Exploring Sleep Quality in Bangladeshi University Students during the COVID-19 Pandemic

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Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Exploring Sleep Quality in Bangladeshi University Students during the COVID-19 Pandemic View ORCID Profile M Nurunnabi , MK Khan , FR Kaiser , View ORCID Profile MG Abbas , View ORCID Profile TT Tabassum , T Farha , View ORCID Profile F Akter , MA Tarafdar doi: https://doi.org/10.1101/2025.04.06.25325308 M Nurunnabi 1 Department of Community Medicine and Public Health, Sylhet Women’s Medical College , Sylhet 3100, Bangladesh Roles: Assistant Professor Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for M Nurunnabi For correspondence: nur.somch{at}gmail.com MK Khan 2 Department of Community Medicine and Public Health, Mymensingh Medical College , Mymensingh 2200, Bangladesh Roles: Associate Professor Find this author on Google Scholar Find this author on PubMed Search for this author on this site FR Kaiser 3 Department of Community Medicine and Public Health, Sylhet Women’s Medical College , Sylhet 3100, Bangladesh Roles: Professor Find this author on Google Scholar Find this author on PubMed Search for this author on this site MG Abbas 4 Department of Occupational and Environmental Health, National Institute of Preventive and Social Medicine , Dhaka 1212, Bangladesh Roles: Assistant Professor Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for MG Abbas TT Tabassum 5 York Trials Unit, University of York , Heslington, York YO10 5DD, United Kingdom Roles: Project Support Officer Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for TT Tabassum T Farha 6 Projahnmo Research Foundation , Sylhet 3100, Bangladesh Roles: Study Physician Find this author on Google Scholar Find this author on PubMed Search for this author on this site F Akter 7 Department of Public Health, Sylhet MAG Osmani Medical College Centre, Bangladesh Open University , Sylhet 3100, Bangladesh Roles: MPH Fellow Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for F Akter MA Tarafdar 8 Department of Community Medicine and Public Health, Diabetic Association Medical College , Faridpur 7800, Bangladesh Roles: Professor and Head Find this author on Google Scholar Find this author on PubMed Search for this author on this site Abstract Full Text Info/History Metrics Data/Code Preview PDF Abstract Background University students frequently experience challenges that affect their sleep quality, including academic stress, lifestyle habits, and socio-demographic factors. Common sleep disturbances, such as delayed sleep onset and poor sleep efficiency, often result in daytime dysfunction and difficulty maintaining enthusiasm. Methods This cross-sectional study appraised sleep quality among undergraduate students in Bangladesh during the COVID-19 pandemic. A total of 530 undergraduate students were purposively selected from three public universities. Participants were chosen through convenience sampling, with students who had contracted COVID-19 during the study excluded from the sample. Results The mean age of the university students was 21.1 (±2.0) years. Regarding PSQI components, the participants showed moderate sleep latency (55.7%) and habitual sleep efficiency (56.0%), with mild levels of sleep disturbances at night (68.1%), daytime dysfunction (51.1%), and difficulty maintaining enthusiasm (48.5%). The global PSQI scores were poor for 59.4% of participants, while 40.6% had good scores, with a mean of 6.5(±2.9). Among the students, 44.9% reported fair subjective sleep quality, followed by good (24.7%), very good (18.1%), and poor (12.3%) sleep quality. Lifestyle factors such as class attendance, online media usage, BMI, physical exercise, tea/coffee consumption, and smoking were significantly associated with sleep quality (p<0.05). Sleep quality factors like daytime sleep duration, nighttime sleep latency, and sleeping pill usage were also significantly associated with sleep quality (p<0.05). Significant associations were found between sleep quality and factors such as age, household income, daily study hours, BMI, daytime sleep, and sleep latency (p<0.05). Conclusion The study revealed that longer sleep latency, daytime sleep, and sleeping pill usage were related with poorer sleep quality. It also emphasized that sleep disturbances, daytime dysfunction, and difficulty maintaining enthusiasm were significant predictors of sleep quality. Introduction Sleep is an essential physiological function for general health and wellbeing 1 . It is crucial for preserving the best possible health and performance since it is important for many facets of physical, mental, and emotional functioning 2 . Numerous advantages of getting enough sleep include enhanced mood control, cognitive function, immune system performance, and metabolic health 3 . Good sleep habits are essential for self-regulation, the brain’s executive function that governs our actions and a deficit of these habits can result from persistently interrupting the body’s natural sleep cycle or from failing to initiate sleep, which wears one out physically, mentally, and emotionally 4 . Sleep quality sorting, particularly using indices comprised of the Pittsburgh Sleep Quality Index (PSQI), offers a comprehensive assessment of all aspects of sleep, including both subjective and objective information. The PSQI assesses seven categories of sleep quality over a period of one month: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction 5 . The PSQI is a standardized and accurate measure of sleep quality across groups that are widely used in clinical and research contexts 6 . Furthermore, the PSQI helps identify individual sleep disruptions and their impact on total sleep quality, allowing for focused interventions to enhance sleep outcomes 7 . A study conducted among undergraduate students found that 70.6% reported sleeping less than eight hours, with an average sleep duration of 7.02 hours, indicating that most students experience sleep deprivation 1 . A significant number of college students experience sleep problems, such as poor sleep quality, symptoms of insomnia, and inconsistent sleep patterns 8 , 9 . Sleep deprivation has been associated with increased susceptibility to infections and lower vaccine efficacy, underscoring the need of adequate sleep for immunological protection 11 . It has also been demonstrated to impair attention, concentration, decision-making, and problem-solving abilities, hence affecting academic and vocational performance, as sleep have a strong link to cognitive functioning 7 , 12 . Furthermore, sleep affects mood regulation and emotional well-being. Adequate sleep is necessary for emotional regulation, stress management, and psychological resilience 13 . Sleep disruptions are intimately associated with mood disorders such as depression and anxiety, and sleep therapies are frequently included in treatment plans 14 . It has also an important role in metabolic control and weight management. Insufficient sleep disturbs hormonal balance, causing changes in appetite-regulating hormones like leptin and ghrelin, which can contribute to weight gain and obesity 15 , 16 . Depression and anxiety symptoms are prevalent among university students who experience poor sleep, and these symptoms are often linked to lower life satisfaction levels 17 - 19 . Additionally, there is also evidence suggesting that individuals who experience significant psychological distress during their time as students are likely to continue experiencing high levels of distress in their life 20 - 22 . Engaging in intentional late-night activities is one facet of this problem 19 . Students’ diverse habits, including excessive use of media devices, smoking, and consumption of caffeine, collectively contribute to poor sleep hygiene 23 , 24 . Research on sleep quality among Bangladeshi university students is limited, with existing studies primarily exploring links to psychological distress, internet addiction, and the COVID-19 pandemic 25 . This study aims to assess sleep quality among students in two Bangladeshi cities and identify associated factors. Methods Study design and settings This cross-sectional study assessed sleep quality among undergraduate students in Bangladesh during the COVID-19 pandemic. Participants were purposively selected from three public universities: Dhaka University, Jahangirnagar University in Dhaka, and Shahjalal University of Science and Technology in Sylhet. Sample selection criteria A total of 530 undergraduate students, aged 18 or older and in their first to fourth year, were selected through convenience sampling. Students who had contracted COVID-19 during the study were excluded. The sample size was calculated using a 95% confidence interval (CI) and a 5% relative precision. Data collection methods Data were collected using a semi-structured questionnaire, pretested with 55 undergraduate students from a private university in Sylhet. Participants completed the questionnaire via Google Forms between July and December 2021, during their enrollment in the study. The questionnaire was designed to include sociodemographic details, lifestyle and sleep quality-related information, and the PSQI scale. Semi-structured questionnaire for the sociodemographic outlines: The questionnaire included sociodemographic variables such as age, gender, marital status, education level, residence, monthly income, family history, and COVID-19 infection status. The Pittsburg Sleep Quality Index (PSQI): The PSQI in this survey assessed sleep quality across seven areas: sleep duration, disturbance, latency, daytime dysfunction, efficiency, subjective quality, and medication use. Scores ranged from ‘0’ (no difficulty) to ‘3’ (severe difficulty) per area. A global score ≤5 indicated good sleep quality, while >5 indicated poor sleep quality. Statistical analysis Data were entered and analyzed using IBM SPSS Version 26(New York, USA). Descriptive statistics were presented as frequencies (percentages) for categorical data and means (±SD) for continuous data. The Chi- square (χ2) test and independent sample t-test were used to assess associations. Univariate linear regression and logistic regression analyses were performed to test for significance. A p-value <0.05 at a 95% confidence interval was considered statistically significant. Ethical aspects Participation was voluntary, with confidentiality ensured through individual code numbers. Informed consent was obtained after explaining the study’s objectives and potential outcomes. The research adhered to the 2013 revised Declaration of Helsinki and its amendments, or comparable ethical standards. Ethical approval was granted by Sylhet Women’s Medical College (SWMC), Sylhet, Bangladesh (Reference: SWMC/Eth.C/IRB/202145). Results Table I showed that the mean age of the participants was 21.1 (±2.0) years, and one-third (33.6%) of the participants were from the 22-23 age group, while a significant proportion (30.8%) belonged to the adolescent group aged 18-19 years. The male-to-female ratio was nearly equal (1:1.2), and a substantial portion (8.1%) were married. The majority of the primary earners in the families were employed in service-related occupations (61.9%), while smaller proportions (7.0%) were engaged in other occupations, including agricultural work and day labor. The mean of family size was 5.0 (±1.2) persons, with nuclear families and rural residency comprising more than two-thirds (69.9% and 69.4%, respectively). The monthly household income was estimated 42,469.8 (±23,261.4) Bangladeshi Taka (BDT). View this table: View inline View popup Table I: Socio-demographic outlines of students (n=530) The prevalence of COVID-19 infection among the students was 72.8%, as confirmed by RT-PCR testing. A significant proportion (7.5%) of students reported the loss of second-degree family members due to COVID-19. The majority of students (88.3%) received the second dose of the COVID-19 vaccine, while the remainder did not due to delays in the registration process and the unavailability of the vaccine at health facilities in their areas of residence. Bronchial asthma was the most prevalent medical condition, affecting 52.5% of students with comorbidities, which were present in 7.5% of the students. Table II described that most students (68.3%) attended online classes regularly, studied ≤4 hours daily (66.8%, mean 3.9±1.9 hours), and spent >4 hours on online media (68.1%, mean 5.4±2.2 hours). The pattern of time spent on online media increased among four-fifths (82.8%) of the students. Nearly one- third of students (31.7%) had a BMI above the normal range (mean 23.5±3.8), while 34.7% engaged in physical exercise regularly, with 54.3% exercising for more than 30 minutes daily. Tea or coffee drinking was frequent among university students (67.9%), with a high prevalence of nighttime consumption (73.9%). Among the students, 40.6% were smokers, with 87.0% of them consuming ≤5 cigarettes per day. The pattern of smoking increased among the majority of respondents, reaching 67.4%. View this table: View inline View popup Table II: Factors influences the lifestyle of students during COVID-19 pandemic (n= 530) View this table: View inline View popup Table III: Association of different factors with the students’ levels sleep quality (n= 530) The sleep duration was ≤6 hours daily for three-fourths (73.0%), with a mean of 5.8 (±1.6) hours. Nearly two-thirds of the students (67.5%) slept during the daytime, with a mean duration of 2.7 (±1.0) hours. The mean duration of sleep latency at night was 101.1 (±47.8) minutes. A significant proportion (7.9%) used to tale sleeping pills regularly, and 17.7% used them occasionally. In terms of PSQI components, it showed that the participants had a moderate level of sleep latency (55.7%) and habitual sleep efficiency (56.0%), with a mild level of sleeping disturbance at night (68.1%), daytime dysfunction (51.1%), and difficulty maintaining enthusiasm during the day (48.5%) ( figure 1 ). The global PSQI scores were poor for 59.4% of participants, while 40.6% had good scores, with a mean of 6.5 (±2.9) ( figure 2 ). Among the students, 44.9% reported fair subjective sleep quality (SSQ), followed by good (24.7%), very good (18.1%), and poor (12.3%) sleep quality ( figure 3 ). Download figure Open in new tab Figure 1: The PSQI components (n=530) Download figure Open in new tab Figure 2: Levels of sleep quality by PSQI scale (n= 530) Download figure Open in new tab Figure 3: Levels of subjective sleep quality (n= 530) A significant association was found between students’ sleep quality and socio-demographic factors such as age, family earner’s occupation, residence, family type, and household income (p<0.05). Poor sleep quality was prevalent among adolescents (82.8%), service-holder families (78.7%), rural residents (63.3%), joint families (67.1%), and households earning ≤75,000 BDT (86.7%). Significant relationships were also found between students’ sleep quality and other factors such as COVID-19 diagnosis, family member loss, and comorbidities (p<0.05). Poor sleep quality was higher among COVID-19 positive individuals (70.7%), those who lost a family member (85.0%), and those with comorbidities (75.0%). Lifestyle factors such as class attendance, online media usage, BMI, physical exercise, tea/coffee consumption, and smoking were significantly associated with sleep quality (p<0.05). Poor sleep quality was observed in students with irregular class attendance (82.7%), reduced online media time (86.7%), obesity (90.7%), occasional exercise (76.0%), regular tea/coffee consumption (66.1%), and increased smoking (62.8%). Sleep quality factors such as daytime sleep duration, nighttime sleep latency, and sleeping pill usage in the past month were significantly associated with sleep quality (p2 hours during the day (64.7%), had a sleep latency of over 60 minutes at night (70.9%), and occasionally used sleeping pills (92.6%). All components of the PSQI were significantly associated with sleep quality (p<0.05). Poor sleep quality was observed in students with severe sleep latency (85.5%), severe habitual sleep efficiency issues (100%), moderate nighttime disturbances (88.9%), severe nighttime disturbances (100%), and moderate daytime enthusiasm problems (98.4%). Subjective sleep quality was also significantly related to sleep quality (p<0.05), with poor sleep quality found in students reporting fair subjective sleep quality (97.5%). Significant associations (p<0.05) have been found between sleep quality and mean age, monthly household income, daily study hours, BMI, daytime sleep duration, and sleep latency ( Table IV ). View this table: View inline View popup Download powerpoint Table IV: Association of factors related with the sleep quality (n=530) The model precisely forecasts the Global PSQI score (F=17.403, p<0.001), accounting for 34.5% of the variation (R-squared= 0.366). Sleep latency, sleep quality declines with longer sleep delay (F=9.160, p<0.001). Habitual sleep efficiency, poorer sleep efficiency correlates with lower sleep quality (F=4.421, p=0.004). Sleep disturbance at night, nighttime disruptions reduce sleep quality (F= 3.657, p=0.012). Daytime dysfunction was associated with poorer sleep quality (F=6.494, p<0.001). Problem difficulty retaining excitement in the daytime predicts poorer sleep quality (F=3.690, p=0.012). Higher SSQ levels were substantially related with poor sleep quality (F=11.417, p<0.001). ( Table V ) View this table: View inline View popup Download powerpoint Table V: Univariate linear regression model Table VI showed the logistic regression analysis revealed several significant findings regarding sleep quality. For very good sleep quality, greater sleep disturbances at night significantly increased the odds of achieving very good sleep (p=0.026). For good sleep quality, longer sleep latency (p=0.003), more sleep disturbances at night (p=0.005), greater daytime dysfunction (p=0.001), and difficulty maintaining enthusiasm (p<0.001) were all significant factors. For fair sleep quality, longer sleep latency (p<0.001), more sleep disturbances at night (p<0.001), and difficulty maintaining enthusiasm (p<0.001) were strongly associated with fair sleep quality. View this table: View inline View popup Download powerpoint Table VI: Logistic regression model Discussion This study assessed sleep quality among university students during the COVID-19 pandemic. The survey’s findings revealed a significant association between age groups and sleep quality, with the majority of students (33.6%) falling into the 22-23 age range. However, the majority of participants (64.7%) in another study conducted in Bangladesh were between the ages of 18-25 years 26 , and there was a deceptive association between adolescence and sleep quality 24 , 27 . Other studies found a significant relationship between sleep disorders and marital status and gender 23 , 28 , whereas our study found none. Our study found relationships within occupation, monthly family income, residence, and family type with sleep quality. However, relationships were observed with small household size and low socioeconomic status 2 , 4 . There were no discernible associates found between age, gender, marital status, and educational attainment in a survey conducted in Turkey 29 . The type of residence was also found to have an impact in other studies, participants (66.8%) felt not get enough sleep since they lived on campus 30 . Overall, 37% of Iranians living in urban areas were classified as poor sleepers 31 and conversely, 27.7% of those in rural China reported having poor sleep quality 32 . Significant relations were found between students’ sleep quality and factors such as being diagnosed with COVID-19 and losing family members to the virus. However, another study in Bangladesh found no correlation between sleep quality and having family members affected by COVID-19-related deaths 26 . Comparing the PSQI score with a study conducted in Switzerland during the COVID-19 pandemic 33 , it was found that sleep quality worsened over time (p=0.035). Reports from Portugal linked home confinement without employment to sleep issues 34 , while in the United States; inadequate sleep was associated with COVID-19-related anxiety 35 . A study on university students in Lebanon showed similar results 36 , with over half of participants reporting poor sleep quality based on their PSQI scores. Co-morbidities were significantly associated with sleep quality (p<0.05), aligning with a U.S. study linking sleep restriction to obesity and diabetes 15 . BMI was also significantly associated with sleep quality (p<0.05), with a U.S. study similarly reporting higher BMI linked to less sleep 14 . Although only 34.7% of students in this study exercised, a significant correlation with sleep quality was found (p<0.05). Conversely, a study in Lebanon found no substantial link between physical activity and PSQI, despite 56.6% of students reporting prior physical activity 36 . Significant relations were found between students’ sleep quality, daily study hours, and online media usage (p<0.05). A study reported that emotional and intellectual stress negatively affected sleep, with 15% of students falling asleep in class weekly and 25% experiencing severe daytime sleepiness 2 . Similarly, in a survey showed that using electronic devices before sleep was significantly linked to poor sleep quality 38 . This survey found significant relationships between tea or coffee intake and sleep quality (p<0.05). A Saudi study reported poor sleep quality in 75.5% of daily tea drinkers and 80% of daily coffee consumers 17 , while a Lebanese study found no significant link between caffeine use and PSQI 36 . Smoking patterns increased to 67.4% during COVID-19, with a significant association between smoking and sleep quality (p<0.05). However, a Bangladeshi study found no such association 26 . In Malaysia 37 , smoking increased during COVID-19, and in other studies, nearly half of participants smoked, with a significant link between cigarette consumption and poorer sleep quality 39 , 40 . This survey revealed that 73% of students slept <6 hours daily, with 44.9% reporting fair sleep quality, followed by good (24.7%), very good (18.1%), and poor (12.3%) sleep quality. Similarly, 76% of students in Saudi Arabia had poor sleep quality (mean PSQI score: 7.11±3.84) 17 . Other studies showed that 58.7% of students reported poor sleep quality 8 , a trend also noted in the USA 2 . In Taiwan, the average daily sleep time was 6.7±1.3 hours 16 , while students in Lebanon had an average PSQI score of 6.57±3.49. 36 Conclusion In conclusion, the study identified key factors influencing sleep quality among university students. Poor sleep quality was associated with demographic factors like age, family income, and residence, as well as health issues such as COVID-19, family loss, and comorbidities. Lifestyle behaviors, including irregular class attendance, high online media use, obesity, lack of exercise, and smoking, were also linked to poor sleep. Furthermore, longer sleep latency, daytime sleep, and sleeping pill usage contributed to lower sleep quality. It also underlined that sleep disturbances, daytime dysfunction, and difficulty maintaining enthusiasm were significant predictors of sleep quality. Addressing these factors could help improve sleep quality in this population. Data Availability All data produced in the present study are available upon reasonable request to the authors Author’s contributions Conceptualization, methods and literature reviews: Nurunnabi M and Abbas MG; Data collection: Abbas MG; Statistical analysis: Nurunnabi M; Preparation of draft manuscript: Nurunnabi M, Khan MK, Tabassum TT, Farha T, and Akter F; and Finalization of manuscript: Nurunnabi M, Khan MK, Kaiser FR, Abbas MG, Tabassum TT, Farha T, Akter F, and Tarafdar MA. All the authors approved the final manuscript Artificial Intelligence Declaration AI (Chat-GPT 4) was used to enhance the clarity of the manuscript and assist with language editing Competing Interests The authors declare that they have no competing interests Funding This study did not receive any funding Acknowledgments The authors gratefully acknowledge the students and data collectors for their valuable contributions to this study. References 1. ↵ Lund HG , Reider BD , Whiting AB , Prichard JR . 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Share Exploring Sleep Quality in Bangladeshi University Students during the COVID-19 Pandemic M Nurunnabi , MK Khan , FR Kaiser , MG Abbas , TT Tabassum , T Farha , F Akter , MA Tarafdar medRxiv 2025.04.06.25325308; doi: https://doi.org/10.1101/2025.04.06.25325308 Share This Article: Copy Citation Tools Exploring Sleep Quality in Bangladeshi University Students during the COVID-19 Pandemic M Nurunnabi , MK Khan , FR Kaiser , MG Abbas , TT Tabassum , T Farha , F Akter , MA Tarafdar medRxiv 2025.04.06.25325308; doi: https://doi.org/10.1101/2025.04.06.25325308 Citation Manager Formats BibTeX Bookends EasyBib EndNote (tagged) EndNote 8 (xml) Medlars Mendeley Papers RefWorks Tagged Ref Manager RIS Zotero Tweet Widget Facebook Like Google Plus One Subject Area Public and Global Health Subject Areas All Articles Addiction Medicine (570) Allergy and Immunology (864) Anesthesia (302) Cardiovascular Medicine (4445) Dentistry and Oral Medicine (444) Dermatology (383) Emergency Medicine (609) Endocrinology (including Diabetes Mellitus and Metabolic Disease) (1515) Epidemiology (15236) Forensic Medicine (30) Gastroenterology (1127) Genetic and Genomic Medicine (6610) Geriatric Medicine (669) Health Economics (1000) Health Informatics (4549) Health Policy (1370) Health Systems and Quality Improvement (1613) Hematology (543) HIV/AIDS (1266) Infectious Diseases (except HIV/AIDS) (15926) Intensive Care and Critical Care Medicine (1104) Medical Education (623) Medical Ethics (147) Nephrology (668) Neurology (6613) Nursing (346) Nutrition (999) Obstetrics and Gynecology (1147) Occupational and Environmental Health (957) Oncology (3341) Ophthalmology (975) Orthopedics (369) Otolaryngology (420) Pain Medicine (436) Palliative Medicine (130) Pathology (665) Pediatrics (1694) Pharmacology and Therapeutics (693) Primary Care Research (714) Psychiatry and Clinical Psychology (5458) Public and Global Health (9244) Radiology and Imaging (2205) Rehabilitation Medicine and Physical Therapy (1370) Respiratory Medicine (1197) Rheumatology (596) Sexual and Reproductive Health (715) Sports Medicine (530) Surgery (713) Toxicology (99) Transplantation (289) Urology (265) (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'a024a555cd898650',t:'MTc3OTg4MDk4OQ=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();