | 1.260 | 1.088–1.459 | 0.002 |
Neutral | 442 | 7.0% | 262(59.3) | 180(40.7) | 1.270 | 0.980–1.647 | 0.071 |
Disharmonious | 69 | 1.1% | 31(44.9) | 38(55.1) | 2.026 | 1.166–3.522 | 0.012 |
Highly disharmonious | 67 | 1.1% | 28(41.8) | 39(58.2) | 2.395 | 1.356–4.228 | 0.003 |
Parental marital status |
Harmonious | 5402 | 86.0% | 3805(70.4) | 1597(29.6) | 1.000 | | 0.847 |
Frequent quarrel | 494 | 7.9% | 295(59.7) | 199(40.3) | 0.984 | 0.778–1.244 | 0.893 |
Separation | 79 | 1.3% | 46(58.2) | 33(41.8) | 1.204 | 0.724–2.001 | 0.475 |
Divorce | 309 | 4.9% | 187(60.5) | 122(39.5) | 1.073 | 0.814–1.415 | 0.617 |
Communication with parents |
Substantial | 1567 | 24.9% | 1186(75.7) | 381(24.3) | 1.000 | | < 0.001 |
Often | 2290 | 36.4% | 1594(69.6) | 696(30.4) | 1.777 | 1.025–3.079 | 0.040 |
Neutral | 1857 | 29.6% | 1162(62.6) | 695(37.4) | 2.511 | 1.486–4.242 | < 0.001 |
Rarely | 398 | 6.3% | 253(63.6) | 145(36.4) | 2.172 | 1.285–3.671 | 0.004 |
Never | 172 | 2.7% | 138(80.2) | 34(19.8) | 1.997 | 1.179–3.383 | 0.010 |
Satisfaction with paternal love |
Very satisfied | 3091 | 49.2% | 2252(72.9) | 839(27.1) | 1.000 | | 0.026 |
Satisfied | 2019 | 32.1% | 1362(67.5) | 657(32.5) | 1.288 | 0.756–2.197 | 0.352 |
Neutral | 786 | 12.5% | 471(59.9) | 315(40.1) | 0.795 | 0.500–1.265 | 0.333 |
Dissatisfied | 174 | 2.8% | 94(54.0) | 80(46.0) | 0.687 | 0.437–1.081 | 0.104 |
Very dissatisfied | 214 | 3.4% | 154(72.0) | 60(28.0) | 0.702 | 0.446–1.103 | 0.125 |
Satisfaction with maternal love |
Very satisfied | 3750 | 59.7% | 2677(71.4) | 1073(28.6) | 1.000 | | 0.011 |
Satisfied | 1855 | 29.5% | 1215(65.5) | 640(34.5) | 0.698 | 0.352–1.384 | 0.304 |
Neutral | 397 | 6.3% | 236(59.4) | 161(40.6) | 1.553 | 0.868–2.780 | 0.138 |
Dissatisfied | 113 | 1.8% | 77(68.1) | 36(31.9) | 1.688 | 0.976–2.919 | 0.061 |
Very dissatisfied | 169 | 2.7% | 128(75.7) | 41(24.3) | 1.652 | 0.957–2.852 | 0.072 |
Relationship with classmates |
Very harmonious | 1791 | 28.5% | 1371(76.5) | 420(23.5) | 1.000 | | < 0.001 |
Harmonious | 3164 | 50.4% | 2191(69.2) | 973(30.8) | 1.696 | 0.762–3.772 | 0.196 |
Neutral | 1157 | 18.4% | 659(57.0) | 498(43.0) | 1.308 | 0.664–2.578 | 0.438 |
Disharmonious | 80 | 1.3% | 45(56.3) | 35(43.8) | 0.878 | 0.446–1.732 | 0.708 |
Highly disharmonious | 92 | 1.5% | 67(72.8) | 25(27.2) | 0.785 | 0.398–1.550 | 0.486 |
Number of good friends |
None | 147 | 2.3% | 91(61.9) | 56(38.1) | 1.000 | | 0.415 |
One | 233 | 3.7% | 150(64.4) | 83(35.6) | 0.694 | 0.413–1.168 | 0.169 |
Two | 826 | 13.1% | 524(63.4) | 302(36.6) | 0.793 | 0.496–1.268 | 0.332 |
Three and above | 5078 | 80.8% | 3568(70.3) | 1510(29.7) | 0.730 | 0.464–1.149 | 0.174 |
Places often going with friends |
Gymnasium | 1662 | 26.40% | 1258(75.7) | 404(24.3) | 1.000 | | 0.002 |
Bar/Karaoke hall/Song and dance hall | 809 | 12.90% | 509(62.9) | 300(37.1) | 1.391 | 1.137–1.702 | 0.001 |
Billiard hall | 301 | 4.80% | 216(71.8) | 85(28.2) | 0.996 | 0.740–1.341 | 0.979 |
Internet cafes | 630 | 10.00% | 449(71.3) | 181(28.7) | 1.020 | 0.814–1.278 | 0.861 |
Other | 2882 | 45.90% | 1901(66.0) | 981(34.0) | 1.286 | 1.101–1.503 | 0.002 |
boyfriend or girlfriend |
Yes | 1587 | 25.3% | 1125(70.9) | 462(29.1) | 1.000 | | |
No | 4697 | 74.7% | 3208(68.3) | 1489(31.7) | 1.142 | 0.997–1.308 | 0.056 |
Collinearity diagnosis was conducted for variables with a statistically significant difference in univariate logistic regression analysis, and variables with VIF<3 were included in the multivariable logistic regression (Table
4).
Table 4
The diagnosis of multicollinearity in univariate logistic regression analysis of sleep quality of college students
Gender | 1.056 | Family relationship | 1.288 |
Alcohol use | 1.062 | Communication with parents | 1.547 |
Study pressure of this academic year | 1.032 | Satisfaction with paternal love | 2.296 |
Days off from school(/month) | 1.210 | Satisfaction with maternal love | 2.311 |
Self-injurious behaviors | 1.242 | Relationship with classmates | 1.240 |
Gambling behaviors | 1.044 | Places often going with friends | 1.065 |
Exercise for more than 30 min (days/week) | 1.081 | | |
The results of the multivariable logistic regression show that students in the lower grades had an increased risk of poor sleep quality (p<0.05). Specifically, freshman and sophomore had a higher risk compared with that senior and senior five (OR = 1.523, 95% CI: 1.168–1.987; OR = 1.327, 95% CI; 1.030–1.709). Alcohol use (OR = 1.634, 1.425–1.874) was significantly associated with poor sleep quality (p<0.05). Gambling behaviors (OR = 1.167, 95% CI: 1.005–1.356) was also shown to be a risk factor (p<0.05). Students who exercised for more than 30 min a week on less than one day (OR = 1.234, 95% CI: 1.016–1.498) had a higher risk of poor sleep quality than those who exercised for 5 to 7 days a week). Feelings of satisfied with parental (OR = 1.849, 95% CI: 1.244–2.749), and harmonious/neutral relationship with classmates (OR = 2.206, 95% CI: 1.312–3.708; OR = 1.700, 95% CI: 1.414–2.045) were also risk factors (p<0.05). Students with study pressure of this academic year had an increased risk during poor sleep quality (p<0.001). Students with no study pressure (OR = 0.210, 95% CI: 0.159–0.276) and had the lowest sleep risk than those with great study pressure. Students who did not skip school (OR = 0.510, 95% CI: 0.354–0.735) had a lower risk of poor sleep quality than those who stayed away from school for more than 5 days in the past month. A lower risk was also found for students who never (OR = 0.413, 95% CI: 0.245–0.698) and sometimes (OR = 0.372, 95% CI: 0.180–0.769) had self-injurious behaviors compared to students who often self-injurious behaviors.
In comparison with highly disharmonious family relationships, very harmonious (OR = 0.377, 95% CI: 0.219–0.650), harmonious (OR = 0.473, 95% CI: 0.274–0.817) and neutral family relationships (OR = 0.498, 95% CI: 0.282–0.879) had a lower risk of poor sleep quality. Frequent communication with parents (OR = 0.524, 95% CI: 0.312–0.880), the feelings of satisfied with maternal love (OR = 0.432, 95% CI: 0.257–0.725) and often went to the gymnasium (OR = 0.770, 95% CI: 0.659–0.899) were the protective factors of poor sleep quality (Table
5).
Table 5
Multivariable logistic regression of factors associated with poor sleep quality
Age |
≤ 20 | −0.043 | 0.092 | 0.219 | 0.640 | 0.958 | 0.800–1.147 |
> 20 | | | | | 1.000 | |
Gender |
Male | 0.004 | 0.067 | 0.004 | 0.948 | 1.004 | 0.880–1.146 |
Female | | | | | 1.000 | |
Grade |
Freshman | 0.421 | 0.136 | 9.645 | 0.002 | 1.523 | 1.168–1.987 |
Sophomore | 0.283 | 0.129 | 4.798 | 0.028 | 1.327 | 1.030–1.709 |
Junior | 0.029 | 0.123 | 0.055 | 0.815 | 1.029 | 0.809–1.308 |
Senior and senior five | | | | 1.000 | |
Alcohol use |
yes | 0.491 | 0.070 | 49.346 | < 0.001 | 1.634 | 1.425–1.874 |
no | | | | | 1.000 | |
Study pressure of this academic year |
no | −1.563 | 0.140 | 123.709 | < 0.001 | 0.210 | 0.159–0.276 |
smaller | −1.249 | 0.134 | 87.531 | < 0.001 | 0.287 | 0.221–0.373 |
general | −1.150 | 0.117 | 96.568 | < 0.001 | 0.317 | 0.252–0.398 |
larger | −0.464 | 0.120 | 14.857 | < 0.001 | 0.629 | 0.497–0.796 |
great | | | | | 1.000 | |
Days off from school(/month) |
0 | −0.673 | 0.186 | 13.091 | < 0.001 | 0.510 | 0.354–0.735 |
< 1 | −0.214 | 0.204 | 1.102 | 0.294 | 0.807 | 0.541–1.204 |
1–2 | −0.381 | 0.213 | 3.189 | 0.074 | 0.683 | 0.450–1.038 |
3–4 | 0.044 | 0.269 | 0.027 | 0.870 | 1.045 | 0.617–1.770 |
≥ 5 | | | | | 1.000 | |
Self-injurious behaviors |
never | −0.883 | 0.268 | 10.897 | 0.001 | 0.413 | 0.245–0.698 |
Occasionally | −0.389 | 0.302 | 1.666 | 0.197 | 0.678 | 0.375–1.224 |
sometimes | −0.988 | 0.370 | 7.123 | 0.008 | 0.372 | 0.180–0.769 |
often | | | | | 1.000 | |
Gambling behaviors |
yes | 0.154 | 0.076 | 4.082 | 0.043 | 1.167 | 1.005–1.356 |
no | | | | | 1.000 | |
Exercise for more than 30 min (days/week) |
0 | 0.210 | 0.099 | 4.512 | 0.034 | 1.234 | 1.016–1.498 |
1–2 | −0.067 | 0.090 | 0.551 | 0.458 | 0.935 | 0.784–1.116 |
3–4 | −0.107 | 0.104 | 1.048 | 0.306 | 0.899 | 0.732–1.103 |
5–7 | | | | | 1.000 | |
Family relationship |
Very harmonious | −0.975 | 0.278 | 12.292 | < 0.001 | 0.377 | 0.219–0.650 |
Harmonious | −0.748 | 0.278 | 7.225 | 0.007 | 0.473 | 0.274–0.817 |
Neutral | −0.698 | 0.290 | 5.783 | 0.016 | 0.498 | 0.282–0.879 |
Disharmonious | −0.191 | 0.372 | 0.264 | 0.608 | 0.826 | 0.398–1.714 |
Highly disharmonious | | | | | 1.000 | |
Communication with parents |
Substantial | −0.646 | 0.265 | 5.969 | 0.015 | 0.524 | 0.312–0.880 |
Often | −0.106 | 0.148 | 0.513 | 0.474 | 0.899 | 0.672–1.203 |
Neutral | 0.223 | 0.096 | 5.371 | 0.020 | 1.249 | 1.035–1.508 |
Rarely | 0.077 | 0.084 | 0.827 | 0.363 | 1.080 | 0.915–1.274 |
Never | | | | | 1.000 | |
Satisfaction with paternal love |
Very satisfied | 0.360 | 0.228 | 2.487 | 0.115 | 1.433 | 0.916–2.240 |
Satisfied | 0.615 | 0.202 | 9.227 | 0.002 | 1.849 | 1.244–2.749 |
Neutral | 0.134 | 0.120 | 1.253 | 0.263 | 1.144 | 0.904–1.448 |
Dissatisfied | −0.020 | 0.092 | 0.049 | 0.825 | 0.980 | 0.818–1.174 |
Very dissatisfied | | | | | 1.000 | |
Satisfaction with maternal love |
Very satisfied | −0.499 | 0.278 | 3.238 | 0.072 | 0.607 | 0.352–1.046 |
Satisfied | −0.840 | 0.265 | 10.074 | 0.002 | 0.432 | 0.257–0.725 |
Neutral | −0.045 | 0.151 | 0.090 | 0.765 | 0.956 | 0.712–1.284 |
Dissatisfied | 0.016 | 0.091 | 0.030 | 0.863 | 1.016 | 0.850–1.214 |
Very dissatisfied | | | | | 1.000 | |
Relationship with classmates |
Very harmonious | 0.412 | 0.317 | 1.686 | 0.194 | 1.509 | 0.811–2.809 |
Harmonious | 0.791 | 0.265 | 8.912 | 0.003 | 2.206 | 1.312–3.708 |
Neutral | 0.531 | 0.094 | 31.805 | < 0.001 | 1.700 | 1.414–2.045 |
Disharmonious | 0.107 | 0.076 | 1.972 | 0.160 | 1.113 | 0.958–1.293 |
Highly disharmonious | | | | | 1.000 | |
Places often going with friends |
Gymnasium | −0.261 | 0.079 | 10.914 | 0.001 | 0.770 | 0.659–0.899 |
Bar/Karaoke hall/Song and dance hall | 0.080 | 0.092 | 0.768 | 0.381 | 1.084 | 0.905–1.297 |
Billiard hall | −0.258 | 0.148 | 3.056 | 0.080 | 0.773 | 0.579–1.032 |
Internet cafes | −0.259 | 0.110 | 5.502 | 0.019 | 0.772 | 0.622–0.958 |
Other | | | | | 1.000 | |
Differences between the genders for the seven PSQI components are depicted in Appendix 2. The mean sleep quality score was 4.51 (
SD = 2.52), the median sleep latency was 10.0 min (P25-P75, 5.0–20.0), the mean sleep efficiency was 96.21% (
SD = 3.85), the mean sleep duration was 7.47 h (
SD = 1.15), and of them, 1.97, 9.01, 29.46, and 59.56% were in < 5/5−/6−/> 7(h) sleep duration subgroups, respectively. Table
5 shows that males scored significantly higher than females on sleep duration (
p = 0.012) and use of sleep medication (
p = 0.013), while females scored significantly higher than males on PSQI total (
p = 0.041) and sleep disturbances (
p < 0.001). No significant difference was observed in subjective sleep quality, sleep latency, sleep efficiency, and daytime dysfunction between males and females.
Discussion
The present study explored the prevalence and associated factors of poor sleep quality among college students in Jilin province, China. With the cut-off (PSQI > 5), our findings of the PSQI total mean score of 4.51 (
SD = 2.52) and the 31.0% prevalence of poor sleep quality were similar to those found in a study conducted in Taiwan university students [
22], who had the PSQI total mean score of 4.9 (
SD = 2.4) and a 33.8% prevalence of poor sleep quality. Furthermore, our result is lower than the prevalence of poor sleep quality in a general university sample in Ethiopia (55.8%) [
23] and in Hong Kong (57.5%) [
10], but higher than another study of medical students in China (19.2%) [
11].
Based on the basic demographic results, students in lower grades had a higher prevalence of poor sleep quality compared with those in the higher grades. Freshmen might be more susceptible to the new freedoms of living away from home for the first time and have little experience in dealing with the academic rigor of the curriculum. Similar results were found in the previous study [
24]. No significant differences were found between males and females in the prevalence of poor sleep quality; this seems to contradict other previous reports [
3,
25]. We also found no association between sleep quality and BMI in college students, while other studies reported sleep quality had a significant association with BMI in the general population [
26,
27]. Ethnicity, age structure, region, socioeconomic level, and lifestyle might be partly responsible for the differences [
13,
26,
28,
29].
Regarding lifestyle, in the present study poor sleep quality was found to be associated with alcohol use, study pressure, days off from school, self-injurious behaviors, suicidal ideation, gambling, and physical exercise. Smoking is considered as a negative factor for improving sleep quality [
30], but this was not observed in our study.
This work also found that poor sleep quality was associated with family and social support. A study demonstrated that family and social support may be an important determinant of sleep quality in the elderly [
30,
31]. Daytime emotional stress, which may be disrupted by the interpersonal environment, has a strong relationship with sleep quality [
32]. Therefore, this study found the association between social support and sleep quality is reasonable.
Our multiple logistic regression results also showed that lower grade, disharmonious family relationships, less frequent communication with parents, alcohol use, study pressure, more days of school absenteeism, self-injurious, suicidal ideation, and physical exercise more often could increase the odds of poor sleep quality after controlling gender and age.
The sleep quality of female students was not worse than that of male students in terms of global PSQI scores and sleep disturbances. The only two significant gender findings were that male students had worse sleep quality in terms of sleep duration and use of sleep medication relative to female students.
Nevertheless, there existed some limitations. First, due to the cross-sectional design of this study, the causal relationship between sleep quality and factors could not be determined; further multi-center and longitudinal studies need to be done. Second, the study only covered college students in just Jilin Province, so the results may not necessarily be generalized to the whole country’s undergraduate population or the Chinese college-aged population. Third, we cannot rule out the possibility that our results are due to unmeasured variables (such as dietary intake, use of the Internet and chronic diseases) that might affect sleep quality, or to chance. Fourth, this study used a self-reported approach to collect data, including height, weight, and sleep quality, which may be subject to some reporting errors. However, the simple self-estimation of the height and weight of college students is accurate enough to be used in place of measurement [
21]. Moreover, the validated and structured questionnaire has been regularly incorporated into the large epidemiologic field surveys [
33]. Fifth, the methods used to access some of the questions in the questionnaire may not be accurate enough. For example, exercise intensity was measured by “how many days per week do you exercise for more than 30 minutes at a time?”. There may be a lack of evidence that family and social support measures have validity and sound psychometric properties. Finally, the limitations of using PSQI to assess sleep quality studies also have been pointed out by other studies, despite its widespread use. The previous study demonstrated that the PSQI sleep parameters appeared to be more biased compared with the Self-Assessment of Sleep Survey and the Self-Assessment of Sleep Survey Split [
34].
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