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Insomnia is a prevalent sleep disorder affecting cognitive functions critical to academic performance. University students, particularly in high-stress academic settings, are highly vulnerable. Despite its significant impact on students' health and education, there is limited research on the prevalence of insomnia among university students in Saudi Arabia. This systematic review and meta-analysis aim to assess the prevalence of insomnia among university students in Saudi Arabia, focusing on demographic variations and academic settings, to provide evidence for targeted interventions.
Methods
A comprehensive literature search was conducted across databases including PubMed, Scopus, and Web of Science, with additional manual searches. Inclusion criteria were cross-sectional studies addressing insomnia prevalence among Saudi university students, using standard diagnostic criteria. A total of 11 studies met the inclusion criteria, comprising data from diverse faculties, including medical and non-medical disciplines. Quality assessment was conducted using the Newcastle-Ottawa Scale. Statistical analyses were performed using a random-effects model to account for heterogeneity.
Results
Eleven studies, involving a total of 8297 university students, were included in the analysis. Insomnia prevalence varied widely, ranging from 19.3% to 98.7%, with a pooled prevalence of 43.3% (95% CI 28.9–58.2%). Subgroup analyses showed a prevalence of 38.6% among medical students and 38.7% among female students. The analysis revealed high heterogeneity (I2 = 99.17%), indicating significant variability in study designs, populations, and diagnostic methods.
Conclusions
Insomnia is highly prevalent among university students in Saudi Arabia, with significant variations across demographics and academic contexts. The findings underscore the urgent need for targeted interventions, including stress management, improved sleep hygiene education, and support systems to mitigate the impact of insomnia on academic performance and overall health. Future research should explore the longitudinal impacts of insomnia and the efficacy of tailored interventions in this population.
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AIS
Athens Insomnia Scale
BQ
Berlin Questionnaire
BIS
Bergen Insomnia Scale
CBT-I
Cognitive Behavioral Therapy for Insomnia
CS
Cross-sectional study
ISI
Insomnia Severity Index
M
Male
F
Female
NR
Not reported
Background
Sleep is an essential component of human physiology, significantly influencing cognitive functions critical to academic achievement [1]. For young adults, the recommended amount of sleep is 7–9 h per night [2]. However, inadequate sleep negatively impacts brain functions, leading to impaired attention, memory, decision-making, problem-solving, and critical thinking [3]. Insomnia, as defined by the American Academy of Sleep Medicine, is a clinically significant sleep disorder characterized by difficulty falling asleep, difficulty staying asleep, early morning awakenings, or nonrestorative sleep, leading to poor sleep quality and subsequent daytime impairments [4]. This disorder is closely associated with diminished academic performance due to the lack of restful sleep [5]. Globally, approximately one-third of the population suffers from insomnia, which is associated with low sleep quality or quantity [6].
Insomnia is categorized into acute (short-term) and chronic (long-term) types [3]. Acute insomnia involves difficulty falling or staying asleep, accompanied by daytime symptoms such as exhaustion and lethargy, lasting less than 3 months and occurring fewer than three times a week [7]. In contrast, chronic insomnia exhibits similar symptoms but persists for more than 3 months, occurring at least three times a week [7, 8]. Statistics indicate that up to 20% of individuals experience acute insomnia, while 10% suffer from chronic insomnia [3].
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The etiology of insomnia can be classified into primary and secondary causes. Primary insomnia is often triggered by stress, unpleasant events, and lifestyle factors such as alcohol consumption, cigarette smoking, and caffeine intake, which disrupt the sleep pattern [9]. Secondary insomnia is linked to medical conditions or medications that interfere with sleep. Conditions such as diabetes, asthma, GERD, and obstructive sleep apnea, along with certain prescription medications, significantly impact sleep quality [10]. Recognizing the symptoms of insomnia—such as daytime fatigue, drowsiness, irritability, impaired concentration, and increased errors and accidents—is crucial, as these symptoms not only threaten daily functioning but also have severe health implications, increasing the risk of hypertension, anxiety, and other mental health issues [9].
Several treatment approaches for insomnia exist, with cognitive behavioral therapy (CBT-I) being the most commonly used. CBT-I involves improving sleep hygiene, changing unhealthy habits, and enhancing sleep quality [11]. In addition, sedative medications and natural supplements like melatonin are often employed to promote sleep and reduce anxiety related to sleep issues [9]. Preventive measures include establishing regular bedtime schedules, avoiding naps, and minimizing screen time before bed [9].
Insomnia can have detrimental physical and mental effects, particularly on students, who often experience poor sleep quality during exams and presentations [12]. Despite the significant burden of insomnia among students, there is a scarcity of scientific research addressing its prevalence and impact on academic performance among university students in Saudi Arabia. Students are especially vulnerable to insomnia due to academic pressures, competition, and concerns about the future [13]. A systematic analysis of studies from various countries, including the United States, Libya, Egypt, and Nigeria, reveals a high prevalence of insomnia among university students [14‐17]. However, research specifically focused on university students in Saudi Arabia is limited, with existing studies primarily targeting medical students [18, 19].
Several risk factors contribute to insomnia among students, including demographic factors like age and gender, social factors such as sleep hygiene, and health issues like physical and mental disorders [6]. A family history of mental health problems, coexisting psychiatric disorders, and high levels of stress and anxiety further increase the risk of insomnia [20]. Poor-quality sleep is a high-risk factor for adverse health outcomes, impacting students' quality of life and academic performance [21]. Insomnia is also associated with daytime somnolence, substance use, suicidal ideation, smoking, and alcohol use, and it negatively impacts driving performance, increasing the risk of road traffic accidents [13].
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Given the profound impact of insomnia on students' lives and academic performance, this systematic review and meta-analysis aim to comprehensively assess the prevalence of insomnia among university students in Saudi Arabia, focusing on different demographics and academic settings. This study provides valuable insights into the extent of the problem and highlights the need for targeted interventions to address insomnia among this vulnerable population.
Methods
Search strategy
To thoroughly identify studies relevant to our focus, we devised a detailed search strategy that utilized major databases such as PubMed, Scopus, Web of Science, and the Cochrane Library. Our search encompassed literature published up to the current year, capturing the most recent studies available. The search was designed using a combination of Medical Subject Headings (MeSH) terms and free-text words to cover all potentially relevant articles comprehensively. The primary search terms included “insomnia,” “sleep disorders,” “university students,” and “Saudi Arabia.” These terms were linked using Boolean operators “AND” and “OR” to include various combinations of keywords and phrases. For example, our PubMed search string was: (“insomnia” OR “sleep disorders”) AND “university students” AND “Saudi Arabia.”
To expand our search and ensure that no relevant study was missed, we included regional databases such as the Saudi Medical Literature Database. In addition, we manually reviewed the reference lists of the identified articles and related review papers to discover any studies that might not have been captured in our initial electronic database searches.
Inclusion and exclusion criteria
Our systematic review and meta-analysis adhered to specific inclusion and exclusion criteria to ensure the relevance and quality of the studies. We exclusively included cross-sectional studies that investigated the prevalence of insomnia among university students in Saudi Arabia. These studies needed to provide detailed data on the prevalence or incidence of insomnia, diagnosed according to recognized clinical standards, such as the Diagnostic and Statistical Manual of Mental Disorders or the International Classification of Sleep Disorders [22, 23]. Our scope was limited to studies conducted within Saudi Arabia and published in English or Arabic to match our review capabilities.
On the exclusion side, we disregarded studies that were not cross-sectional, including clinical trials, reviews, editorials, and case reports. We also excluded studies that focused on populations other than university students in Saudi Arabia or those involving mixed populations where data specific to university students could not be extracted. Research that did not directly measure the prevalence of insomnia, or that used non-standard diagnostic criteria, was also omitted. Furthermore, studies conducted outside Saudi Arabia, those with incomplete data or lacking crucial methodological details, and those published in languages other than English or Arabic were excluded. This rigorous selection process aimed to ensure that our review accurately and comprehensively reflected the prevalence of insomnia among university students in Saudi Arabia.
Study selection
This study selection process was organized to guarantee comprehensive identification and assessment of relevant research. Initially, all identified articles were imported into EndNote to facilitate the removal of duplicates. The initial screening phase involved two independent reviewers evaluating the titles of the studies to eliminate those that were irrelevant or did not meet the study criteria. This step was followed by a detailed assessment of abstracts by the same reviewers to further refine our selection. Articles that were considered relevant at this stage were subjected to a full-text review conducted by another set of independent reviewers to confirm their eligibility based on our predefined criteria. This extensive evaluation process allowed for a thorough examination of the methodologies, populations studied, and outcomes reported in each study. Any discrepancies encountered at any stage of the selection process were resolved through discussion, or if necessary, by consulting a third reviewer to make a decisive judgment. In addition, we conducted a manual search of references listed in the selected studies to ensure no significant literature was overlooked, thus maintaining the integrity and thoroughness of our review.
Data collection
In our systematic review and meta-analysis, we executed a data collection process focusing on the prevalence of insomnia among university students in Saudi Arabia. The data were extracted from a selection of cross-sectional studies, each examined for pertinent details. This process involved recording the primary author and the year of publication to ensure the inclusion of the most recent and relevant data. The gender distribution of the study participants was noted, encompassing both male and female students. The specific universities where these studies were conducted were also documented to offer insights into the geographical and educational contexts across Saudi Arabia.
Moreover, we collected data on the age groups or academic years of the participating students, encompassing individuals from their first year to their senior year. The total number of participants in each study was recorded to gauge the scale of the research. A critical component of our data collection was the criteria or methods used to diagnose insomnia in these studies, which ranged from the use of standard insomnia severity indexes to customized sleep quality questionnaires. The prevalence rates of insomnia, as reported in each study, were also documented.
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Quality assessment
Assessing the methodological quality of the studies included in our review was paramount to ensure their reliability and to identify potential biases. We employed the Newcastle–Ottawa Scale (NOS) for this purpose, a well-recognized tool designed to evaluate observational studies. The NOS assesses studies based on three critical aspects: the selection of the study groups, the comparability of these groups, and the ascertainment of the exposure or outcome. The assessment criteria encompassed selection (max 4 points), comparability (max 2 points), and exposure/outcome (max 3 points), with a possible total of 9 points [24].
Each study was independently evaluated by two reviewers using the NOS criteria, involving a detailed scoring system that appraises the quality of selection, comparability, and outcome measures. These scores were then used to categorize the studies into three tiers of quality: high, moderate, and low. Studies achieving high scores in most of the NOS criteria were classified as high-quality, indicating a lower risk of bias. Studies meeting some of the criteria were deemed moderate quality, while those failing to meet several criteria were categorized as low quality, indicating a potential for higher bias. Discrepancies between reviewers regarding quality scores were resolved through discussion until a consensus was achieved, ensuring an unbiased and thorough evaluation.
Statistical analysis
In this study examining the prevalence of insomnia among university students in Saudi Arabia, we utilized Rayyan–Qatar Computing Research Institute (QCRI) as an effective tool for the systematic organization and selection of relevant articles [25]. This approach greatly enhanced the reliability of our data management and subsequent analyses. The statistical analysis was performed using STATA version 17 (StataCorp LP, College Station, TX, USA), a software chosen for its robust capabilities in managing complex meta-analytical data sets. Our meta-analysis aimed to determine the prevalence of insomnia among university students.
To address this objective, we implemented a random-effects model using the weighted inverse variance method, as described by Borenstein et al. [26]. This model was specifically selected to accommodate the expected high heterogeneity among the included studies, which varied in terms of study designs, student populations, and diagnostic methods used for insomnia. The results of our meta-analysis were visually depicted through forest plots, which clearly illustrated the pooled prevalence rates along with their respective 95% confidence intervals (CIs). This visual representation was instrumental in facilitating the interpretation of our findings. Furthermore, to evaluate the degree of variability and the robustness of this study conclusions, we applied the Higgins I2 test statistic. An I2 value over 50% was taken as an indication of substantial heterogeneity, which is often encountered in studies examining the prevalence of health conditions such as insomnia among diverse student populations.
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Results
A comprehensive literature search identified a total of 39 records through PubMed and other relevant research databases. Subsequent screening and elimination of duplicates refined the selection to 32 records. Following thorough screening and assessment for eligibility, 11 primary studies were included in the systematic review and meta-analysis (Fig. 1). The detailed characteristics of the included studies are presented in Table 1.
Fig. 1
Flow diagram of articles screening and selection process for studies
M male, F female, CS cross-sectional study, ISI insomnia severity index, AIS Athens Insomnia Scale, BQ Berlin questionnaire, BIS Bergen Insomnia Scale, NR not reported. ISI: Subthreshold insomnia (8–14 points); Clinical insomnia (moderate severity) (15–21 points); Clinical insomnia (severe) (22–28 points). AIS: Mild insomnia (6–9 points); Moderate insomnia (10–15), Severe insomnia (16–24)
Characteristics of the included studies
Among the studies included, all employed a cross-sectional design and were conducted across various universities in Saudi Arabia between 2011 and 2023, with publications ranging from 2016 to 2023. The study populations were university students with a focus on medical and health science faculties, though some studies also included students from other faculties such as computer science and business management. The mean age of the participants varied, with a range typically from early to late twenties, reflecting the diverse university stages from freshman year to graduate levels. The total number of participants in these studies ranged from 250 to 5,140, indicating a substantial variation in the study scale (Table 1).
Pooled estimates of insomnia disorders
Our meta-analysis focused on the prevalence of insomnia among university students, medical students, and specifically female students yielded significant findings across different settings and demographics.
The forest plot analysis revealed a wide range of insomnia prevalence among university students. The highest reported prevalence was by Alshehri in 2023, with a staggering 98.7%, and the lowest was by Albasheer in 2020 at 19.3%. The pooled prevalence from the meta-analysis stood at 43.3%, with a 95% confidence interval (CI) of 28.9–58.2%. The analysis displayed high heterogeneity (I-squared = 99.17%), indicative of varied insomnia rates across different studies, possibly due to diverse environmental and academic pressures faced by students (Fig. 2).
Fig. 2
Forest plot of the prevalence of Insomnia among University Students. Blue square boxes represent the prevalence
In a more focused analysis of medical students, the prevalence rates ranged from a high of 74.0% reported by Alfadeel in 2019 to a low of 21.1% by Mohamed in 2020. The pooled estimate of insomnia prevalence among medical students was calculated to be 38.6%, with a 95% CI of 23.4–55.0%. This subset of data also showed a high degree of heterogeneity (I-squared = 96.73%), reflecting the different stressors and academic demands encountered by medical students across various universities (Fig. 3).
Fig. 3
Forest plot of the prevalence of Insomnia among Medical Students. Blue square boxes represent the prevalence
Looking at female students, the prevalence of insomnia was notably high, with Alrashed in 2021 documenting the highest rate at 44.9%. The pooled prevalence for insomnia among female students was 38.7%, with a more constrained 95% CI of 32.8–44.8%. This group exhibited a moderate level of heterogeneity (I-squared = 67.03%), which could be attributed to varying societal, psychological, and physiological factors affecting female students differently across different cultural and educational environments (Fig. 4).
Fig. 4
Forest plot of the prevalence of Insomnia among Female Students. Blue square boxes represent the prevalence
Analysis of insomnia etiologies and contributing factors
Table 2 provides a comprehensive overview of the etiologies and contributing factors associated with insomnia among university students in Saudi Arabia, highlighting both the breadth and depth of the factors explored across various studies. Several studies, such as those by Alrashed and Alshehri, emphasized the significant role of psychological stress and academic pressure in contributing to insomnia [32, 36]. These studies pointed out that the stress related to academic performance, particularly among medical students, often leads to poor sleep quality and heightened insomnia symptoms. However, specific psychological traits like anxiety and obsessive personalities were explicitly analyzed only in a few studies, such as Mohamed, which identified a strong correlation between anxiety and insomnia [31].
Table 2
Overview of insomnia etiologies and contributing factors in university students in Saudi Arabia
Author
Study population
Anxious/obsessive personalities
Faulty lifestyle
Unhealthy sleep hygiene
Unhealthy food and obesity
Chronic medical/neurological problems
Notes on methodology
Alsaggaf
Medical students at King Abdulaziz University
N/A
N/A
The study evaluated sleep hygiene through the use of electronic devices before sleep and irregular sleep patterns
N/A
N/A
The study primarily focused on sleep patterns and disorders, such as the impact of electronic device usage on sleep quality, but it did not delve into detailed etiological factors like anxiety, lifestyle choices, or chronic health conditions
Mansour
Medical students at Taibah University
The study recognized the potential impact of anxiety related to academic performance on sleep quality, noting a significant association between insomnia and students' fear of academic failure
Lifestyle factors were partially examined, particularly through the analysis of fast-food consumption and soft drink preferences, which were linked to increased sleep disturbances
The study explored unhealthy sleep hygiene by assessing sleep patterns, difficulty falling asleep, and the use of sleep medication, which were associated with insomnia
The study analyzed the frequency of fast-food consumption and its correlation with insomnia, highlighting the role of poor dietary habits in sleep disturbances
The presence of medical problems was recorded, and their association with insomnia was examined, though not in extensive detail
The study provided a moderate analysis of lifestyle factors and their relationship with insomnia, focusing on diet and sleep patterns, but it did not deeply explore psychological factors like anxiety or chronic health issues
Alfadeel
Female medical students at Almaarefa Colleges
The study did not explicitly focus on anxious or obsessive personality traits, though it acknowledged that stress from academic demands might indirectly affect sleep
Faulty lifestyle factors were examined, particularly in relation to study hours and exam-related stress, which were found to contribute to insomnia
Unhealthy sleep hygiene was analyzed through the assessment of sleep hours, bedtime routines, and the impact of academic pressure, all of which were linked to insomnia
The study explored the relationship between insomnia and obesity, as well as other chronic medical conditions, showing a significant correlation between these factors and sleep disturbances
Chronic medical conditions, including chronic pain and obesity, were specifically analyzed for their association with insomnia, with significant findings reported
This study provided a thorough examination of the relationship between insomnia and various lifestyle factors, including academic pressure and chronic health conditions, but it lacked a detailed focus on psychological traits like anxiety
Albasheer
Students from various faculties at Jazan University
N/A
N/A
The study examined sleep quality and disturbances, including sleep duration and irregular sleep patterns, as primary factors
N/A
N/A
The research focused on general sleep disturbances and their prevalence across different faculties, without delving into specific etiologies like anxiety, lifestyle factors, or chronic health issues
Alturaiqy
University students at Qassim University
N/A
The study examined faulty lifestyle factors like irregular sleep patterns and insufficient sleep, which were associated with academic performance
Unhealthy sleep hygiene was analyzed through variables such as sleep duration, sleep satisfaction, and changes in sleep patterns during exams and holidays
N/A
N/A
The research provided a broad analysis of sleep disturbances among students, focusing on how sleep quality and duration affect academic performance, but did not deeply explore psychological or medical etiologies
Mohamed
Medical students at Majmaah University
The study explicitly analyzed the relationship between insomnia and anxiety, finding a significant correlation between the two. Anxiety was identified as a major contributing factor to insomnia
N/A
The study explored sleep hygiene by assessing sleep difficulties, sleep duration, and insomnia symptoms, linking them to anxiety and academic demands
N/A
N/A
This study provided a detailed analysis of the relationship between anxiety and insomnia among medical students, highlighting anxiety as a significant contributing factor to sleep disturbances. It also considered the impact of academic stress on sleep patterns
Alrashed
Medical students at King Saud University
N/A
Faulty lifestyle factors were partially examined, especially in relation to screen time and physical inactivity, which were linked to poor sleep quality
The study explored sleep hygiene issues, particularly irregular sleep patterns, use of electronic devices before sleep, and sleep deprivation, all of which were associated with insomnia
N/A
The study considered chronic medical conditions, noting their association with higher insomnia rates, but did not focus extensively on specific conditions
This study highlighted the role of academic stress and poor sleep hygiene in contributing to insomnia, with some consideration of lifestyle factors like screen time and physical inactivity. It did not deeply explore psychological traits or dietary factors
AlHadi
University students across Saudi Arabia during COVID-19 lockdown
The study identified a strong association between anxiety, depression, and insomnia, with these psychological factors being significant predictors of insomnia severity
Faulty lifestyle factors, such as prolonged sitting and lack of physical activity during the lockdown, were identified as contributing to insomnia
The study analyzed unhealthy sleep hygiene, particularly irregular sleep schedules, screen time, and sleep disturbances related to changes in daily routine during the lockdown
N/A
Chronic medical conditions, including diabetes, hypertension, and asthma, were found to be significantly associated with insomnia
This study provided a comprehensive analysis of the factors contributing to insomnia during the COVID-19 lockdown, with a strong focus on psychological and lifestyle factors, as well as chronic medical conditions. It is one of the more detailed studies in this regard
Alasimi
Respiratory therapy students across 19 universities in Saudi Arabia
N/A
Faulty lifestyle factors such as prolonged studying hours and lack of exercise were acknowledged as contributing to insomnia
Unhealthy sleep hygiene was analyzed through factors like irregular sleep patterns, late-night studying, and the use of electronic devices, all contributing to insomnia
N/A
N/A
The study addressed lifestyle factors related to academic pressures and poor sleep hygiene but did not delve into psychological traits or chronic health conditions as primary contributors to insomnia
Albikawi
Female nursing students at King Khalid University
N/A
Faulty lifestyle factors, particularly low physical activity levels, were examined and found to be significantly associated with insomnia
Unhealthy sleep hygiene was analyzed through the use of mobile phones before sleep, which was found to contribute to insomnia
The study investigated the impact of family support on stress and sleep but did not specifically focus on unhealthy food or obesity
N/A
This study emphasized the role of stress, physical inactivity, and poor sleep hygiene, particularly mobile phone usage before sleep, in contributing to insomnia among nursing students. It did not delve into psychological traits or chronic health conditions
Alshehri
Medical students at King Abdulaziz University
The study recognized the role of psychological stress and academic pressure in contributing to insomnia but did not specifically focus on anxious or obsessive personalities
N/A
The study explored unhealthy sleep hygiene by assessing sleep quality, insomnia symptoms, and the use of sleep assessment tools like the Athens Insomnia Scale and Pittsburgh Sleep Quality Index
N/A
N/A
The research highlighted the significant role of stress and academic pressure on sleep quality and insomnia but did not deeply explore other etiologies such as lifestyle factors or chronic medical conditions
Unhealthy sleep hygiene was a recurring theme across the studies. For example, Alhadi and Alasimi examined the impact of irregular sleep schedules, the use of electronic devices before bed, and changes in sleep patterns during exam periods [33, 34]. These studies underscored the critical role that poor sleep habits play in the prevalence of insomnia among students, particularly during high-stress periods like exams or the COVID-19 lockdown. Faulty lifestyle factors, including low physical activity and poor dietary habits, were explored in some studies, such as Albikawi, which found a significant association between low levels of physical activity and increased insomnia rates among female nursing students [35]. Similarly, Mansour highlighted the impact of fast-food consumption and soft drink preferences on sleep disturbances, drawing attention to the role of diet in sleep quality [28]. However, not all studies delved into these lifestyle factors, with some, like Albasheer, focusing more narrowly on sleep patterns without exploring broader lifestyle issues [29].
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The role of chronic medical or neurological conditions was less frequently addressed, though Alhadi identified a significant association between chronic conditions like diabetes, hypertension, and asthma with higher rates of insomnia [33]. This finding contrasts with studies like Alasimi and Albasheer, which did not specifically examine these health conditions in relation to sleep disturbances [29, 34].
Study‑level quality assessment
The quality assessment of the included studies in the systematic review reveals a generally high methodological quality across most studies (see Table 3). The assessment criteria encompassed selection (max 4 points), comparability (max 2 points), and exposure/outcome (max 3 points), with a possible total of 9 points. Most studies scored in the high-quality tier, with AlHadi achieving the highest score of 9 points, indicating optimal adherence to quality criteria across all categories. Alfadeel, Albasheer, Mohamed, and Alshehri each scored 8 points, also placing them in the high-quality tier. Studies by Alturaiqy, Alrashed, and Alasimi received a total of 6 points each, categorizing them as moderate quality. This distribution of scores demonstrates a robust methodological framework in the majority of the studies, ensuring reliable and valid results in the analysis of insomnia prevalence among university students.
This systematic review and meta-analysis investigated the prevalence of insomnia among university students in Saudi Arabia. Our findings indicate significant variation in insomnia prevalence across studies, with rates ranging from 19.3% to 98.7%. This wide range can be attributed to differences in study design, sample characteristics, and diagnostic tools. The pooled prevalence estimates of 43.3% (95% CI 28.9–58.2%) underscores the high burden of insomnia in this population.
Our results are consistent with regional studies, such as Chaabane and et al. [37], which reported a similar range of insomnia prevalence among medical students in the Middle East and North Africa (MENA) region. Chaabane and colleagues highlighted that insomnia prevalence in medical students ranged from 30.4% in Jordan to 59.1% in Morocco, underscoring the pervasive nature of this condition across the region.
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The high heterogeneity (I2 = 99.17%) observed in our meta-analysis reflects the diverse environmental and academic pressures faced by university students. For instance, Alshehri [36] reported the highest prevalence rate of 98.7%, which could be attributed to the unique stressors and lifestyle factors specific to the study population during the COVID-19 pandemic.
This study found notable gender differences in insomnia prevalence, with female students exhibiting higher rates (pooled prevalence of 38.7%, 95% CI 32.8–44.8%) compared to their male counterparts. This finding aligns with Tang and colleagues [38], who also reported higher insomnia rates among females than males. Possible explanations for this gender disparity include hormonal differences, higher susceptibility to stress and anxiety, and societal roles that disproportionately affect women. The higher prevalence of insomnia among female students may also reflect the cumulative impact of multiple stressors, including academic pressure, social expectations, and personal health concerns.
The academic environment plays a critical role in the prevalence of insomnia among university students. Studies included in our review highlighted the significant impact of academic stress, with higher prevalence rates observed during examination periods and among students in advanced years of study. For example, Alrashed [32], noted an increased prevalence of insomnia among students in their third-to-fifth years of medical school, a period characterized by heightened academic demands and clinical responsibilities. Similarly, a previous study found that insomnia disorders were significantly associated with being in clinical or late clinical years, reflecting the intense pressure experienced by medical students during these stages of their education [27].
The COVID-19 pandemic has exacerbated sleep disturbances among university students, as evidenced by several studies included in our meta-analysis. Some studies reported increased insomnia prevalence during the pandemic, which can be attributed to heightened anxiety, disruptions in daily routines, and increased screen time due to online learning. The shift to remote learning and the uncertainties surrounding the pandemic likely contributed to the disruption of students' sleep patterns [39]. Chaabane et al. [37] also highlighted similar trends, with significant increases in insomnia rates during the pandemic lockdown in Saudi Arabia and Morocco. The increased prevalence of insomnia during the pandemic underscores the need for targeted interventions to address the mental health and well-being of students in times of crisis.
The prevalence of insomnia among university students in Saudi Arabia is comparable to global trends. Insomnia and other sleep disorders are common among university students worldwide due to factors such as academic pressure, lifestyle changes, and mental health issues. For instance, a meta-analysis by Jiang et al. [40] reported a global prevalence of insomnia among university students ranging from 9 to 38%, similar to our findings. The consistency of these trends highlights the universal nature of insomnia as a significant public health issue among young adults in higher education.
The multifaceted nature of insomnia among university students in Saudi Arabia, revealing a complex interplay between psychological, lifestyle, and medical factors. The prominence of academic stress as a contributing factor, as highlighted in studies like those by Alrashed and [32, 36], aligns with existing literature that identifies stress as a major driver of sleep disturbances in student populations [12, 41]. These findings are particularly relevant in the context of medical students, who face intense academic pressures that significantly impact their sleep quality [32]. However, the inconsistent focus on specific psychological traits, such as anxiety or obsessive tendencies, suggests that further research is needed to explore these dimensions more comprehensively. Mohamed stands out in this regard, providing a clear linkage between anxiety and insomnia, which could serve as a foundation for future studies aimed at understanding the psychological underpinnings of sleep disorders in this demographic [16, 19].
Moreover, the varying emphasis on lifestyle factors such as physical activity and dietary habits highlights a potential gap in the current research. Studies like Albikawi and Mansour demonstrate the importance of considering these elements, showing how lifestyle choices can exacerbate or mitigate sleep issues [19, 35]. Yet, the fact that some studies, such as Albasheer, did not explore these factors indicates an area where further investigation could be beneficial [29]. In addition, the relatively limited attention given to chronic medical or neurological conditions, despite the significant findings by Alhadi, points to a need for more in-depth exploration of how these health issues interact with sleep patterns in students [33].
[1, 6, 12, 13] Given the high prevalence of insomnia among university students, there is a critical need for targeted interventions to address this public health issue [5]. Universities should consider implementing comprehensive mental health programs that include sleep hygiene education, stress management workshops, and counselling services [10]. Promoting good sleep hygiene practices, such as maintaining a regular sleep schedule, creating a conducive sleep environment, and limiting the use of electronic devices before bedtime, can significantly improve sleep quality [10]. Stress management workshops can equip students with techniques to manage academic and personal stressors effectively, reducing their impact on sleep [42]. Counselling services should be readily accessible to students experiencing mental health issues, providing them with the necessary support to manage their conditions and improve their overall well-being.
In parallel, further studies in Saudi Arabia should prioritize a more comprehensive investigation into the understudied etiologies and conditions contributing to insomnia among university students. Future research should delve deeper into psychological traits such as anxiety and obsessive–compulsive tendencies, exploring their specific impacts on sleep patterns, which have only been partially addressed in current studies. In addition, lifestyle factors, particularly dietary habits and physical activity levels, warrant more rigorous examination, as their influence on insomnia has not been consistently explored. The role of chronic medical and neurological conditions in exacerbating sleep disturbances should also be a focal point, with future studies aiming to understand how these conditions interact with the academic and social pressures faced by students. A holistic approach that integrates these psychological, lifestyle, and medical factors will provide a more nuanced understanding of insomnia and inform more effective interventions in this population.
Limitations
Despite the comprehensive nature of our review, several limitations should be acknowledged. First, the included studies varied significantly in their methodological quality, as reflected in the moderate to high quality scores. This variability may have introduced bias into our pooled estimates. In addition, the cross-sectional design of the included studies limits the ability to infer causal relationships between insomnia and associated factors. Second, the reliance on self-reported measures of insomnia may have introduced reporting bias, as students might underreport or overreport their sleep disturbances. Future studies should incorporate objective measures, such as actigraphy or polysomnography, to validate self-reported data. Third, our review was limited to studies published in English and Arabic, potentially excluding relevant research published in other languages. Expanding the language scope in future reviews could provide a more comprehensive understanding of insomnia prevalence among university students.
Conclusion
The high prevalence of insomnia among university students in Saudi Arabia underscores the urgent need for interventions to address this public health issue. Targeted strategies to reduce academic stress, promote sleep hygiene, and provide mental health support are essential to improve the well-being of this vulnerable population. Universities should implement comprehensive mental health programs that include sleep hygiene education, stress management workshops, and counselling services. Further research using longitudinal and objective measures is necessary to better understand the determinants of insomnia and develop effective interventions. By addressing the factors contributing to insomnia, we can enhance the overall health and academic performance of university students.
Acknowledgements
We extend our heartfelt gratitude to the Arab Clinical Research Institute (ACRI) for their invaluable support. Their comprehensive training programs empowered researchers at all levels, enabling us to undertake this study and achieve authorship. We are deeply appreciative of the remarkable guidance and resources provided by ACRI.
Declarations
Ethics approval and consent to participate
The need for ethics approval and consent to participate was waived for this systematic review and meta-analysis as it did not involve direct human subjects.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
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Prevalence of insomnia among university students in Saudi Arabia: a systematic review and meta‑analysis
Verfasst von
Mohamed Baklola
Mohamed Terra
Mohamed Al-barqi
Yaqeen Hasan AbdulHusain
Sohaila Ahmed Asiri
Norah Saad Jadaan
Ali Haroona
Sayed Almosawi
Sarah Saud Al Ahmari
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Wer insgesamt zuversichtlicher aufs Leben blickt, trägt ein geringeres Risiko, später einmal an Demenz zu erkranken als pessimistischere Zeitgenossen. Dafür sprechen zumindest Ergebnisse einer Längsschnittdatenanalyse aus den USA. Ob mehr Optimismus allerdings tatsächlich einer Demenz vorbeugt, bleibt unklar.
Eine hochdosierte Influenza-Vakzine geht mit einer verzögerten Demenzdiagnose einher. Darauf deutet eine Auswertung von US-Gesundheitsdaten hin. Besonders auffällig sind die Effekte in den ersten Monaten nach der Impfung.
Intensive Senkung eines erhöhten Blutdrucks kann nach einer intrazerebralen Blutung die funktionelle Erholung verbessern – mutmaßlich über eine Reduktion der Hämatomausdehnung. Offenbar hängt das aber vom Ausgangsvolumen ab, wie eine Analyse ergeben hat.
Da schmeckt das Rinderfilet gleich doppelt so gut: Fleisch beugt einer aktuellen Studie zufolge einer Demenz vor. Allerdings gilt das nur für ApoE4-Träger. Diese haben sich im Laufe der Evolution offenbar an einen hohen Fleischkonsum angepasst – und brauchen ihre Steak-Rationen.
