Quality of sleep effects physical and psychological health of an individual. Poor sleep quality deteriorates academic and cognitive performance of college students. Objective of this study was to assess the quality of sleep and its determinants. Study was conducted among 1215 undergraduate students using Pittsburg Sleep Quality Index (PSQI) and sociodemographic survey. Approximately one third (33.8%) of study participants had poor sleep quality; more so in female college students (χ2 test p =.001, OR 1.514). The probable relationship of poor sleep quality with female gender, physical inactivity, smoking and caffeine / tea intake was reported in the study.

• Sleep quality; College students; Pittsburg sleep quality index; Latency; Disturbance; Efficiency; Physical activity; Tea; Coffee; Smoking

Kaur G (2018) A Study on the Sleep Quality of Indian College Students. JSM Brain Sci 3(1): 1018.

Good quality sleep is pertinent for the health and wellbeing of an individual. It is a key for next day freshness, energy, enthusiasm and saneness. Depth, restfulness of sleep and feeling freshness after awakening are some of the salient characteristic of sleep quality.Good sleep is unbroken, uneventful, has short latency and has no awakening throughout [1].

Optimum quantity and good quality sleep maintains delicate equilibrium between the state of sleep and wakefulness. Loss of quality of life, medical and nonmedical costs estimates due to sleep problems are very high.

Poor sleep quality/nonrestorative sleep is one of the diagnostic features of insomnia [2]. Poor sleep quality is a symptom of many other sleep and psychiatric disorders. Quality of sleep also deteriorates in many chronic illnesses [3].

Epidemiological evidences showing association of sleep disorders with cardiovascular mortality [4], stroke [5], diabetes, impaired glucose tolerance, immune dysfunction [6], endocrine impairments [7], and psychiatric morbidities [8] are expanding. Poor sleep quality is linked with poor cognitive performance [9], poor life quality [10], and emotional dysfunction [11]. The results of bad sleep quality are reflected in next day fatigue and poor concentration. The bad sleep quality contributes to poor academic performance and poor cognitive performance. Lemma et al. [12], found that the sleep quality score was significantly associated with academic/cognitive performance in college students. Sleep quality affects college students’ academic function, physical and psychological health [12-14]. Thus, poor sleep quality is a serious problem in college students.

Sleep quality is affected by many socio demographic and lifestyle factors. Alcohol, tobacco and stimulant beverages such as tea/ caffeine affect the quality of sleep.There are many tools for assessing sleep quality. The Pittsburgh Sleep Quality Index (PSQI) is one of such tool used to assess sleep quality and disturbances over a month time interval [15].

There is dearth of research on sleep health in Indian population. A few studies are showing high burden of sleep problems in Indian students [16-21]. Excessive day time sleepiness, poor sleep quality, poor sleep hygiene and its impact on general health of college students was explored in these studies. Thus there is need to research the sleep quality of college students as very few studies are available. Objective of this study was to assess the determinants of quality of sleep of college students.

This was a cross sectional study conducted during October 2013 to December 2014 among 1215 college students of Chandigarh, India. Chandigarh is a capital of Punjab and Haryana; the two provinces of India and it fairly represents the fastdeveloping Indian cities. A socio demographic survey and PSQI scale was used to measure sleep quality and socio demographic variables. All colleges from Chandigarh were included in the survey. Students pursuing graduation (B. A, B. Com, B.Sc., B.Tech, B.D.S, and M.B.B.S) from different colleges were included in study.

Study tool

The PSQI scale is a self-administered questionnaire used to assess sleep quality in last 1 month. It has high internal consistency chronbach alpha of .83 and high-test retest reliabity of .85 (p<.001). It produces single factor in factor analysis [15]. Nineteen individual items generate seven subcomponent of sleep quality i.e., sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medications and daytime dysfunction. This subcomponent combines to give a combined PSQI score that ranges from 0 to 21, and a higher score is indicative of poorer sleep quality. Scores less than or equal to five were associated with good sleep quality and score more than five were considered as poor sleep quality [15]. To invite participants, the pamphlets were distributed in the colleges. Posters inviting students to participate were displayed on notice boards at prominent places such as canteens and common rooms of colleges. The announcements to invite participants into the study were made in classrooms. Those who were ill at any time during the last month were excluded from study as illness disturbs the natural sleep pattern. Before participation informed consent was obtained from all participants for this cross-sectional interview based non-interventional study. SPSS statistical package 20.00 was used for statistical analysis. Percentage, mean, S.D., χ2 test and t- test, were used for statistical analysis

Socio demographic profile of study participants

Data was collected from 1215 participants. Age range of study participants was from 16 to 28 years. Mean age was 19.50 years. Male participants were 51.4% and 48.6% were females. 28.3% of study participants were from arts and commerce stream, 24.3% were from professional courses and 47.4% were from science stream. In arts and commerce stream 15.2% of the participants were from B. A, 13.1% from B. Com, in professional courses 12.2% from B.Tech, 6.3% from BDS and 5.8% were from MBBS. 34.6% of participants were from first year, 32.1% of participants were from second year and 33.3% participants were from third year of educational courses (Table 1).

Lifestyle profile

The consumption of coffee/tea was reported by 78.6% of the study participants. Tobacco smoking was reported by 3.50% and liquor consumption was reported by 7.8% of the study participants. Of the participants studied, 47.74% were not physically active, 31.6% of participants reported participating in physical activity one to three times in a week and 20.66% reported participating in physical activity four or more times a week. BMI was found to be low in 27.6% and normal in 61.5% of study participants. 10.9% of the study participants were found to be overweight (Table 1).

Prevalence of poor sleep quality

The sleep quality was poor in 33.8% and was normal in 66.2% of participants (Table 2).

Sleep quality and sleep behaviors

Average time to go to bed was 11:12 PM and average getting up time was 7:55 AM. Study participants slept for 7.65 ± 1.69 hours on an average. On an average participant took 22.06 ± 17.65 minutes to go to sleep.

In frequency distribution of responses to PSQI items, the proportion of responses to “Once or twice a week” and “Three or more times a week” were higher with items related to sleep disturbance (5b, 5c, 5f, and 5h), sleep latency (5a) and subjective sleep quality (9). Only one third of study participant could go to sleep within 30 minutes after going to bed. Waking up in the middle of the night or early morning, getting up to use the bathroom, feeling too cold and having dreams were common disturbances in sleep experienced by students. Minority of study Table 1: Sociodemographic and Lifestyle profile of study participants. Variable Category N (%) Gender Male 624 (51.4) Female 591 (48.6) Year of study First 421 (34.6) Second 390 (32.1) Third 404 (33.3) Study Stream Arts/Commerce 344 (28.3) Science 576 (24.2) Professional 295 (47.4) BMI Low ( 25 132 (10.9) Physical Activity frequency (in addition to work) in a week 0 580 (47.74) 1-3 times in a week 384 (31.6) More than 4 times a week 251 (20.66) Coffee/ Tea intake Yes 955 (78.6) No 260 (27.4) Liquor Intake Yes 83 (7.8) No 1132 (93.2) Smoking Yes 42 (3.5) No 1173 (95.5) Table 2: Pittsburg Sleep Quality index among study participants. Categories Frequency (%) Normal Sleep Quality (5) 411 (33.8) participants didn’t wake up in middle of the night (36.45%) or didn’t get up to use bathroom (37.8%). One third of study participants scored their sleep quality to be very good (Table 3).

The total PSQI score of study participants was 4.77 ± 2.52. The component scores of sleep latency, sleep disturbance, and subjective sleep quality were comparatively higher and share major contribution to total PSQI score. Minimum score was observed in sleepmedicine component and maximum score was observed for sleep disturbances (Table 4).

Majority of the study participant (75.9%) slept for more than 7 hours and very few (2.8%) slept for less than 5 hours (Table 5).

Determinants of poor sleep quality

Prevalence of poor sleep quality was significantly associated with female sex. However no significant association was observed between stream, year of study and prevalence of poor sleep quality. There was statistically significant difference between prevalence of poor sleep quality between males and females (χ2 test p=.001) females had 1.514 times higher odds of poor sleep quality (Table 6).

Prevalence of poor sleep quality was significantly associated with physical activity, consumption of tea / coffee and smoking (χ2 test p=.009, .006 and .010). Mean PSQI scores were significantly higher in females as compared to males Mean PSQI scores were significantly higher in participants who were not involved in physical activity, tea/coffee consumers and smokers (χ2 test p=0.004,.000 and .009) (Table 7).

College prepares an individual to face the challenges in professional and personal life. Quality of sleep also impacts the physical health, mental health and quality of life of college students. Poor sleep quality also deteriorates academic and cognitive performance. Approximately one third (33.8%) of our respondents had poor sleep quality: Rest had normal PSQI Scores. It means that threeout of ten college students are suffering from poor sleep quality. A study in Indian medical students has reported that two out of ten medical students suffers from poor sleep quality [20]. However, another study reported that 62.6% of the Indian under graduate students had poor sleep quality [21].

Almost similar data is reported from Malaysian university students [22]. Studies in Chinese [23], Thai [24], Taiwanese [25], Ethiopian [12], Lebanese [25], Chilean [26] and American [27] college students reported that 40- 55% of students had poor sleep quality. Prevalence of poor sleep quality was almost double in Taiwanese [25], Lebanese [26] and Ethiopian [12] college students than study population. A substantial portion (96.4%) of the Brazilian college students also had poor sleep quality [28]. Thus, the problem of poor sleep in college students has a public health importance.

Average time to go to bed and average getting up time indicates that our study participants slept late in night and woke up late. Average sleep hours and time to go to bed is also similar in college students in other countriesalso [22,25,26,29]. It means that trends of sleeping late and getting up late are catching up in college students. One quarter of the study participants are not sleeping for minimum seven hours. This is a serious problem. Only one thirdof study participant could go to sleep within half hour after going to bed. This behavior is also reflected in high mean component score of sleep latency. Almost similar results were observed in in Palestine undergraduates [29].

Prevalence of sleep disturbances was very high in study population and the mean component score for sleep disturbance was highest. Sleep disturbances related to nocturnal awakenings (waking in middle of the night or getting up to go to bathroom) is more prevalent as compared to other (breathing problems, snoring, pain, cold, heat and bad dreams). It means high burden of sleep disturbances is major contributor to poor sleep quality in study participants. In Palestine undergraduates also two thirds (64.8%) of the students reported having at least one nocturnal awakening and nightmares were the most common parasomnia reported [29].

Almost one fourth of study participants reported problem in staying awake while driving, eating meals, or engaging in social activity. This is a very important finding because sleepiness on wheels is one of the main causes of fatal road accidents. Approximately 60% students lacked enough enthusiasms to get things done. It is one of the significant causes of poor performance and productivity. It affects the quality of life of the individual. When study participants were asked to rate sleep quality approximately 17% reported their sleep quality to be fairlybad or very bad. It means that these study participants themselves recognize their sleep quality to be bad.

Female college student had one and half times higher odds of poor sleep quality than males. It means female college students are poor sleeper as compared to male college students. Poor sleep quality was significantly higher in Taiwanese [25], Chinese [23] and Ethiopian [12], female college / university students. Cause of increase prevalence of poor sleep quality may be the unique hormonal and physiological make up of females. Sex differences in sleep begin at a very early age and women report poorer sleep quality [31]. Different stages in the life of woman are associated with significant physiological and hormonal changes that favor the disruption of normal sleep pattern and by this way possibly, increase risk of sleep disturbance [32]. The mensuration cycle and other hormonal changes affect the sleep pattern of the female [33]. Menstrual cycle changes affect sleep cycle and women with severe premenstrual syndrome experience a decline in subjective sleep quality [34]. Significant increase in sleep onset latency and decrease in sleep efficiency and sleep quality during the luteal phase [35]. However, there is a need of further research in such findings in this study.

Significant association was also observed between prevalence of poor sleep quality and frequency of physical activity (χ2 test p. = 0.009). It can be inferred that regular physical activity improves sleep quality. Regular exercise training causes moderate improvements in objective and subjective sleep quality [36]. Exercise increased total sleep time and delayed REM sleep onset and increased slow-wave sleep [37]. Regular exercise has small beneficial effectson total sleep time and sleep efficiency, sleep onset latency, and moderate beneficial effects on sleep quality [38,39].

The study also observed that the amount coffee tea intake and smoking were significantly associated with poor sleep quality (χ2 test p = 0.006, χ2 test p = 0.010). Smokers had 2.212 higher odds of poor sleep quality. Research has now emerged on association of stimulants beverages such as coffee / tea with poor sleep quality [40-42]. Studies in Thai, Taiwanese, and Chilean college poor sleep quality was significantly associated with coffee consumption and smoking [24,25,27].

The problem of poor sleep quality is common in Indian college students. Three out of ten students had problem of poor sleep quality and females found to be more at risk. Thus it is a serious health problem in Indian college students. Probable association of poor sleep quality with physical inactivity, smoking and caffeine/ tea consumption was observed in the study.

Tool used in the study self-administered questionnaire, so respondent’s bias can’t be ruled out. Participants were recruited by open invitation, so study is not immune to selection bias.

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