Impulsivity Mediates the Relationship between Sleep Quality and Interpersonal Functioning: A Cross-sectional Study in a Sample of University Students

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Farrell, Robert W. Emmerton, Christina Camilleri, Stephen Sammut This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3970668/v2 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 25 Sep, 2024 Read the published version in Sleep Science and Practice → Version 2 posted 9 You are reading this latest preprint version Show more versions Abstract Background : Amid the current mental health pandemic, research continues to investigate potential contributors associated with increasing levels of negative mental health. Among such contributors is sleep, which is vital for physiological and psychological functioning with potential downstream behavioral consequences, including in relation to impulsivity and social functioning. Given the significant rates of poor sleep quality reported in the literature, our study sought to investigate the relationship between sleep quality, impulsivity and interpersonal functioning among university students. Methods : An anonymous online survey was administered to university students (Ages 18+; N=526; 33% male, 67% female) addressing demographics, sleep quality, impulsivity, and interpersonal functioning. Results : Our findings indicate a substantial proportion of students reporting poor sleep quality and impulsivity. Moreover, higher levels of impulsivity and lower interpersonal functioning were associated with poor sleep quality. Mediation analysis revealed a significant mediating role of attentional impulsivity in the relationship between sleep quality and interpersonal functioning. Conclusions : Repeated reports of significant levels of impulsivity underlying numerous psychiatric disorders, its prevalence socially, and the fundamental issue that impulsivity reflects (i.e., lack of self-control/self-discipline), suggests a necessity to reorient therapeutic efforts towards the root of the problem. Thus, efforts should seek to maximize preventative behaviors that build character/virtue and strengthen the individual (e.g., improving sleep quality and minimizing impulsivity), including through self-discipline and perseverance, in order to reduce negative outcomes (e.g., dysfunctional interpersonal functioning). sleep quality impulsivity interpersonal functioning self-discipline university students cross-sectional Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Introduction Research continues to indicate growing levels of negative mental health among university students (e.g., 1, 2–7). The correlates to negative mental health are many, and scientific research continues to seek further understanding of such correlates in all contexts, including in the university student population, in order to provide potential solutions. Among the numerous correlates identified in the scientific literature, including in our previous work, sleep continues to be an important source of stress/concern ( 1 , 8 – 10 ). Furthermore, substantial proportions of college students in the United States and globally report poor sleep quality and/or an inadequate amount of sleep ( 11 – 16 ). Proper sleep quality and appropriate/healthy levels of sleep play a significant restorative role physiologically, immunologically, hormonally, neurologically, and psychologically ( 17 – 21 ). Thus, the consequences of disturbed or inadequate sleep can have broad pathological implications ranging from the cellular to the behavioral levels. Under such situations, at the neurobehavioral level, executive functioning, which regulates basic behaviors such as attention ( 22 ) and impulse control ( 23 – 27 ), is reduced. Effective/appropriate executive functioning is necessary in the processes of error detection ( 28 , 29 ), emotional regulation ( 30 ) and social cue processing ( 31 ). Therefore, when negatively impacted by factors such as sleep deprivation, error detection becomes dysregulated ( 32 , 33 ). Additionally, emotional dysregulation can result, potentially due to a dysfunctional metabolism impacting amygdalar regulation ( 17 , 33 – 35 ). Consequently, this can lead to an enhanced sensitivity to negative stimuli, decreased responsiveness to long-term positive events, reduced positive moods, hysterical behaviors and increased irritability ( 35 – 39 ). The potential for more serious negative behaviors, including but not limited to, suicidal thoughts and behaviors, is also present (e.g., 32, 34, 40, 41, 42). Such consequences/behaviors not only impact the individual experiencing them, but also the social surroundings of the individual, as their behaviors can influence the way in which they interact with others. Additionally, as indicated above, executive functioning is important in impulse control. A deficiency in impulse control can lead/contribute to a wide range of negative, disinhibited and often risky behaviors. Such behaviors include, but are not limited to, excessive texting, texting while driving, drug abuse and/or inappropriate alcohol use and risky sexual behaviors and any consequences resulting from such behaviors ( 23 – 27 , 43 – 45 ). Related, inappropriate impulse control can also lead to adverse/dysfunctional social behaviors evident in such behaviors as inappropriate peer influence, social anxiety, aggression and antisocial personality disorder ( 46 – 51 ). In addition to the potential effects of emotional dysregulation discussed above, the presence of inappropriate social behaviors, including dysregulation in social cue processing ( 52 , 53 ), can also subsequently influence interpersonal functioning (defined as intimacy and empathy; DSM-5) and the formation and maintenance of relationships ( 54 – 56 ). Ultimately, healthy social relationships, and therefore appropriate interpersonal functioning, have been shown to influence the overall well-being of the individual (e.g., 57, 58). Therefore, given 1) the prevalence and plethora of negative outcomes associated with poor sleep quality on aspects of executive functioning (such as error detection, emotional regulation and impulsivity), 2) the various relationships reported in the literature between sleep, executive functioning, emotional regulation and interpersonal relationships, and 3) the importance of quality/healthy relationships in the midst of the mental health “pandemic”, our study sought to investigate the relationship between sleep quality and interpersonal functioning and the potential mediating role of impulsivity in such a relationship, in a sample of university students. 2. Methods This survey research was conducted in compliance with Federal Law pertaining to the protection of human research subjects. Prior to administration of the survey, Franciscan University of Steubenville Institutional Review Board (IRB) approval was obtained (#2022-4). Our study consisted of a convenience sample of university/college (undergraduate and graduate) students from Franciscan University of Steubenville, OH, United States. An anonymous survey was sent via the university student email address, to all students taking classes at Franciscan University, who were at least 18 years of age. Over the course of two weeks (April 19th – May 3rd, 2022), the survey was administered through the online survey engine SurveyMonkey®. Prior to completing the survey, participants were directed to a consent form, which detailed the confidentiality and the nature of the study and explained that participation in the study implied consent to analyze and publish the overall results. Participants who did not provide consent were directed to the Disqualification Page . The projected time of completion of the survey was approximately 15 minutes. The final page of the survey included a link to enter an optional drawing for one ( 1 ) of four ( 4 ) VISA gift cards ( $ 25 each). The participants were informed that there was no possibility of linking the drawing information to that of the survey and that their information would remain confidential. 2.1 Exclusion Criteria Any individual who ( 1 ) was younger than 18 years of age (n = 0), ( 2 ) was not a student at Franciscan University of Steubenville (n = 4), ( 3 ) was an online-only student (n = 185), or ( 4 ) responded “No” to the consent question (n = 3) was immediately directed to the Disqualification Page . Additionally, 75 individuals exited the survey prior to completing any or all of the above required criteria. Exclusion criteria included any individual who: ( 1 ) did not complete the survey question regarding their age (n = 14), or ( 2 ) did not provide a response to (n = 46) or complete the required questions (n = 21) for the Pittsburgh Sleep Quality Index (PSQI). The final number of participants whose responses met inclusion criteria was 526 (60% of the original 874 total respondents; 22% of the 2386 students in the target population who received the invitation email). 2.2 Survey Structure 2.2.1 Demographic Questions Demographic questions included: age, sex, primary major, and living status during the school year. Participants were also asked regarding the average number of hours a day they spend on academics outside of scheduled classes, number of credit hours currently being taken and the number of semesters they have spent living on campus at Franciscan University (including the semester currently underway), as well as on other university campuses (i.e., not Franciscan University). Additionally, participants were asked to complete the “Daily Spiritual Experiences” domain of the Brief Multidimensional Measurement of Religiousness/Spirituality, which is comprised of a number of domains that address various aspects pertaining to religiosity and spirituality, which can be utilized separately ( 59 ). The “Daily Spiritual Experiences” domain consisted of 7 items measured on a six-point Likert scale (1 = Many times a day to 6 = Never or almost never ). 2.2.2 Pittsburgh Sleep Quality Index (PSQI) The Pittsburgh Sleep Quality Index (PSQI)( 60 ) was used to assess participants’ sleep quality and disturbances over the past month. Subjects were asked questions regarding various aspects of their sleep habits, including the rating of statements on various Likert scales (e.g., 0 = Not during the past month to 3 = Three or more times a week ). The PSQI is comprised of seven components (e.g., subjective sleep quality, sleep duration, etc.), which are “standardized versions of areas routinely assessed in clinical interviews of patients with sleep/wake complaints” ( 60 ). The scores of the seven components are then summed to create a global/total PSQI score (ranging from 0–21), with higher scores being indicative of worse sleep quality. Moreover, a global PSQI score greater than 5 has been previously indicated as a reliable cutoff for indicating “poor” versus “good” sleepers ( 60 ). The question regarding a roommate or bed partner originally included additional components scored on a four-point Likert scale. However, for the purpose of our survey, this question, which does not contribute to the global score, was modified to simply ask if the participant had a roommate and if so, whether they were in the same room or another room. 2.2.3 Barratt Impulsiveness Scale (BIS-11) Our survey also included the Barratt Impulsiveness Scale Version 11 (BIS-11)( 61 ) to assess various components of impulsiveness. Participants were asked to indicate the appropriate response (on a four-point Likert scale: Rarely/Never to Almost always/Always ) regarding various statements pertaining to ways in which they act and think. A total score (Total BIS) was calculated, as well as scores for each of the three subscales: Attentional Impulsiveness (AttImp), Motor Impulsiveness (MotImp), Non-planning Impulsiveness (NpImp). Cronbach’s alpha indicated good internal consistency for Total BIS (α = 0.84), and acceptable for the AttImp and NpImp (α = 0.75 and 0.72, respectively) subscales and questionable for the MotImp (α = 0.64) subscale. 2.2.4 Functional Idiographic Assessment Template - Questionnaire - Short Form (FIAT-Q-SF) The short form of the Functional Idiographic Assessment Template - Questionnaire (FIAT-Q-SF)( 62 ) was utilized to assess various aspects associated with the participants’ interpersonal relationships/functioning. Individuals were asked to indicate on a six-point Likert scale ( Strongly disagree to Strongly agree ) whether or not the statement applies to them. Based on Darrow and colleagues ( 62 ), total overall scores (Total FIAT) were calculated, as well as total scores for each of the following factors: Avoidance of Interpersonal Intimacy (AvdInt), Argumentativeness or Disagreement (ArgDis), Connection and Reciprocity (ConRec), Conflict Aversion (ConAve), Emotional Experience and Expression (EmoExp), and Excessive Expressivity (ExcExp). Cronbach’s alpha pertaining to the FIAT-Q-SF indicated good internal consistency for the Total FIAT (α = 0.85), as well as the AvdInt, ArgDis, ConAve and ExcExp subscales (α = 0.88, 0.82, 0.81, 0.82, respectively). Additionally, Cronbach’s alpha indicated acceptable internal consistency for the ConRec subscale (α = 0.72) and questionable internal consistency for the EmoExp subscale (α = 0.64). 2.3 Statistical Analysis Analyses were conducted on all data remaining following the application of the exclusion criteria (n = 526) using R version 4.3.0, SigmaPlot version 14.0 (Systat Software, Inc.) and Jamovi version 2.3.15. Proportions tests were utilized to assess ( 1 ) the percentage of individuals scoring within poor versus good sleep quality, ( 2 ) differences in the percentage of males and females scoring within poor sleep quality and ( 3 ) differences in the proportion of those reporting poor sleep quality within each of the BIS-11 scoring categories. Additionally, independent measures t-test (two-tailed) were used to assess ( 1 ) sex differences in total/global PSQI, BIS-11 and FIAT-Q-SF scores, ( 2 ) sex differences in the subscales/components of each scale utilized in this study (i.e., PSQI, BIS-11, FIAT-Q-SF), and ( 3 ) differences in BIS-11 and FIAT-Q-SF total scores, as well as the individual subscales, between participants reporting good vs poor sleep quality (as measured by the PSQI). Pearson correlations were utilized to assess the relationships between the PSQI, BIS-11 and FIAT-Q-SF. Given ( 1 ) the various correlations between the variables measured in this study, in addition to ( 2 ) previous literature (addressed above) indicating a relationship between sleep and factors associated with both impulsiveness and social relationships, as well as ( 3 ) previous research addressing impulsivity as a mediator between variables associated with sociality and well-being ( 63 ), mediation analysis using Baron and Kenny’s criteria ( 64 , 65 ), as well as 1000 bootstrapping replicates ( 65 ), was utilized to investigate the potential relationship between sleep quality (predictor) and interpersonal functioning (outcome), and the potential mediating effect of impulsiveness (mediator) on such a relationship. Differences were considered significant at p < 0.05. 3. Results 3.1 Demographics The distribution of participants in this survey was 33% male and 67% female, which is relatively representative of the student body at Franciscan University. The data for the demographic questions outlined above are shown across sex in Supplementary Table 1 (See Additional File 1). 3.2 Sleep Quality (PSQI) In relation to sleep quality, as measured by the PSQI, average global PSQI scores and average scores for each of the components (as outlined by Buysse et al. (1989)) are shown in Table 1. In this regard, analysis indicated significantly higher global PSQI scores in females relative to males ( p <0.05). Additionally, in relation to the PSQI subscales, females scored significantly higher in both sleep disturbance ( p <0.05) and daytime dysfunction due to sleepiness ( p 0.05). Table 1. Average PSQI, BIS-11 and FIAT-Q-SF scores in overall sample, as well as sex differences. Scale/Subscale Overall Male Female t r 2 PSQI Global PSQI Sleep duration Sleep disturbance Sleep latency Daytime dysfunction due to sleepiness Sleep efficiency Overall sleep quality Sleep medication use 7.17 (0.14) 0.49 (0.03) 1.21 (0.02) 1.32 (0.04) 1.68 (0.03) 0.79 (0.04) 1.19 (0.03) 0.46 (0.04) 6.71 (0.24) 0.54 (0.06) 1.13 (0.04) 1.27 (0.07) 1.56 (0.06) 0.79 (0.07) 1.19 (0.05) 0.30 (0.06) 7.39 (0.18) 0.47 (0.04) 1.25 (0.03) 1.34 (0.05) 1.74 (0.04) 0.80 (0.05) 1.19 (0.03) 0.54 (0.05) 2.260* -1.116 2.429* 0.762 2.587** 0.146 -0.093 2.844 0.011 0.002 0.011 0.001 0.013 0.000 0.000 0.015 BIS-11 Total BIS Attentional Impulsiveness Motor Impulsiveness Non-planning Impulsiveness 64.81 (0.48) 18.50 (0.19) 21.53 (0.19) 24.78 (0.22) 64.46 (0.84) 17.59 (0.33) 22.15 (0.33) 24.72 (0.39) 64.97 (0.59) 18.93 (0.23) 21.24 (0.23) 24.80 (0.27) 0.499 3.306** -2.268* 0.170 0.000 0.021 0.010 0.000 FIAT-Q-SF Total FIAT Avoidance of Interpersonal Intimacy Argumentativeness or Disagreement Connection and Reciprocity Conflict Aversion Emotional Experience and Expression Excessive Expressivity 86.87 (0.85) 27.49 (0.43) 16.95 (0.29) 6.82 (0.13) 10.42 (0.18) 14.54 (0.20) 10.65 (0.23) 86.13 (1.47) 27.28 (0.71) 18.10 (0.48) 7.41 (0.25) 9.17 (0.31) 13.98 (0.39) 10.18 (0.37) 87.19 (1.04) 27.58 (0.54) 16.45 (0.36) 6.56 (0.16) 10.96 (0.22) 14.79 (0.24) 10.85 (0.29) 0.576 0.325 -2.612** -2.954** 4.610*** 1.849† 1.319 0.001 0.000 0.015 0.019 0.045 0.008 0.004 PSQI : Global PSQI - Male: n = 147, Female: n = 307; Sleep duration and Sleep disturbance - Male: n = 174, Female: n = 352; Sleep latency - Male: n = 172, Female: n = 350; Daytime dysfunction due to sleepiness , Overall sleep quality , and Sleep medication use - Male: n = 171, Female: n = 352; Sleep efficiency - Male: n = 150, Female: n = 308. BIS-11 - Male: n = 162, Female: n = 341. FIAT-Q-SF - Male: n = 136; Female: n = 312. Data is reported as mean (Standard error of the mean). t-statistic and r-squared based on two-tailed independent measures t-tests. Degrees of freedom = sum of the number of males and females (provided for each scale/subscale) minus 2. * p <0.05, ** p <0.01, *** p <0.001, † 0.05< p <0.1. Analysis of sleep quality (PSQI), as defined by Buysse et al. (60), indicated that a significantly higher proportion [χ 2 (1, N=454) = 97.80, p <0.001] of participants reported poor (66.5%) relative to good (33.5%) sleep quality. Figure 1 portrays the distribution of participants across global PSQI scores. Additionally, a significantly higher percentage [χ 2 (1, N=454) = 4.78, p <0.05] of females (70.0%) relative to males (59.2%) reported scores indicating poor sleep quality. 3.3 Impulsivity (BIS-11) Average total BIS-11 scores and the average sum for each subscale (Attentional Impulsiveness, Motor Impulsiveness and Non-planning Impulsiveness) and standard errors of the mean are reported for the overall sample (i.e., sexes combined) and across the sexes in Table 1, as well as statistics (i.e., t-statistics and r-squared values) for the appropriate tests. Average scores are also shown for Total BIS and each subscale across poor and good sleep quality (as measured by the PSQI), as well as appropriate statistics in Table 2. Based on the total score cut-offs addressed in Stanford and colleagues (66), 26.2% of respondents would be categorized as “highly impulsive” (72 or higher), 62.8% as “within normal limits of impulsiveness” (52-71) and 10.9% as “an individual that is either extremely over-controlled or who has not honestly completed the questionnaire” (<52). Table 2. Average scores across BIS-11 and FIAT-Q-SF across poor and good sleep quality (PSQI). Scale/Subscale Poor Good t r 2 BIS-11 Total BIS Attentional Impulsiveness Motor Impulsiveness Non-planning Impulsiveness 66.56 (0.64) 19.42 (0.25) 21.95 (0.26) 25.20 (0.29) 61.97 (0.85) 16.72 (0.33) 21.13 (0.34) 24.12 (0.41) 4.207*** 6.358*** 1.891† 2.123* 0.039 0.084 0.008 0.010 FIAT-Q-SF Total FIAT Avoidance of Interpersonal Intimacy Argumentativeness or Disagreement Connection and Reciprocity Conflict Aversion Emotional Experience and Expression Excessive Expressivity 89.53 (1.09) 28.65 (0.55) 17.39 (0.38) 6.57 (0.15) 10.51 (0.25) 15.05 (0.26) 11.36 (0.32) 83.06 (1.57) 25.54 (0.79) 16.57 (0.56) 7.05 (0.27) 10.36 (0.32) 13.76 (0.38) 9.78 (0.39) 3.359*** 3.213** 1.210 -1.656† 0.359 2.835** 2.950** 0.028 0.026 0.004 0.007 0.000 0.020 0.022 Poor and Good : poor and good sleep quality, respectively, as measured by the PSQI (BIS-11: Poor: n = 293, Good: n = 147; FIAT-Q-SF: Poor: n = 266, Good: n = 125). Data is reported as mean (Standard error of the mean). t-statistic and r-squared based on two-tailed independent measures t-tests). Degrees of freedom = sum of the number of subjects reporting Good and Poor sleep quality for each scale (provided in the table) minus 2. * p <0.05, ** p <0.01, *** p <0.001, † 0.05< p 0.05) between males and females in the average total BIS-11 scores. Analysis also revealed significantly higher ( p <0.01) average AttImp scores among females relative to males, while males scored significantly higher ( p 0.05). 3.3.2 BIS-11 and Sleep Quality In relation to sleep quality and impulsivity, as measured by the PSQI and BIS-11, respectively, of the individuals scoring within the category of “highly impulsive”, 70.5% reported poor sleep quality. Additionally, of those scoring “within normal limits of impulsiveness”, 55.7% reported poor sleep quality, while 43.6% of those scoring in the lowest category of impulsiveness (<52) reported poor sleep quality. Proportions test indicated a significantly higher percentage [χ 2 (2, N=503) = 13.76, p <0.01] of poor sleep quality among those reporting high impulsivity (score 72 or higher) relative to both other groups (score between 52-71: p <0.05; score<52: p <0.01) Additionally, in relation to impulsivity across sleep quality (Table 2; Figure 2B), analysis indicated that those reporting poor sleep quality indicated significantly higher average BIS-11 total scores ( p <0.001) than those reporting good sleep quality. Analysis also revealed significantly higher average Attentional Impulsiveness ( p <0.001) and Non-planning Impulsiveness ( p <0.05) scores in participants reporting poor relative to good sleep quality. Moreover, there was a tendency towards significance ( p = 0.059) in Motor Impulsiveness scores between poor and good sleep quality. 3.4 Interpersonal Functioning (FIAT-Q-SF) Average total FIAT-Q-SF scores and the average sum for each subscale (AvdInt, ArgDis, ConRec, ConAve, EmoExp, ExcExp) and standard errors of the mean are reported for the overall sample (i.e., sexes combined) and across the sexes in Table 1, as well as the appropriate statistics (i.e., t-statistics and r-squared values). Average scores are also shown for Total FIAT and each subscale across poor and good sleep quality (as measured by the PSQI), in addition to the appropriate statistics in Table 2. 3.4.1 FIAT-Q-SF Across Sex In relation to the FIAT-Q-SF across the sexes (Table 1; Figure 2C), analysis of the total FIAT-Q-SF scores indicated no significant difference between males and females ( p >0.05). Additional analysis indicated various sex differences across the FIAT-Q-SF subscales. Specifically, males reported significantly higher scores relative to females in ArgDis and ConRec (both p <0.01), while females reported significantly higher ConAve scores ( p 0.05). 3.4.2 FIAT-Q-SF and Sleep Quality Analysis pertaining to sleep quality (PSQI) and interpersonal functioning (FIAT-Q-SF) (Table 2; Figure 2D) indicated significantly higher ( p <0.001) Total FIAT scores in those reporting poor relative to good sleep quality. Additionally, analysis indicated significantly higher average AvdInt, EmoExp and ExcExp scores (all p <0.01) in those reporting poor relative to good sleep quality. Moreover, there was a tendency towards significance ( p =0.099) in average ConRec scores with those reporting good sleep quality scoring higher than those reporting poor sleep quality. 3.5 Correlation of PSQI, BIS-11 and FIAT-Q-SF Correlation analysis indicated various significant positive relationships between the variables measured pertaining to sleep quality (Global PSQI), impulsivity (BIS-11; Total BIS, AttImp, MotImp, NpImp), and interpersonal functioning (FIAT-Q-SF; Total FIAT, AvdInt, ArgDis, ConRec, ConAve, EmoExp, ExcExp) (Figure 3). 3.6 Mediation Analysis of PSQI, BIS-11 and FIAT-Q-SF Mediation analysis was performed to assess the potential mediating role of impulsiveness (as measured by the BIS-11 subscales; AttImp, MotImp, NpImp; M=mediator in Figure 4) on the relationship between sleep quality (as measured by the Global PSQI Score; PSQI/IV=independent variable in Figure 4) and interpersonal functioning (as measured by the Total FIAT-Q-SF Score; FIAT/DV=dependent variable in Figure 4). Figure 4 shows both the hypothesized conceptual model (Figure 4A) and the final model (Figure 4B). Significant mediation pathways, including the indirect relationships, shown in-text (full results shown in Supplementary Table 2 (See Additional File 2)), revealed that the total effect of sleep quality (PSQI) on interpersonal functioning (FIAT-Q-SF) was significant (H1: β=1.727, t=6.09, p <0.001). With the inclusion of the mediating variables (BIS-11: AttImp, MotImp, NpImp), the impact of sleep quality (PSQI) on interpersonal functioning (FIAT-Q-SF) was still found significant (β=0.747, t=2.48, p <0.05). The indirect effect of PSQI on FIAT-Q-SF was found significant through AttImp (β=0.987, SE=0.180, t=5.47, p <0.001, 95% CI=0.678, 1.392). However, the indirect effect of PSQI through both MotImp (β=-0.116, t=-1.76, p =0.079) and NpImp (β=0.110, t=1.74, p =0.083) were both a tendency towards significance. 4. Discussion Our study sought to explore the relationship between sleep quality, impulsivity and interpersonal functioning, including the potential mediating role of impulsivity in the dynamic of sleep quality and interpersonal functioning. Our study confirms the significant presence of poor sleep quality and impulsivity among university students. Moreover, corroborating previous reports, our results support the relationship between poor sleep quality, higher levels of impulsivity and lower interpersonal functioning ( 46 , 48 , 67 – 72 ). In relation to sex differences, females reported a significantly higher prevalence of poor sleep quality (Global PSQI) relative to males, supporting previous findings ( 73 , 74 ). Additionally, while there were no significant sex differences in overall impulsivity (Total BIS) and interpersonal functioning (Total FIAT), differences were observed between males and females in relation to some of the subscales, specifically, Attentional Impulsiveness and Motor Impulsiveness (for the BIS-11), as well as Argumentativeness or Disagreement , Connection and Reciprocity , and Conflict Aversion (for the FIAT-Q-SF). Pertaining to the impact of sleep quality on impulsivity, individuals reporting poor sleep quality also reported significantly higher levels of overall impulsivity, and higher scores in the specific subscales of Attentional and Non-planning Impulsiveness . Moreover, individuals with poor sleep quality also reported significantly higher total FIAT-Q-SF scores, indicating worse overall interpersonal functioning. Furthermore, within the specific subscales pertaining to interpersonal functioning, those reporting poor sleep quality also reported higher scores in Avoidance of Interpersonal Intimacy , Emotional Experience and Excessive Expressivity . Correlation analysis revealed significant relationships between sleep quality and various aspects of impulsivity and interpersonal functioning, corroborating the dynamics previously discussed. Additionally, mediation analysis indicated that Attentional Impulsiveness (AttImp), but not Motor (MotImp) or Non-planning Impulsiveness (NpImp), significantly mediated the relationship between sleep quality (PSQI) and interpersonal functioning (FIAT). 4.1 Interpersonal Functioning, Sleep and Basic Human Functioning In relation to interpersonal functioning, human interactions and relationships are fundamental/essential for normal human behavior ( 57 , 58 ). Deprivation from such interactions is known to result in detrimental physiological, and ultimately, psychological effects ( 75 – 78 ). However, the interaction between physiology and complex behaviors, such as those observed in human interactions, is not only bidirectional, but is also mediated/impacted by innate behaviors such as sleep. Through its impact on normal physiological functioning, including but not limited to, molecular and neuronal processes (e.g., 79, 80, 81), appropriate/inappropriate sleep behaviors can significantly impact basic human functioning in relation to learning, memory, decision-making, concentration/attention, and resilience/tolerance to stress ( 82 – 90 ). Consequently, behaviors are impacted at an individual level (e.g., lead to irritability) with subsequent consequences on human relationships/interactions (e.g., 88, 91, 92), and while various pharmacological agents can be utilized to buffer the effects of inappropriate sleep behaviors, their efficacy is limited and temporary (e.g., 93). Our findings appear to support these dynamics through the relationships observed between sleep quality and both impulsivity and interpersonal functioning; specifically, lower sleep quality was associated with higher impulsivity scores and worse interpersonal functioning. Additionally, our findings demonstrate that impulsivity (specifically attentional impulsivity) plays a significant role in mediating the relationship between sleep and interpersonal functioning. 4.2 Interpersonal Functioning, Sleep and Executive Function It is important to note that interpersonal functioning is highly influenced by executive functioning ( 94 , 95 ) through various factors that can be modulated by sleep , such as emotional regulation, decision-making and attention, as indicated above. In fact, at a neurological level, amygdalar (emotion) and ventromedial prefrontal cortex (executive function) dysfunction resulting from improper sleep has been reported to detrimentally impact emotional control, decision-making and attention ( 71 , 96 ). This dynamic could potentially be underlying our findings pertaining to the impact of sleep quality on interpersonal functioning, particularly those aspects potentially influenced by emotional regulation (e.g., the Emotional Experience and Expression subscale of the FIAT-Q-SF). Additionally, attention (which, again, is significantly impacted by executive functioning) is fundamental to all behavior and significantly informs decision-making at all stages of human life (e.g., 97, 98). The impact of poor sleep quality on executive functioning may also be reflected in the correlation/relationship between sleep quality and impulsivity, most especially in relation to attentional impulsiveness (which represents attention and cognitive instability ( 61 )), and to a lesser extent, to motor (motor impulsiveness and perseverance) and non-planning (self-control and cognitive complexity) impulsiveness. Going further into this dynamic, the mediating role of attentional impulsiveness in the relationship between sleep and interpersonal functioning is substantiated by both the aforementioned physiological consequences associated with poor sleep quality, as well as the importance of attention in interpersonal functioning ( 96 , 99 – 101 ). 4.3 Role of sleep, attention and interpersonal functioning in daily life/functioning 4.3.1 Within the student population While academics should be the fundamental objective of student life, they do not occur in a vacuum. As per society in general, students are functioning within a social structure that forms the university community and consists of social interactions. As indicated by our findings, students’ interpersonal functioning was negatively impacted by poor sleep quality. Previous literature pertaining to university students has suggested that a lack of social interactions or the presence of negative social interactions have been associated with increased negative psychological consequences (e.g., increased perceived stress, increased proneness to boredom, increased negative emotional wellbeing) (e.g, 102, 103). In addition, other research has indicated the beneficial role of positive social interactions, including indirectly through their influence on other positive behaviors such as physical activity, which has also been shown to be beneficial to well-being (e.g., 104, 105, 106). While the impact of social interactions on well-being has been recognized extensively in the literature, its relevance became particularly pronounced during COVID-19, a time when many individuals were deprived of in-person social interactions, contributing to a decline in mental health (e.g., 102, 107). Another fundamental aspect pertaining to the university student population that warrants attention is the impact of the students’ lifestyle (e.g., quality of sleep, involvement in sports, etc.) on their academics. Within the student population, a significant amount of literature has indicated the importance of sleep and proper attention in academic functioning and success (e.g., 108, 109–111). This is of particular concern given the levels of inappropriate sleep, in addition to its consequences on attention, reported both in the current study, as well as other contemporary research ( 13 , 112 , 113 ), as addressed above. 4.3.2 Beyond the student population While our study addressed sleep, impulsivity, and interpersonal functioning specifically in the university student population with its specific characteristics (e.g., studying, learning) and lifestyle (e.g., new social circles, sleep-habit changes, dietary changes), the findings also have broader implications on the general population. In this regard, executive functioning, attention, interpersonal relationships, and the impact of sleep on such behaviors, have the potential to significantly influence numerous common day-to-day human behaviors and tasks (e.g., reading, writing, etc.), including in the context of various work settings (e.g., hands-on labor, operation of equipment, etc.) ( 114 – 116 ). Thus, it is not just the student population that suffers the consequences resulting from inappropriate/poor sleep. Ultimately, despite the differences that naturally exist across various social environments (e.g., school, workplace, home), there is a fundamental modus operandi in human physiological and behavioral functioning that is impacted by sleep and therefore, in reality, the implications of our findings are generalizable well beyond the student population. 4.4 Addressing the issue: The need to focus on the problem 4.4.1 Focusing on the symptom - Reactive approach As previously mentioned, pharmacological agents have been known to be used in an attempt to counteract the negative consequences associated with poor/inappropriate sleep (i.e., reactive approach). However, these drugs cannot and do not replace the role of sleep as an essential innate physiological behavior. Thus, aside from their temporary and limited effects, there are also potential significant down-stream repercussions associated with substances utilized to counteract the consequences of the lack of sleep (e.g., beverages containing caffeine such as, energy drinks, coffee, etc.), including, but not limited to, an increased propensity for error, including in critical/crucial situations (e.g., surgeon errors, adverse performance and safety outcomes in police officers, etc.) ( 117 , 118 ). However, when a problem, such as inappropriate sleep, is already present and requires long-term adjustments, a reactive approach is often warranted (e.g., the use of melatonin to assist in the adjustment of the sleep schedule ( 119 , 120 )) in order to address the immediate reality of the situation, in addition to allowing for the appropriate disposition that would facilitate such adjustments. Such a reactive response is distinct from reactive responses geared towards simply counteracting the negative consequences associated with poor or inappropriate sleep. 4.4.2 Focusing on the problem - Proactive approach While addressing problems in a reactive manner (addressing the symptom) may be necessary when a problem is already present, the long-term goal of a program/approach must be focused on addressing the root of the issue (e.g., 121). A significant factor underlying negative mental health is the issue of impulsive behaviors, which underlies a broad spectrum of psychiatric disorders (e.g., 122, 123, 124). In contrast, impulse control (i.e., increasing self-control), including its promotion and utilization in therapy, has been previously shown to be of benefit in a broad spectrum of behaviors ( 122 , 123 ). Thus, encouraging principled behaviors that promote self-discipline/self-control has the potential to reduce negative (e.g., impulsive) and contribute to positive behaviors across a broad spectrum of life circumstances, including, but not limited to, interpersonal relationships, academics and avoidance of destructive behaviors, such as alcohol abuse ( 123 , 125 – 127 ). The necessity for principled behaviors in order to achieve success, including in academia, is not a new concept, remembering that university life reflects, in many ways, a microcosm of society. Self-discipline, through its influence on decision-making, ultimately impacts common daily behaviors, such as sleep, diet and general hygiene ( 128 , 129 ), and requires a consistent effort over time, through potential modifications of behavior, to achieve one’s ultimate goal (e.g., improving sleep) ( 130 – 132 ). Such perseverance (sometimes referred to as “grit” in the literature, or “perseverance and passion for long-term goals” ( 130 )) has long term implications, with an ultimate potential outcome of improved overall general and psychological well-being ( 130 , 133 , 134 ). Underlying principled behaviors, self-discipline, and perseverance is motivation, which drives personal initiative and, in turn, is dependent on personal autonomy ( 135 , 136 ). However, given the social nature of humans, and that personal autonomy does not exclude social interaction and community (including, but not limited to, family), but rather includes healthy social relationships while preserving the capacity for self-determination ( 137 , 138 ), the cooperation of individuals is necessary in order to maximize the impact of self-discipline. While personal effort is imperative on the side of the individual (e.g., student, employee, etc.) to be self-disciplined (e.g., getting proper sleep, studying, etc.), community support and reinforcement (e.g., in policy-making, in education, by university administration, professors, parents, etc.) is essential. In effect, self-discipline needs to become “everyone’s reality” ( 125 ). 4.5 Limitations The primary limitation of our study is that associations with measures of mental health such as depression, anxiety and stress cannot be made given a direct measure of mental health (e.g., DASS-21) was not included. However, the study did investigate impulsivity, which is an underlying characteristic of various mental health disorders (e.g., 139, 140) and reflects a dysfunctional corticolimbic dynamic which is documented extensively clinically and in the scientific literature as underlying psychopathology/psychiatric disorders (e.g., 141, 142). A consideration pertaining to the interpretation of the results and their implications is the necessity to also consider the limitations (which continue to be debated, most especially in the field of psychology) of any research design and the optimal statistical methods utilized. This is particularly relevant in relation to the more complex analyses such as mediation analysis. However, while caution is always necessary when implying causation, the reality of the complexity of human behavior and the multidirectional and multicomponent relationships that most investigated human behaviors involve (i.e. the rarity of unidirectional relationships) need to be considered, as well as the consistency and logic of any findings with those of existing research and human experience, which we sought to consider in the discussion of our findings. Additionally, while our study consisted of a sample size representative of our population, a larger sample size or alternative design (e.g., longitudinal study) could potentially have provided further clarity on certain statistical outcomes that were bordering on significance such as the impulsivity subscales in relation to their potential mediating role. Moreover, while our study included a sample from a single university student population, the findings should be considered in the context of the fundamental consistencies that exist within human behavior across cultures/societies, and the congruity between the findings in our samples and other scientific literature pertaining to university students and the general population. 4.6 Conclusions The levels of poor sleep quality and impulsivity reported both in our study and previous literature are of particular concern, given their potential to negatively impact an individual’s physiological/physical and psychological well-being, which can ultimately influence behaviors, including interpersonal functioning (as indicated by our findings), with the potential to further impact the well-being of the individual. This is particularly important given the continued deterioration in mental health despite the increased resources being made available. Overall, our findings suggest that sleep quality and its relationship with impulsivity, specifically attentional impulsivity, have the potential to impact an individual’s interpersonal functioning. As appears to be the case in most circumstances in life, in order to achieve overall well-being, it is ideal that a proactive long-term solution is considered, rather than a reactive short-term approach. However, when an issue is already present, the solution/treatment should seek to address the root of the issue, rather than simply targeting the phenotypic “symptoms” of any potential negative consequences resulting from the issue. In regard to the current findings, rather than simply seeking to minimize the negative consequences associated with lower interpersonal functioning, it would appear to be more beneficial to maximize preventative constructive behaviors (such as improving sleep quality and minimizing impulsivity, i.e., addressing the root of the issue) that build character/virtue and strengthen the individual, including through self-discipline and perseverance. Abbreviations PSQI Pittsburgh Sleep Quality Index BIS 11-Barratt Impulsiveness Scale Version 11 AttImp Attentional Impulsiveness MotImp Motor Impulsiveness NpImp Non-planning Impulsiveness FIAT Q-SF-Functional Idiographic Assessment Template-Questionnaire-Short Form AvdInt Avoidance of Interpersonal Intimacy ArgDis Argumentativeness or Disagreement ConRec Connection and Reciprocity ConAve Conflict Aversion EmoExp Emotional Experience and Expression ExcExp Excessive Expressivity Declarations Ethics approval and consent to participate: The study involved human participants and was reviewed and approved by the Franciscan University of Steubenville Institutional Review Board (IRB: #2022-4). The participants provided informed consent to participate in the study. Consent for publication: Not applicable. Availability of data and materials : The data underlying this article will be shared on reasonable request to the corresponding author. Competing interests: The authors declare that they have no competing interests. Funding: This research was funded by small, private individual, restricted donations made to Franciscan University as a 501(c)3 organization and specifically designated for work currently conducted by SS. Funding for the SurveyMonkey® subscription and gift card drawings was provided to SS by Franciscan University of Steubenville. Neither the donors nor the university had any role in the study design, data collection and analysis, interpretation of results, decision to publish, or preparation of the manuscript. Authors’ contributions : SS supervised the study. BJF and SS contributed to the conception, design and conducting of the study. SS, CC, RWE performed the statistical analyses and contributed to the writing of the first draft of the manuscript. All authors contributed to the revisions of the manuscript and read and approved the submitted version. 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Sleep deprivation increases the costs of attentional effort: Performance, preference and pupil size. Neuropsychologia. 2019;123:169-77. Chua EC, Fang E, Gooley JJ. Effects of total sleep deprivation on divided attention performance. PLoS One. 2017;12(11):e0187098. Litwiller B, Snyder LA, Taylor WD, Steele LM. The relationship between sleep and work: A meta-analysis. The Journal of applied psychology. 2017;102(4):682-99. Pilcher JJ, Morris DM. Sleep and Organizational Behavior: Implications for Workplace Productivity and Safety. Frontiers in psychology. 2020;11:45. Brossoit RM, Crain TL, Leslie JJ, Hammer LB, Truxillo DM, Bodner TE. The effects of sleep on workplace cognitive failure and safety. J Occup Health Psychol. 2019;24(4):411-22. Ogeil RP, Barger LK, Lockley SW, O'Brien CS, Sullivan JP, Qadri S, et al. Cross-sectional analysis of sleep-promoting and wake-promoting drug use on health, fatigue-related error, and near-crashes in police officers. BMJ Open. 2018;8(9):e022041. Parry PI, Lefringhausen A, Turni C, Neil CJ, Cosford R, Hudson NJ, et al. 'Spikeopathy': COVID-19 Spike Protein Is Pathogenic, from Both Virus and Vaccine mRNA. Biomedicines. 2023;11(8). Herxheimer A, Petrie KJ. Melatonin for the prevention and treatment of jet lag. Cochrane Database Syst Rev. 2002;2010(1). Baird MB, Asif IM. Medications for Sleep Schedule Adjustments in Athletes. Sports Health. 2018;10(1):35-9. Riera-Sampol A, Rodas L, Martinez S, Moir HJ, Tauler P. Caffeine Intake among Undergraduate Students: Sex Differences, Sources, Motivations, and Associations with Smoking Status and Self-Reported Sleep Quality. Nutrients. 2022;14(8). Smith T, Panfil K, Bailey C, Kirkpatrick K. Cognitive and behavioral training interventions to promote self-control. J Exp Psychol Anim Learn Cogn. 2019;45(3):259-79. Tangney JP, Baumeister RF, Boone AL. High Self-Control Predicts Good Adjustment, Less Pathology, Better Grades, and Interpersonal Success. Journal of Personality. 2004;72(2):271-324. Griffin SA, Lynam DR, Samuel DB. Dimensional conceptualizations of impulsivity. Personal Disord. 2018;9(4):333-45. Rogus JF. Promoting Self-Discipline: A Comprehensive Approach. Theory Into Practice. 1985;24(4):271-6. Shi Y, Qu S. The effect of cognitive ability on academic achievement: The mediating role of self-discipline and the moderating role of planning. Frontiers in psychology. 2022;13:1014655. Claver F, Martinez-Aranda LM, Conejero M, Gil-Arias A. Motivation, Discipline, and Academic Performance in Physical Education: A Holistic Approach From Achievement Goal and Self-Determination Theories. Frontiers in psychology. 2020;11:1808. Hershner S, O'Brien LM. The Impact of a Randomized Sleep Education Intervention for College Students. J Clin Sleep Med. 2018;14(3):337-47. Sertillanges AG. The intellectual life: Its spirit, conditions, methods: The Catholic University of America Press; 1946 (1998). Duckworth AL, Peterson C, Matthews MD, Kelly DR. Grit: perseverance and passion for long-term goals. J Pers Soc Psychol. 2007;92(6):1087-101. Hagger MS, Hamilton K. Grit and self-discipline as predictors of effort and academic attainment. Br J Educ Psychol. 2019;89(2):324-42. Li J, Li Y. The Role of Grit on Students' Academic Success in Experiential Learning Context. Frontiers in psychology. 2021;12. Verberg F, Helmond P, Otten R, Overbeek G. Mindset and perseverance of adolescents with intellectual disabilities: Associations with empowerment, mental health problems, and self-esteem. Res Dev Disabil. 2019;91:103426. Lee D, Reasoner K, Davidson C, Pennings JS, Lee DH. The Relationships Between Grit, Burnout, and Demographic Characteristics in Medical Students. Psychological reports. 2023;126(5):2511-29. Cook DA, Artino AR, Jr. Motivation to learn: an overview of contemporary theories. Med Educ. 2016;50(10):997-1014. Patel PC, Thatcher SMB. Sticking It Out. Journal of Management. 2012;40(7):1932-79. Vansteenkiste M, Ryan RM. On psychological growth and vulnerability: Basic psychological need satisfaction and need frustration as a unifying principle. Journal of Psychotherapy Integration. 2013;23(3):263-80. Ryff CD. Psychological well-being revisited: advances in the science and practice of eudaimonia. Psychother Psychosom. 2014;83(1):10-28. Chamorro J, Bernardi S, Potenza MN, Grant JE, Marsh R, Wang S, et al. Impulsivity in the general population: a national study. J Psychiatr Res. 2012;46(8):994-1001. Moeller FG, Barratt ES, Dougherty DM, Schmitz JM, Swann AC. Psychiatric aspects of impulsivity. Am J Psychiatry. 2001;158(11):1783-93. Kovner R, Oler JA, Kalin NH. Cortico-Limbic Interactions Mediate Adaptive and Maladaptive Responses Relevant to Psychopathology. Am J Psychiatry. 2019;176(12):987-99. Spikman JM, Deelman BG, van Zomeren AH. Executive functioning, attention and frontal lesions in patients with chronic CHI. J Clin Exp Neuropsychol. 2000;22(3):325-38. Additional Declarations No competing interests reported. Supplementary Files AdditionalFile1.docx Name and file format: Additional File 1.docx Title: Supplementary Table 1. Description: Summary of demographic variables. AdditionalFile2.docx Name and file format: Additional File 2.docx Title: Supplementary Table 2. Description: Complete results for mediation pathways between sleep quality (PSQI) and interpersonal functioning (FIAT-Q-SF) with impulsivity (BIS-11: AttImp, MotImp, NpImp) as potential mediators. PSQI = Global PSQI; AttImp = Attentional impulsiveness; MotImp = Motor impulsiveness; NpImp = Non-planning impulsiveness; FIAT = Total FIAT-Q-SF. Cite Share Download PDF Status: Published Journal Publication published 25 Sep, 2024 Read the published version in Sleep Science and Practice → Version 2 posted Editorial decision: Revision requested 28 May, 2024 Reviews received at journal 13 May, 2024 Reviews received at journal 02 May, 2024 Reviewers agreed at journal 22 Apr, 2024 Reviewers agreed at journal 19 Apr, 2024 Reviewers invited by journal 16 Apr, 2024 Submission checks completed at journal 04 Apr, 2024 Editor assigned by journal 04 Apr, 2024 First submitted to journal 03 Apr, 2024 You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3970668","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[{"code":1,"date":"2024-02-21 18:15:44","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":290162246,"identity":"7b8d65e6-bfc8-4473-96a7-0275094942c8","order_by":0,"name":"Brian J. Farrell","email":"","orcid":"","institution":"Franciscan University of Steubenville","correspondingAuthor":false,"prefix":"","firstName":"Brian","middleName":"J.","lastName":"Farrell","suffix":""},{"id":290162247,"identity":"f39b74da-9351-4400-9fdd-2261895d1054","order_by":1,"name":"Robert W. Emmerton","email":"","orcid":"","institution":"Franciscan University of Steubenville","correspondingAuthor":false,"prefix":"","firstName":"Robert","middleName":"W.","lastName":"Emmerton","suffix":""},{"id":290162248,"identity":"6ef52f34-0a28-413d-9354-4309eba1b10d","order_by":2,"name":"Christina Camilleri","email":"","orcid":"","institution":"Franciscan University of Steubenville","correspondingAuthor":false,"prefix":"","firstName":"Christina","middleName":"","lastName":"Camilleri","suffix":""},{"id":290162249,"identity":"fdfe1e3d-391d-483f-825e-4e58c5c8a993","order_by":3,"name":"Stephen Sammut","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIiWNgGAWjYBADOfYGEGUA5fIQ1mFgzHOAVC2JPQeQ+fi0yPcffrrpZtuf9B7pw88e/Ciok+ef3cD44G0bHuNvpJndzm0zyO3hSzM37DE4bDjjzgFmw7n4tEgwQLTs52Ewk2YwOJDAcCOBTZoXjxb5/uPfQFrSeXjYvwG11CXI30hg/41PC8OBHLAtCTw8PCBbmBMMgLYw49NicCOn7HbOOWPDHh6eMkmQXzbeSGyWnHMOr8O23c4pk5MHOmybxI8/dfJyN5IPfnhThsdhWABjA2nqR8EoGAWjYBRgAACcp00yYAqgwAAAAABJRU5ErkJggg==","orcid":"","institution":"Franciscan University of Steubenville","correspondingAuthor":true,"prefix":"","firstName":"Stephen","middleName":"","lastName":"Sammut","suffix":""}],"badges":[],"createdAt":"2024-02-19 18:35:20","currentVersionCode":2,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-3970668/v2","doiUrl":"https://doi.org/10.21203/rs.3.rs-3970668/v2","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s41606-024-00113-8","type":"published","date":"2024-09-25T15:56:55+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":54594166,"identity":"02d9ebbd-cb8a-423c-84e8-45a94e6f4146","added_by":"auto","created_at":"2024-04-12 18:21:57","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":78889,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution (percentage) of participants across sleep quality (Global PSQI scores). \u003c/strong\u003eColoring indicates \u003cem\u003epoor \u003c/em\u003e(red) versus \u003cem\u003egood\u003c/em\u003e (gray) sleep quality as defined by Buysse et al. (1989), i.e., scores greater than 5 indicate poor sleep quality.\u003c/p\u003e","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-3970668/v2/225c2d6115180d4317b27333.png"},{"id":54594165,"identity":"c5274eba-9b47-4d33-8917-3f97c1bfa139","added_by":"auto","created_at":"2024-04-12 18:21:54","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":570427,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAverage impulsivity and interpersonal functioning subscale total scores across sex and sleep quality category. (A)\u003c/strong\u003e BIS-11 (impulsiveness) subscale totals across sex; \u003cstrong\u003e(B)\u003c/strong\u003e BIS-11 subscale totals across PSQI category (\u003cem\u003epoor\u003c/em\u003evs \u003cem\u003egood\u003c/em\u003e sleep quality);\u003cstrong\u003e (C)\u003c/strong\u003e FIAT-Q-SF (interpersonal functioning) subscale totals across sex; \u003cstrong\u003e(D) \u003c/strong\u003eFIAT-Q-SF subscale totals across PSQI category.\u003cstrong\u003e \u003c/strong\u003eData shown as mean +/- standard error of the mean. *\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05, **\u003cem\u003ep\u003c/em\u003e\u0026lt;0.01, ***\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001, # 0.05\u0026lt;\u003cem\u003ep\u003c/em\u003e\u0026lt;0.1.\u003c/p\u003e","description":"","filename":"Fig2ad.png","url":"https://assets-eu.researchsquare.com/files/rs-3970668/v2/49883b14f1159916f2435bf6.png"},{"id":54593535,"identity":"4701a71f-b9cd-4473-b5ca-115940856f0f","added_by":"auto","created_at":"2024-04-12 18:13:51","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1454845,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCorrelation plot of sleep quality (PSQI), impulsivity (BIS-11) and interpersonal functioning (FIAT-Q-SF). \u003c/strong\u003e\u003cem\u003e\u003cstrong\u003ePSQI\u003c/strong\u003e\u003c/em\u003e: Global PSQI Score; \u003cem\u003e\u003cstrong\u003eBIS-11\u003c/strong\u003e\u003c/em\u003e: BIS, Total BIS; AttImp, Attentional Impulsiveness; MotImp, Motor Impulsiveness; NpImp, Non-planning Impulsiveness; \u003cem\u003e\u003cstrong\u003eFIAT-Q-SF\u003c/strong\u003e\u003c/em\u003e: FIAT, Total FIAT; AvdInt, Avoidance of Interpersonal Intimacy; ArgDis, Argumentativeness or Disagreement; ConRec, Connection and Reciprocity; ConAve, Conflict Aversion; EmoExp, Emotional Experience and Expression; ExcExp, Excessive Expressivity. *\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05, **\u003cem\u003ep\u003c/em\u003e\u0026lt;0.01, ***\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001.\u003c/p\u003e","description":"","filename":"Fig3.png","url":"https://assets-eu.researchsquare.com/files/rs-3970668/v2/7f78598ab8525f40368c8a3c.png"},{"id":54594168,"identity":"213b973f-785f-4460-91e1-b4e54354e585","added_by":"auto","created_at":"2024-04-12 18:22:00","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":175042,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe impact of sleep quality (PSQI) on interpersonal functioning (FIAT-Q-SF), mediated through impulsiveness (BIS-11). (A) \u003c/strong\u003eHypothesized mediation model; \u003cstrong\u003e(B) \u003c/strong\u003eFinal mediation model. \u003cem\u003e\u003cstrong\u003ePSQI\u003c/strong\u003e\u003c/em\u003e: Global PSQI Score; \u003cem\u003e\u003cstrong\u003eBIS-11\u003c/strong\u003e\u003c/em\u003e: AttImp, Attentional Impulsiveness; MotImp, Motor Impulsiveness; NpImp, Non-planning Impulsiveness; \u003cem\u003e\u003cstrong\u003eFIAT\u003c/strong\u003e\u003c/em\u003e: FIAT-Q-SF Total Score. Data represents estimates/betas - direct (total). IV, independent variable; DV, dependent variable; M, mediator. *\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05, **\u003cem\u003ep\u003c/em\u003e\u0026lt;0.01, ***\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001.\u003c/p\u003e","description":"","filename":"Fig4ab.png","url":"https://assets-eu.researchsquare.com/files/rs-3970668/v2/ad32a0707b0ae74ecb2fef77.png"},{"id":65627053,"identity":"01547a92-ea9a-4459-9a36-f48ce17224ed","added_by":"auto","created_at":"2024-09-30 16:09:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3968451,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3970668/v2/8f358047-64e5-48ca-8e0d-741563eb2914.pdf"},{"id":54593531,"identity":"1dd87c22-284b-413d-ba27-998cd6a0fa9f","added_by":"auto","created_at":"2024-04-12 18:13:50","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":27674,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eName and file format\u003c/strong\u003e: Additional File 1.docx\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTitle\u003c/strong\u003e: Supplementary Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDescription\u003c/strong\u003e: Summary of demographic variables.\u003c/p\u003e","description":"","filename":"AdditionalFile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-3970668/v2/d125db37f7a153f2577cc3cf.docx"},{"id":54593534,"identity":"a0fe9d9a-e219-4742-9470-236718f8e89d","added_by":"auto","created_at":"2024-04-12 18:13:51","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":28509,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eName and file format\u003c/strong\u003e: Additional File 2.docx\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTitle\u003c/strong\u003e:\u003cstrong\u003e \u003c/strong\u003eSupplementary Table 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDescription\u003c/strong\u003e: Complete results for mediation pathways between sleep quality (PSQI) and interpersonal functioning (FIAT-Q-SF) with impulsivity (BIS-11: AttImp, MotImp, NpImp) as potential mediators. PSQI = Global PSQI; AttImp = Attentional impulsiveness; MotImp = Motor impulsiveness; NpImp = Non-planning impulsiveness; FIAT = Total FIAT-Q-SF.\u003c/p\u003e","description":"","filename":"AdditionalFile2.docx","url":"https://assets-eu.researchsquare.com/files/rs-3970668/v2/28587c9170fa29c0bac20e7d.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impulsivity Mediates the Relationship between Sleep Quality and Interpersonal Functioning: A Cross-sectional Study in a Sample of University Students","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eResearch continues to indicate growing levels of negative mental health among university students (e.g., 1, 2\u0026ndash;7). The correlates to negative mental health are many, and scientific research continues to seek further understanding of such correlates in all contexts, including in the university student population, in order to provide potential solutions. Among the numerous correlates identified in the scientific literature, including in our previous work, sleep continues to be an important source of stress/concern (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Furthermore, substantial proportions of college students in the United States and globally report poor sleep quality and/or an inadequate amount of sleep (\u003cspan additionalcitationids=\"CR12 CR13 CR14 CR15\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eProper sleep quality and appropriate/healthy levels of sleep play a significant restorative role physiologically, immunologically, hormonally, neurologically, and psychologically (\u003cspan additionalcitationids=\"CR18 CR19 CR20\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Thus, the consequences of disturbed or inadequate sleep can have broad pathological implications ranging from the cellular to the behavioral levels. Under such situations, at the neurobehavioral level, executive functioning, which regulates basic behaviors such as attention (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) and impulse control (\u003cspan additionalcitationids=\"CR24 CR25 CR26\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), is reduced.\u003c/p\u003e \u003cp\u003eEffective/appropriate executive functioning is necessary in the processes of error detection (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e), emotional regulation (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) and social cue processing (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Therefore, when negatively impacted by factors such as sleep deprivation, error detection becomes dysregulated (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Additionally, emotional dysregulation can result, potentially due to a dysfunctional metabolism impacting amygdalar regulation (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan additionalcitationids=\"CR34\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Consequently, this can lead to an enhanced sensitivity to negative stimuli, decreased responsiveness to long-term positive events, reduced positive moods, hysterical behaviors and increased irritability (\u003cspan additionalcitationids=\"CR36 CR37 CR38\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). The potential for more serious negative behaviors, including but not limited to, suicidal thoughts and behaviors, is also present (e.g., 32, 34, 40, 41, 42). Such consequences/behaviors not only impact the individual experiencing them, but also the social surroundings of the individual, as their behaviors can influence the way in which they interact with others.\u003c/p\u003e \u003cp\u003eAdditionally, as indicated above, executive functioning is important in impulse control. A deficiency in impulse control can lead/contribute to a wide range of negative, disinhibited and often risky behaviors. Such behaviors include, but are not limited to, excessive texting, texting while driving, drug abuse and/or inappropriate alcohol use and risky sexual behaviors and any consequences resulting from such behaviors (\u003cspan additionalcitationids=\"CR24 CR25 CR26\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan additionalcitationids=\"CR44\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). Related, inappropriate impulse control can also lead to adverse/dysfunctional social behaviors evident in such behaviors as inappropriate peer influence, social anxiety, aggression and antisocial personality disorder (\u003cspan additionalcitationids=\"CR47 CR48 CR49 CR50\" citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e). In addition to the potential effects of emotional dysregulation discussed above, the presence of inappropriate social behaviors, including dysregulation in social cue processing (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e), can also subsequently influence interpersonal functioning (defined as intimacy and empathy; DSM-5) and the formation and maintenance of relationships (\u003cspan additionalcitationids=\"CR55\" citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e). Ultimately, healthy social relationships, and therefore appropriate interpersonal functioning, have been shown to influence the overall well-being of the individual (e.g., 57, 58).\u003c/p\u003e \u003cp\u003eTherefore, given 1) the prevalence and plethora of negative outcomes associated with poor sleep quality on aspects of executive functioning (such as error detection, emotional regulation and impulsivity), 2) the various relationships reported in the literature between sleep, executive functioning, emotional regulation and interpersonal relationships, and 3) the importance of quality/healthy relationships in the midst of the mental health \u0026ldquo;pandemic\u0026rdquo;, our study sought to investigate the relationship between sleep quality and interpersonal functioning and the potential mediating role of impulsivity in such a relationship, in a sample of university students.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003eThis survey research was conducted in compliance with Federal Law pertaining to the protection of human research subjects. Prior to administration of the survey, Franciscan University of Steubenville Institutional Review Board (IRB) approval was obtained (#2022-4). Our study consisted of a convenience sample of university/college (undergraduate and graduate) students from Franciscan University of Steubenville, OH, United States. An anonymous survey was sent via the university student email address, to all students taking classes at Franciscan University, who were at least 18 years of age. Over the course of two weeks (April 19th \u0026ndash; May 3rd, 2022), the survey was administered through the online survey engine SurveyMonkey\u0026reg;. Prior to completing the survey, participants were directed to a consent form, which detailed the confidentiality and the nature of the study and explained that participation in the study implied consent to analyze and publish the overall results. Participants who did not provide consent were directed to the \u003cem\u003eDisqualification Page\u003c/em\u003e. The projected time of completion of the survey was approximately 15 minutes. The final page of the survey included a link to enter an optional drawing for one (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) of four (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) VISA gift cards (\u003cspan\u003e$\u003c/span\u003e25 each). The participants were informed that there was no possibility of linking the drawing information to that of the survey and that their information would remain confidential.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Exclusion Criteria\u003c/h2\u003e \u003cp\u003eAny individual who (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) was younger than 18 years of age (n\u0026thinsp;=\u0026thinsp;0), (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) was not a student at Franciscan University of Steubenville (n\u0026thinsp;=\u0026thinsp;4), (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) was an online-only student (n\u0026thinsp;=\u0026thinsp;185), or (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) responded \u0026ldquo;No\u0026rdquo; to the consent question (n\u0026thinsp;=\u0026thinsp;3) was immediately directed to the \u003cem\u003eDisqualification Page\u003c/em\u003e. Additionally, 75 individuals exited the survey prior to completing any or all of the above required criteria.\u003c/p\u003e \u003cp\u003eExclusion criteria included any individual who: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) did not complete the survey question regarding their age (n\u0026thinsp;=\u0026thinsp;14), or (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) did not provide a response to (n\u0026thinsp;=\u0026thinsp;46) or complete the required questions (n\u0026thinsp;=\u0026thinsp;21) for the Pittsburgh Sleep Quality Index (PSQI). The final number of participants whose responses met inclusion criteria was 526 (60% of the original 874 total respondents; 22% of the 2386 students in the target population who received the invitation email).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Survey Structure\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1 Demographic Questions\u003c/h2\u003e \u003cp\u003eDemographic questions included: age, sex, primary major, and living status during the school year. Participants were also asked regarding the average number of hours a day they spend on academics outside of scheduled classes, number of credit hours currently being taken and the number of semesters they have spent living on campus at Franciscan University (including the semester currently underway), as well as on other university campuses (i.e., not Franciscan University).\u003c/p\u003e \u003cp\u003eAdditionally, participants were asked to complete the \u0026ldquo;Daily Spiritual Experiences\u0026rdquo; domain of the Brief Multidimensional Measurement of Religiousness/Spirituality, which is comprised of a number of domains that address various aspects pertaining to religiosity and spirituality, which can be utilized separately (\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e). The \u0026ldquo;Daily Spiritual Experiences\u0026rdquo; domain consisted of 7 items measured on a six-point Likert scale (1\u0026thinsp;=\u0026thinsp;\u003cem\u003eMany times a day\u003c/em\u003e to 6\u0026thinsp;=\u0026thinsp;\u003cem\u003eNever or almost never\u003c/em\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2 Pittsburgh Sleep Quality Index (PSQI)\u003c/h2\u003e \u003cp\u003eThe Pittsburgh Sleep Quality Index (PSQI)(\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e) was used to assess participants\u0026rsquo; sleep quality and disturbances over the past month. Subjects were asked questions regarding various aspects of their sleep habits, including the rating of statements on various Likert scales (e.g., 0\u0026thinsp;=\u0026thinsp;\u003cem\u003eNot during the past month\u003c/em\u003e to 3\u0026thinsp;=\u0026thinsp;\u003cem\u003eThree or more times a week\u003c/em\u003e). The PSQI is comprised of seven components (e.g., subjective sleep quality, sleep duration, etc.), which are \u0026ldquo;standardized versions of areas routinely assessed in clinical interviews of patients with sleep/wake complaints\u0026rdquo; (\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e). The scores of the seven components are then summed to create a global/total PSQI score (ranging from 0\u0026ndash;21), with higher scores being indicative of worse sleep quality. Moreover, a global PSQI score greater than 5 has been previously indicated as a reliable cutoff for indicating \u0026ldquo;poor\u0026rdquo; versus \u0026ldquo;good\u0026rdquo; sleepers (\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe question regarding a roommate or bed partner originally included additional components scored on a four-point Likert scale. However, for the purpose of our survey, this question, which does not contribute to the global score, was modified to simply ask if the participant had a roommate and if so, whether they were in the same room or another room.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.2.3 Barratt Impulsiveness Scale (BIS-11)\u003c/h2\u003e \u003cp\u003eOur survey also included the Barratt Impulsiveness Scale Version 11 (BIS-11)(\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e) to assess various components of impulsiveness. Participants were asked to indicate the appropriate response (on a four-point Likert scale: \u003cem\u003eRarely/Never\u003c/em\u003e to \u003cem\u003eAlmost always/Always\u003c/em\u003e) regarding various statements pertaining to ways in which they act and think. A total score (Total BIS) was calculated, as well as scores for each of the three subscales: \u003cem\u003eAttentional Impulsiveness\u003c/em\u003e (AttImp), \u003cem\u003eMotor Impulsiveness\u003c/em\u003e (MotImp), \u003cem\u003eNon-planning Impulsiveness\u003c/em\u003e (NpImp). Cronbach\u0026rsquo;s alpha indicated good internal consistency for Total BIS (α\u0026thinsp;=\u0026thinsp;0.84), and acceptable for the AttImp and NpImp (α\u0026thinsp;=\u0026thinsp;0.75 and 0.72, respectively) subscales and questionable for the MotImp (α\u0026thinsp;=\u0026thinsp;0.64) subscale.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.2.4 Functional Idiographic Assessment Template - Questionnaire - Short Form (FIAT-Q-SF)\u003c/h2\u003e \u003cp\u003eThe short form of the Functional Idiographic Assessment Template - Questionnaire (FIAT-Q-SF)(\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e) was utilized to assess various aspects associated with the participants\u0026rsquo; interpersonal relationships/functioning. Individuals were asked to indicate on a six-point Likert scale (\u003cem\u003eStrongly disagree\u003c/em\u003e to \u003cem\u003eStrongly agree\u003c/em\u003e) whether or not the statement applies to them. Based on Darrow and colleagues (\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e), total overall scores (Total FIAT) were calculated, as well as total scores for each of the following factors: \u003cem\u003eAvoidance of Interpersonal Intimacy\u003c/em\u003e (AvdInt), \u003cem\u003eArgumentativeness or Disagreement\u003c/em\u003e (ArgDis), \u003cem\u003eConnection and Reciprocity\u003c/em\u003e (ConRec), \u003cem\u003eConflict Aversion\u003c/em\u003e (ConAve), \u003cem\u003eEmotional Experience and Expression\u003c/em\u003e (EmoExp), and \u003cem\u003eExcessive Expressivity\u003c/em\u003e (ExcExp).\u003c/p\u003e \u003cp\u003eCronbach\u0026rsquo;s alpha pertaining to the FIAT-Q-SF indicated good internal consistency for the Total FIAT (α\u0026thinsp;=\u0026thinsp;0.85), as well as the AvdInt, ArgDis, ConAve and ExcExp subscales (α\u0026thinsp;=\u0026thinsp;0.88, 0.82, 0.81, 0.82, respectively). Additionally, Cronbach\u0026rsquo;s alpha indicated acceptable internal consistency for the ConRec subscale (α\u0026thinsp;=\u0026thinsp;0.72) and questionable internal consistency for the EmoExp subscale (α\u0026thinsp;=\u0026thinsp;0.64).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Statistical Analysis\u003c/h2\u003e \u003cp\u003eAnalyses were conducted on all data remaining following the application of the exclusion criteria (n\u0026thinsp;=\u0026thinsp;526) using R version 4.3.0, SigmaPlot version 14.0 (Systat Software, Inc.) and Jamovi version 2.3.15. Proportions tests were utilized to assess (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) the percentage of individuals scoring within \u003cem\u003epoor\u003c/em\u003e versus \u003cem\u003egood\u003c/em\u003e sleep quality, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) differences in the percentage of males and females scoring within \u003cem\u003epoor\u003c/em\u003e sleep quality and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) differences in the proportion of those reporting poor sleep quality within each of the BIS-11 scoring categories. Additionally, independent measures t-test (two-tailed) were used to assess (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) sex differences in total/global PSQI, BIS-11 and FIAT-Q-SF scores, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) sex differences in the subscales/components of each scale utilized in this study (i.e., PSQI, BIS-11, FIAT-Q-SF), and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) differences in BIS-11 and FIAT-Q-SF total scores, as well as the individual subscales, between participants reporting \u003cem\u003egood\u003c/em\u003e vs \u003cem\u003epoor\u003c/em\u003e sleep quality (as measured by the PSQI). Pearson correlations were utilized to assess the relationships between the PSQI, BIS-11 and FIAT-Q-SF. Given (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) the various correlations between the variables measured in this study, in addition to (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) previous literature (addressed above) indicating a relationship between sleep and factors associated with both impulsiveness and social relationships, as well as (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) previous research addressing impulsivity as a mediator between variables associated with sociality and well-being (\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e), mediation analysis using Baron and Kenny\u0026rsquo;s criteria (\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e), as well as 1000 bootstrapping replicates (\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e), was utilized to investigate the potential relationship between sleep quality (predictor) and interpersonal functioning (outcome), and the potential mediating effect of impulsiveness (mediator) on such a relationship. Differences were considered significant at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003ch2\u003e3.1 Demographics\u003c/h2\u003e\n\u003cp\u003eThe distribution of participants in this survey was 33% male and 67% female, which is relatively representative of the student body at Franciscan University. The data for the demographic questions outlined above are shown across sex in Supplementary Table 1 (See Additional File 1).\u003c/p\u003e\n\u003ch2\u003e3.2 Sleep Quality (PSQI)\u003c/h2\u003e\n\u003cp\u003eIn relation to sleep quality, as measured by the PSQI, average global PSQI scores and average scores for each of the components (as outlined by Buysse et al. (1989)) are shown in Table 1. In this regard, analysis indicated significantly higher global PSQI scores in females relative to males (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05). Additionally, in relation to the PSQI subscales, females scored significantly higher in both sleep disturbance (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05) and daytime dysfunction due to sleepiness (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.01) relative to males. All other comparisons were not significant (all \u003cem\u003ep\u003c/em\u003e\u0026gt;0.05).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Average PSQI, BIS-11 and FIAT-Q-SF scores in overall sample, as well as sex\u0026nbsp;differences.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"648\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.574074074074076%\"\u003e\n \u003cp\u003e\u003cstrong\u003eScale/Subscale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.734567901234568%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.734567901234568%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.734567901234568%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\"\u003e\n \u003cp\u003e\u003cstrong\u003et\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\"\u003e\n \u003cp\u003e\u003cstrong\u003er\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.574074074074076%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePSQI\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eGlobal PSQI\u003c/p\u003e\n \u003cp\u003eSleep duration\u003c/p\u003e\n \u003cp\u003eSleep disturbance\u003c/p\u003e\n \u003cp\u003eSleep latency\u003c/p\u003e\n \u003cp\u003eDaytime dysfunction due to sleepiness\u003c/p\u003e\n \u003cp\u003eSleep efficiency\u003c/p\u003e\n \u003cp\u003eOverall sleep quality\u003c/p\u003e\n \u003cp\u003eSleep medication use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.734567901234568%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7.17 (0.14)\u003c/p\u003e\n \u003cp\u003e0.49 (0.03)\u003c/p\u003e\n \u003cp\u003e1.21 (0.02)\u003c/p\u003e\n \u003cp\u003e1.32 (0.04)\u003c/p\u003e\n \u003cp\u003e1.68 (0.03)\u003c/p\u003e\n \u003cp\u003e0.79 (0.04)\u003c/p\u003e\n \u003cp\u003e1.19 (0.03)\u003c/p\u003e\n \u003cp\u003e0.46 (0.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.734567901234568%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6.71 (0.24)\u003c/p\u003e\n \u003cp\u003e0.54 (0.06)\u003c/p\u003e\n \u003cp\u003e1.13 (0.04)\u003c/p\u003e\n \u003cp\u003e1.27 (0.07)\u003c/p\u003e\n \u003cp\u003e1.56 (0.06)\u003c/p\u003e\n \u003cp\u003e0.79 (0.07)\u003c/p\u003e\n \u003cp\u003e1.19 (0.05)\u003c/p\u003e\n \u003cp\u003e0.30 (0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.734567901234568%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7.39 (0.18)\u003c/p\u003e\n \u003cp\u003e0.47 (0.04)\u003c/p\u003e\n \u003cp\u003e1.25 (0.03)\u003c/p\u003e\n \u003cp\u003e1.34 (0.05)\u003c/p\u003e\n \u003cp\u003e1.74 (0.04)\u003c/p\u003e\n \u003cp\u003e0.80 (0.05)\u003c/p\u003e\n \u003cp\u003e1.19 (0.03)\u003c/p\u003e\n \u003cp\u003e0.54 (0.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.260*\u003c/p\u003e\n \u003cp\u003e-1.116\u003c/p\u003e\n \u003cp\u003e2.429*\u003c/p\u003e\n \u003cp\u003e0.762\u003c/p\u003e\n \u003cp\u003e2.587**\u003c/p\u003e\n \u003cp\u003e0.146\u003c/p\u003e\n \u003cp\u003e-0.093\u003c/p\u003e\n \u003cp\u003e2.844\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.574074074074076%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBIS-11\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eTotal BIS\u003c/p\u003e\n \u003cp\u003eAttentional Impulsiveness\u003c/p\u003e\n \u003cp\u003eMotor Impulsiveness\u003c/p\u003e\n \u003cp\u003eNon-planning Impulsiveness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.734567901234568%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e64.81 (0.48)\u003c/p\u003e\n \u003cp\u003e18.50 (0.19)\u003c/p\u003e\n \u003cp\u003e21.53 (0.19)\u003c/p\u003e\n \u003cp\u003e24.78 (0.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.734567901234568%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e64.46 (0.84)\u003c/p\u003e\n \u003cp\u003e17.59 (0.33)\u003c/p\u003e\n \u003cp\u003e22.15 (0.33)\u003c/p\u003e\n \u003cp\u003e24.72 (0.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.734567901234568%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e64.97 (0.59)\u003c/p\u003e\n \u003cp\u003e18.93 (0.23)\u003c/p\u003e\n \u003cp\u003e21.24 (0.23)\u003c/p\u003e\n \u003cp\u003e24.80 (0.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.499\u003c/p\u003e\n \u003cp\u003e3.306**\u003c/p\u003e\n \u003cp\u003e-2.268*\u003c/p\u003e\n \u003cp\u003e0.170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.574074074074076%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIAT-Q-SF\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eTotal FIAT\u003c/p\u003e\n \u003cp\u003eAvoidance of Interpersonal Intimacy\u003c/p\u003e\n \u003cp\u003eArgumentativeness or Disagreement\u003c/p\u003e\n \u003cp\u003eConnection and Reciprocity\u003c/p\u003e\n \u003cp\u003eConflict Aversion\u003c/p\u003e\n \u003cp\u003eEmotional Experience and Expression\u003c/p\u003e\n \u003cp\u003eExcessive Expressivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.734567901234568%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e86.87 (0.85)\u003c/p\u003e\n \u003cp\u003e27.49 (0.43)\u003c/p\u003e\n \u003cp\u003e16.95 (0.29)\u003c/p\u003e\n \u003cp\u003e6.82 (0.13)\u003c/p\u003e\n \u003cp\u003e10.42 (0.18)\u003c/p\u003e\n \u003cp\u003e14.54 (0.20)\u003c/p\u003e\n \u003cp\u003e10.65 (0.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.734567901234568%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e86.13 (1.47)\u003c/p\u003e\n \u003cp\u003e27.28 (0.71)\u003c/p\u003e\n \u003cp\u003e18.10 (0.48)\u003c/p\u003e\n \u003cp\u003e7.41 (0.25)\u003c/p\u003e\n \u003cp\u003e9.17 (0.31)\u003c/p\u003e\n \u003cp\u003e13.98 (0.39)\u003c/p\u003e\n \u003cp\u003e10.18 (0.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.734567901234568%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e87.19 (1.04)\u003c/p\u003e\n \u003cp\u003e27.58 (0.54)\u003c/p\u003e\n \u003cp\u003e16.45 (0.36)\u003c/p\u003e\n \u003cp\u003e6.56 (0.16)\u003c/p\u003e\n \u003cp\u003e10.96 (0.22)\u003c/p\u003e\n \u003cp\u003e14.79 (0.24)\u003c/p\u003e\n \u003cp\u003e10.85 (0.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.576\u003c/p\u003e\n \u003cp\u003e0.325\u003c/p\u003e\n \u003cp\u003e-2.612**\u003c/p\u003e\n \u003cp\u003e-2.954**\u003c/p\u003e\n \u003cp\u003e4.610***\u003c/p\u003e\n \u003cp\u003e1.849\u0026dagger;\u003c/p\u003e\n \u003cp\u003e1.319\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePSQI\u003c/em\u003e:\u0026nbsp;\u003c/strong\u003e\u003cem\u003eGlobal PSQI\u003c/em\u003e - Male: n = 147, Female: n = 307; \u003cem\u003eSleep duration\u003c/em\u003e and \u003cem\u003eSleep disturbance\u0026nbsp;\u003c/em\u003e- Male: n = 174, Female: n = 352; \u003cem\u003eSleep latency\u003c/em\u003e - Male: n = 172, Female: n = 350; \u003cem\u003eDaytime dysfunction due to sleepiness\u003c/em\u003e, \u003cem\u003eOverall sleep quality\u003c/em\u003e,\u003cem\u003e\u0026nbsp;\u003c/em\u003eand \u003cem\u003e\u0026nbsp;Sleep medication use\u003c/em\u003e - Male: n = 171, Female: n = 352; \u003cem\u003eSleep efficiency\u003c/em\u003e - Male: n = 150, Female: n = 308. \u003cstrong\u003e\u003cem\u003eBIS-11\u003c/em\u003e\u003c/strong\u003e - Male: n = 162, Female: n = 341. \u003cstrong\u003e\u003cem\u003eFIAT-Q-SF\u003c/em\u003e\u003c/strong\u003e - Male: n = 136; Female: n = 312. Data is reported as mean (Standard error of the mean). t-statistic and r-squared based on two-tailed independent measures t-tests. Degrees of freedom = sum of the number of males and females (provided for each scale/subscale) minus 2. * \u003cem\u003ep\u003c/em\u003e\u0026lt;0.05, ** \u003cem\u003ep\u003c/em\u003e\u0026lt;0.01, *** \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001, \u0026dagger; 0.05\u0026lt;\u003cem\u003ep\u003c/em\u003e\u0026lt;0.1.\u003c/p\u003e\n\u003cp\u003eAnalysis of sleep quality (PSQI), as defined by Buysse et al.\u0026nbsp;(60), indicated that a significantly higher proportion [\u0026chi;\u003csup\u003e2\u003c/sup\u003e (1, N=454) = 97.80, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001] of participants reported \u003cem\u003epoor\u003c/em\u003e (66.5%) relative to \u003cem\u003egood\u003c/em\u003e (33.5%) sleep quality. Figure 1 portrays the distribution of participants across global PSQI scores. Additionally, a significantly higher percentage [\u0026chi;\u003csup\u003e2\u003c/sup\u003e (1, N=454) = 4.78, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.05] of females (70.0%) relative to males (59.2%) reported scores indicating \u003cem\u003epoor\u0026nbsp;\u003c/em\u003esleep quality.\u003c/p\u003e\n\u003ch2\u003e3.3 Impulsivity (BIS-11)\u003c/h2\u003e\n\u003cp\u003eAverage total BIS-11 scores and the average sum for each subscale (Attentional Impulsiveness, Motor Impulsiveness and Non-planning Impulsiveness) and standard errors of the mean are reported for the overall sample (i.e., sexes combined) and across the sexes in Table 1, as well as statistics (i.e., t-statistics and r-squared values) for the appropriate tests. Average scores are also shown for Total BIS and each subscale across poor and good sleep quality (as measured by the PSQI), as well as appropriate statistics in Table 2. Based on the total score cut-offs addressed in Stanford and colleagues\u0026nbsp;(66), 26.2% of respondents would be categorized as \u0026ldquo;highly impulsive\u0026rdquo; (72 or higher), 62.8% as \u0026ldquo;within normal limits of impulsiveness\u0026rdquo; (52-71) and 10.9% as \u0026ldquo;an individual that is either extremely over-controlled or who has not honestly completed the questionnaire\u0026rdquo; (\u0026lt;52).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Average scores across BIS-11 and FIAT-Q-SF across poor and good sleep quality (PSQI).\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.81184668989547%\"\u003e\n \u003cp\u003e\u003cstrong\u003eScale/Subscale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.770034843205575%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePoor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.770034843205575%\"\u003e\n \u003cp\u003e\u003cstrong\u003eGood\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.498257839721255%\"\u003e\n \u003cp\u003e\u003cstrong\u003et\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.149825783972126%\"\u003e\n \u003cp\u003e\u003cstrong\u003er\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.81184668989547%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBIS-11\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eTotal BIS\u003c/p\u003e\n \u003cp\u003eAttentional Impulsiveness\u003c/p\u003e\n \u003cp\u003eMotor Impulsiveness\u003c/p\u003e\n \u003cp\u003eNon-planning Impulsiveness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.770034843205575%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e66.56 (0.64)\u003c/p\u003e\n \u003cp\u003e19.42 (0.25)\u003c/p\u003e\n \u003cp\u003e21.95 (0.26)\u003c/p\u003e\n \u003cp\u003e25.20 (0.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.770034843205575%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e61.97 (0.85)\u003c/p\u003e\n \u003cp\u003e16.72 (0.33)\u003c/p\u003e\n \u003cp\u003e21.13 (0.34)\u003c/p\u003e\n \u003cp\u003e24.12 (0.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.498257839721255%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4.207***\u003c/p\u003e\n \u003cp\u003e6.358***\u003c/p\u003e\n \u003cp\u003e1.891\u0026dagger;\u003c/p\u003e\n \u003cp\u003e2.123*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.149825783972126%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.039\u003c/p\u003e\n \u003cp\u003e0.084\u003c/p\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.81184668989547%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIAT-Q-SF\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eTotal FIAT\u003c/p\u003e\n \u003cp\u003eAvoidance of Interpersonal Intimacy\u003c/p\u003e\n \u003cp\u003eArgumentativeness or Disagreement\u003c/p\u003e\n \u003cp\u003eConnection and Reciprocity\u003c/p\u003e\n \u003cp\u003eConflict Aversion\u003c/p\u003e\n \u003cp\u003eEmotional Experience and Expression\u003c/p\u003e\n \u003cp\u003eExcessive Expressivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.770034843205575%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e89.53 (1.09)\u003c/p\u003e\n \u003cp\u003e28.65 (0.55)\u003c/p\u003e\n \u003cp\u003e17.39 (0.38)\u003c/p\u003e\n \u003cp\u003e6.57 (0.15)\u003c/p\u003e\n \u003cp\u003e10.51 (0.25)\u003c/p\u003e\n \u003cp\u003e15.05 (0.26)\u003c/p\u003e\n \u003cp\u003e11.36 (0.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.770034843205575%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e83.06 (1.57)\u003c/p\u003e\n \u003cp\u003e25.54 (0.79)\u003c/p\u003e\n \u003cp\u003e16.57 (0.56)\u003c/p\u003e\n \u003cp\u003e7.05 (0.27)\u003c/p\u003e\n \u003cp\u003e10.36 (0.32)\u003c/p\u003e\n \u003cp\u003e13.76 (0.38)\u003c/p\u003e\n \u003cp\u003e9.78 (0.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.498257839721255%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3.359***\u003c/p\u003e\n \u003cp\u003e3.213**\u003c/p\u003e\n \u003cp\u003e1.210\u003c/p\u003e\n \u003cp\u003e-1.656\u0026dagger;\u003c/p\u003e\n \u003cp\u003e0.359\u003c/p\u003e\n \u003cp\u003e2.835**\u003c/p\u003e\n \u003cp\u003e2.950**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.149825783972126%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003cp\u003e0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003ePoor\u003c/em\u003e and \u003cem\u003eGood\u003c/em\u003e: poor and good sleep quality, respectively, as measured by the PSQI (BIS-11: Poor: n = 293, Good: n = 147; FIAT-Q-SF: Poor: n = 266, Good: n = 125). Data is reported as mean (Standard error of the mean). t-statistic and r-squared based on two-tailed independent measures t-tests). Degrees of freedom = sum of the number of subjects reporting Good and Poor sleep quality for each scale (provided in the table) minus 2. * \u003cem\u003ep\u003c/em\u003e\u0026lt;0.05, ** \u003cem\u003ep\u003c/em\u003e\u0026lt;0.01, ***\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001, \u0026dagger; 0.05\u0026lt;\u003cem\u003ep\u003c/em\u003e\u0026lt;0.1.\u003c/p\u003e\n\u003ch3\u003e3.3.1 BIS-11 Across Sex\u003c/h3\u003e\n\u003cp\u003eAnalysis of the BIS-11 across the sexes (Table 1; Figure 2A) indicated no significant difference (\u003cem\u003ep\u003c/em\u003e\u0026gt;0.05) between males and females in the average total BIS-11 scores. Analysis also revealed significantly higher (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.01) average AttImp scores among females relative to males, while males scored significantly higher (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05) in MotImp relative to females. In relation to NpImp, there was no significant sex difference in average scores (\u003cem\u003ep\u003c/em\u003e\u0026gt;0.05).\u003c/p\u003e\n\u003ch3\u003e3.3.2 BIS-11 and Sleep Quality\u003c/h3\u003e\n\u003cp\u003eIn relation to sleep quality and impulsivity, as measured by the PSQI and BIS-11, respectively, of the individuals scoring within the category of \u0026ldquo;highly impulsive\u0026rdquo;, 70.5% reported poor sleep quality. Additionally, of those scoring \u0026ldquo;within normal limits of impulsiveness\u0026rdquo;, 55.7% reported poor sleep quality, while 43.6% of those scoring in the lowest category of impulsiveness (\u0026lt;52) reported poor sleep quality. Proportions test indicated a significantly higher percentage [\u0026chi;\u003csup\u003e2\u003c/sup\u003e (2, N=503) = 13.76, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.01] of poor sleep quality among those reporting high impulsivity (score 72 or higher) relative to both other groups (score between 52-71: \u003cem\u003ep\u003c/em\u003e\u0026lt;0.05; score\u0026lt;52: \u003cem\u003ep\u003c/em\u003e\u0026lt;0.01)\u003c/p\u003e\n\u003cp\u003eAdditionally, in relation to impulsivity across sleep quality (Table 2; Figure 2B), analysis indicated that those reporting \u003cem\u003epoor\u003c/em\u003e sleep quality indicated significantly higher average BIS-11 total scores (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001) than those reporting \u003cem\u003egood\u003c/em\u003e sleep quality.\u003c/p\u003e\n\u003cp\u003eAnalysis also revealed significantly higher average \u003cem\u003eAttentional Impulsiveness\u0026nbsp;\u003c/em\u003e(\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001) and \u003cem\u003eNon-planning Impulsiveness\u003c/em\u003e (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05) scores\u003cem\u003e\u0026nbsp;\u003c/em\u003ein participants reporting \u003cem\u003epoor\u0026nbsp;\u003c/em\u003erelative to \u003cem\u003egood\u0026nbsp;\u003c/em\u003esleep quality. Moreover, there was a tendency towards significance (\u003cem\u003ep\u003c/em\u003e = 0.059) in \u003cem\u003eMotor Impulsiveness\u0026nbsp;\u003c/em\u003escores between \u003cem\u003epoor\u0026nbsp;\u003c/em\u003eand \u003cem\u003egood\u0026nbsp;\u003c/em\u003esleep quality.\u003c/p\u003e\n\u003ch2\u003e3.4 Interpersonal Functioning (FIAT-Q-SF)\u003c/h2\u003e\n\u003cp\u003eAverage total FIAT-Q-SF scores and the average sum for each subscale (AvdInt, ArgDis, ConRec, ConAve, EmoExp, ExcExp) and standard errors of the mean are reported for the overall sample (i.e., sexes combined) and across the sexes in Table 1, as well as the appropriate statistics (i.e., t-statistics and r-squared values). Average scores are also shown for Total FIAT and each subscale across poor and good sleep quality (as measured by the PSQI), in addition to the appropriate statistics in Table 2.\u003c/p\u003e\n\u003ch3\u003e3.4.1 FIAT-Q-SF Across Sex\u003c/h3\u003e\n\u003cp\u003eIn relation to the FIAT-Q-SF across the sexes (Table 1; Figure 2C), analysis of the total FIAT-Q-SF scores indicated no significant difference between males and females (\u003cem\u003ep\u003c/em\u003e\u0026gt;0.05). Additional analysis indicated various sex differences across the FIAT-Q-SF subscales. Specifically, males reported significantly higher scores relative to females in ArgDis and ConRec (both \u003cem\u003ep\u003c/em\u003e\u0026lt;0.01), while females reported significantly higher ConAve scores (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001). Additionally, there was a tendency towards significance in EmoExp (\u003cem\u003ep\u003c/em\u003e=0.065) with females scoring higher than males. All other comparisons were not significant (all \u003cem\u003ep\u003c/em\u003e\u0026gt;0.05).\u003c/p\u003e\n\u003ch3\u003e3.4.2 FIAT-Q-SF and Sleep Quality\u003c/h3\u003e\n\u003cp\u003eAnalysis pertaining to sleep quality (PSQI) and interpersonal functioning (FIAT-Q-SF) (Table 2; Figure 2D) indicated significantly higher (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001) Total FIAT scores in those reporting \u003cem\u003epoor\u0026nbsp;\u003c/em\u003erelative to \u003cem\u003egood\u003c/em\u003e sleep quality. Additionally, analysis indicated significantly higher average AvdInt, EmoExp and ExcExp scores (all \u003cem\u003ep\u003c/em\u003e\u0026lt;0.01) in those reporting \u003cem\u003epoor\u003c/em\u003e relative to \u003cem\u003egood\u003c/em\u003e sleep quality. Moreover, there was a tendency towards significance (\u003cem\u003ep\u003c/em\u003e=0.099) in average ConRec scores with those reporting \u003cem\u003egood\u0026nbsp;\u003c/em\u003esleep quality scoring higher than those reporting \u003cem\u003epoor\u003c/em\u003e sleep quality.\u003c/p\u003e\n\u003ch2\u003e3.5 Correlation of PSQI, BIS-11 and FIAT-Q-SF\u003c/h2\u003e\n\u003cp\u003eCorrelation analysis indicated various significant positive relationships between the variables measured pertaining to sleep quality (Global PSQI), impulsivity (BIS-11; Total BIS, AttImp, MotImp, NpImp), and interpersonal functioning (FIAT-Q-SF; Total FIAT, AvdInt, ArgDis, ConRec, ConAve, EmoExp, ExcExp) (Figure 3).\u003c/p\u003e\n\u003ch2\u003e3.6 Mediation Analysis of PSQI, BIS-11 and FIAT-Q-SF\u003c/h2\u003e\n\u003cp\u003eMediation analysis was performed to assess the potential mediating role of impulsiveness (as measured by the BIS-11 subscales; AttImp, MotImp, NpImp; M=mediator in Figure 4) on the relationship between sleep quality (as measured by the Global PSQI Score; PSQI/IV=independent variable in Figure 4) and interpersonal functioning (as measured by the Total FIAT-Q-SF Score; FIAT/DV=dependent variable in Figure 4). Figure 4 shows both the hypothesized conceptual model (Figure 4A) and the final model (Figure 4B). Significant mediation pathways, including the indirect relationships, shown in-text (full results shown in Supplementary Table 2 (See Additional File 2)), revealed that the total effect of sleep quality (PSQI) on interpersonal functioning (FIAT-Q-SF) was significant (H1: \u0026beta;=1.727, t=6.09, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003eWith the inclusion of the mediating variables (BIS-11: AttImp, MotImp, NpImp), the impact of sleep quality (PSQI) on interpersonal functioning (FIAT-Q-SF) was still found significant (\u0026beta;=0.747, t=2.48, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003eThe indirect effect of PSQI on FIAT-Q-SF was found significant through AttImp (\u0026beta;=0.987, SE=0.180, t=5.47, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001, 95% CI=0.678, 1.392). However, the indirect effect of PSQI through both MotImp (\u0026beta;=-0.116, t=-1.76, \u003cem\u003ep\u003c/em\u003e=0.079) and NpImp (\u0026beta;=0.110, t=1.74, \u003cem\u003ep\u003c/em\u003e=0.083) were both a tendency towards significance.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eOur study sought to explore the relationship between sleep quality, impulsivity and interpersonal functioning, including the potential mediating role of impulsivity in the dynamic of sleep quality and interpersonal functioning. Our study confirms the significant presence of poor sleep quality and impulsivity among university students. Moreover, corroborating previous reports, our results support the relationship between poor sleep quality, higher levels of impulsivity and lower interpersonal functioning (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan additionalcitationids=\"CR68 CR69 CR70 CR71\" citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn relation to sex differences, females reported a significantly higher prevalence of poor sleep quality (Global PSQI) relative to males, supporting previous findings (\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e). Additionally, while there were no significant sex differences in \u003cem\u003eoverall\u003c/em\u003e impulsivity (Total BIS) and interpersonal functioning (Total FIAT), differences were observed between males and females in relation to some of the subscales, specifically, \u003cem\u003eAttentional Impulsiveness\u003c/em\u003e and \u003cem\u003eMotor Impulsiveness\u003c/em\u003e (for the BIS-11), as well as \u003cem\u003eArgumentativeness or Disagreement\u003c/em\u003e, \u003cem\u003eConnection and Reciprocity\u003c/em\u003e, and \u003cem\u003eConflict Aversion\u003c/em\u003e (for the FIAT-Q-SF).\u003c/p\u003e \u003cp\u003ePertaining to the impact of sleep quality on impulsivity, individuals reporting \u003cem\u003epoor\u003c/em\u003e sleep quality also reported significantly higher levels of \u003cem\u003eoverall\u003c/em\u003e impulsivity, and higher scores in the specific subscales of \u003cem\u003eAttentional\u003c/em\u003e and \u003cem\u003eNon-planning Impulsiveness\u003c/em\u003e. Moreover, individuals with poor sleep quality also reported significantly higher total FIAT-Q-SF scores, indicating worse overall interpersonal functioning. Furthermore, within the specific subscales pertaining to interpersonal functioning, those reporting poor sleep quality also reported higher scores in \u003cem\u003eAvoidance of Interpersonal Intimacy\u003c/em\u003e, \u003cem\u003eEmotional Experience\u003c/em\u003e and \u003cem\u003eExcessive Expressivity\u003c/em\u003e. Correlation analysis revealed significant relationships between sleep quality and various aspects of impulsivity and interpersonal functioning, corroborating the dynamics previously discussed. Additionally, mediation analysis indicated that \u003cem\u003eAttentional Impulsiveness\u003c/em\u003e (AttImp), but not \u003cem\u003eMotor\u003c/em\u003e (MotImp) or \u003cem\u003eNon-planning Impulsiveness\u003c/em\u003e (NpImp), significantly mediated the relationship between sleep quality (PSQI) and interpersonal functioning (FIAT).\u003c/p\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Interpersonal Functioning, Sleep and Basic Human Functioning\u003c/h2\u003e \u003cp\u003eIn relation to interpersonal functioning, human interactions and relationships are fundamental/essential for normal human behavior (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e). Deprivation from such interactions is known to result in detrimental physiological, and ultimately, psychological effects (\u003cspan additionalcitationids=\"CR76 CR77\" citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e). However, the interaction between physiology and complex behaviors, such as those observed in human interactions, is not only bidirectional, but is also mediated/impacted by innate behaviors such as sleep. Through its impact on normal physiological functioning, including but not limited to, molecular and neuronal processes (e.g., 79, 80, 81), appropriate/inappropriate sleep behaviors can significantly impact basic human functioning in relation to learning, memory, decision-making, concentration/attention, and resilience/tolerance to stress (\u003cspan additionalcitationids=\"CR83 CR84 CR85 CR86 CR87 CR88 CR89\" citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e). Consequently, behaviors are impacted at an individual level (e.g., lead to irritability) with subsequent consequences on human relationships/interactions (e.g., 88, 91, 92), and while various pharmacological agents can be utilized to buffer the effects of inappropriate sleep behaviors, their efficacy is limited and temporary (e.g., 93). Our findings appear to support these dynamics through the relationships observed between sleep quality and both impulsivity and interpersonal functioning; specifically, lower sleep quality was associated with higher impulsivity scores and worse interpersonal functioning. Additionally, our findings demonstrate that impulsivity (specifically attentional impulsivity) plays a significant role in mediating the relationship between sleep and interpersonal functioning.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Interpersonal Functioning, Sleep and Executive Function\u003c/h2\u003e \u003cp\u003eIt is important to note that \u003cem\u003einterpersonal functioning\u003c/em\u003e is highly influenced by \u003cem\u003eexecutive functioning\u003c/em\u003e (\u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e94\u003c/span\u003e, \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e) through various factors that can be modulated by \u003cem\u003esleep\u003c/em\u003e, such as emotional regulation, decision-making and attention, as indicated above. In fact, at a neurological level, amygdalar (emotion) and ventromedial prefrontal cortex (executive function) dysfunction resulting from improper sleep has been reported to detrimentally impact emotional control, decision-making and attention (\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e). This dynamic could potentially be underlying our findings pertaining to the impact of sleep quality on interpersonal functioning, particularly those aspects potentially influenced by emotional regulation (e.g., the \u003cem\u003eEmotional Experience and Expression\u003c/em\u003e subscale of the FIAT-Q-SF).\u003c/p\u003e \u003cp\u003eAdditionally, attention (which, again, is significantly impacted by executive functioning) is fundamental to all behavior and significantly informs decision-making at all stages of human life (e.g., 97, 98). The impact of poor sleep quality on executive functioning may also be reflected in the correlation/relationship between sleep quality and impulsivity, most especially in relation to \u003cem\u003eattentional impulsiveness\u003c/em\u003e (which represents attention and cognitive instability (\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e)), and to a lesser extent, to motor (motor impulsiveness and perseverance) and non-planning (self-control and cognitive complexity) impulsiveness. Going further into this dynamic, the mediating role of attentional impulsiveness in the relationship between sleep and interpersonal functioning is substantiated by both the aforementioned physiological consequences associated with poor sleep quality, as well as the importance of attention in interpersonal functioning (\u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e, \u003cspan additionalcitationids=\"CR100\" citationid=\"CR99\" class=\"CitationRef\"\u003e99\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR101\" class=\"CitationRef\"\u003e101\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Role of sleep, attention and interpersonal functioning in daily life/functioning\u003c/h2\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003e4.3.1 Within the student population\u003c/h2\u003e \u003cp\u003eWhile academics should be the fundamental objective of student life, they do not occur in a vacuum. As per society in general, students are functioning within a social structure that forms the university community and consists of social interactions. As indicated by our findings, students\u0026rsquo; interpersonal functioning was negatively impacted by poor sleep quality. Previous literature pertaining to university students has suggested that a lack of social interactions or the presence of negative social interactions have been associated with increased negative psychological consequences (e.g., increased perceived stress, increased proneness to boredom, increased negative emotional wellbeing) (e.g, 102, 103). In addition, other research has indicated the beneficial role of positive social interactions, including indirectly through their influence on other positive behaviors such as physical activity, which has also been shown to be beneficial to well-being (e.g., 104, 105, 106). While the impact of social interactions on well-being has been recognized extensively in the literature, its relevance became particularly pronounced during COVID-19, a time when many individuals were deprived of in-person social interactions, contributing to a decline in mental health (e.g., 102, 107).\u003c/p\u003e \u003cp\u003eAnother fundamental aspect pertaining to the university student population that warrants attention is the impact of the students\u0026rsquo; lifestyle (e.g., quality of sleep, involvement in sports, etc.) on their academics. Within the student population, a significant amount of literature has indicated the importance of sleep and proper attention in academic functioning and success (e.g., 108, 109\u0026ndash;111). This is of particular concern given the levels of inappropriate sleep, in addition to its consequences on attention, reported both in the current study, as well as other contemporary research (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR112\" class=\"CitationRef\"\u003e112\u003c/span\u003e, \u003cspan citationid=\"CR113\" class=\"CitationRef\"\u003e113\u003c/span\u003e), as addressed above.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003e4.3.2 Beyond the student population\u003c/h2\u003e \u003cp\u003eWhile our study addressed sleep, impulsivity, and interpersonal functioning specifically in the university student population with its specific characteristics (e.g., studying, learning) and lifestyle (e.g., new social circles, sleep-habit changes, dietary changes), the findings also have broader implications on the general population. In this regard, executive functioning, attention, interpersonal relationships, and the impact of sleep on such behaviors, have the potential to significantly influence numerous common day-to-day human behaviors and tasks (e.g., reading, writing, etc.), including in the context of various work settings (e.g., hands-on labor, operation of equipment, etc.) (\u003cspan additionalcitationids=\"CR115\" citationid=\"CR114\" class=\"CitationRef\"\u003e114\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR116\" class=\"CitationRef\"\u003e116\u003c/span\u003e). Thus, it is not just the student population that suffers the consequences resulting from inappropriate/poor sleep. Ultimately, despite the differences that naturally exist across various social environments (e.g., school, workplace, home), there is a fundamental modus operandi in human physiological and behavioral functioning that is impacted by sleep and therefore, in reality, the implications of our findings are generalizable well beyond the student population.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Addressing the issue: The need to focus on the problem\u003c/h2\u003e \u003cdiv id=\"Sec28\" class=\"Section3\"\u003e \u003ch2\u003e4.4.1 Focusing on the symptom - Reactive approach\u003c/h2\u003e \u003cp\u003eAs previously mentioned, pharmacological agents have been known to be used in an attempt to counteract the negative consequences associated with poor/inappropriate sleep (i.e., reactive approach). However, these drugs cannot and do not replace the role of sleep as an essential innate physiological behavior. Thus, aside from their temporary and limited effects, there are also potential significant down-stream repercussions associated with substances utilized to counteract the consequences of the lack of sleep (e.g., beverages containing caffeine such as, energy drinks, coffee, etc.), including, but not limited to, an increased propensity for error, including in critical/crucial situations (e.g., surgeon errors, adverse performance and safety outcomes in police officers, etc.) (\u003cspan citationid=\"CR117\" class=\"CitationRef\"\u003e117\u003c/span\u003e, \u003cspan citationid=\"CR118\" class=\"CitationRef\"\u003e118\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, when a problem, such as inappropriate sleep, is already present and requires long-term adjustments, a reactive approach is often warranted (e.g., the use of melatonin to assist in the adjustment of the sleep schedule (\u003cspan citationid=\"CR119\" class=\"CitationRef\"\u003e119\u003c/span\u003e, \u003cspan citationid=\"CR120\" class=\"CitationRef\"\u003e120\u003c/span\u003e)) in order to address the immediate reality of the situation, in addition to allowing for the appropriate disposition that would facilitate such adjustments. Such a reactive response is distinct from reactive responses geared towards simply counteracting the negative consequences associated with poor or inappropriate sleep.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section3\"\u003e \u003ch2\u003e4.4.2 Focusing on the problem - Proactive approach\u003c/h2\u003e \u003cp\u003eWhile addressing problems in a reactive manner (addressing the symptom) may be necessary when a problem is already present, the long-term goal of a program/approach must be focused on addressing the \u003cem\u003eroot\u003c/em\u003e of the issue (e.g., 121). A significant factor underlying negative mental health is the issue of impulsive behaviors, which underlies a broad spectrum of psychiatric disorders (e.g., 122, 123, 124). In contrast, impulse control (i.e., increasing self-control), including its promotion and utilization in therapy, has been previously shown to be of benefit in a broad spectrum of behaviors (\u003cspan citationid=\"CR122\" class=\"CitationRef\"\u003e122\u003c/span\u003e, \u003cspan citationid=\"CR123\" class=\"CitationRef\"\u003e123\u003c/span\u003e). Thus, encouraging principled behaviors that promote self-discipline/self-control has the potential to reduce negative (e.g., impulsive) and contribute to positive behaviors across a broad spectrum of life circumstances, including, but not limited to, interpersonal relationships, academics and avoidance of destructive behaviors, such as alcohol abuse (\u003cspan citationid=\"CR123\" class=\"CitationRef\"\u003e123\u003c/span\u003e, \u003cspan additionalcitationids=\"CR126\" citationid=\"CR125\" class=\"CitationRef\"\u003e125\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR127\" class=\"CitationRef\"\u003e127\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe necessity for principled behaviors in order to achieve success, including in academia, is not a new concept, remembering that university life reflects, in many ways, a microcosm of society. Self-discipline, through its influence on decision-making, ultimately impacts common daily behaviors, such as sleep, diet and general hygiene (\u003cspan citationid=\"CR128\" class=\"CitationRef\"\u003e128\u003c/span\u003e, \u003cspan citationid=\"CR129\" class=\"CitationRef\"\u003e129\u003c/span\u003e), and requires a consistent effort over time, through potential modifications of behavior, to achieve one\u0026rsquo;s ultimate goal (e.g., improving sleep) (\u003cspan additionalcitationids=\"CR131\" citationid=\"CR130\" class=\"CitationRef\"\u003e130\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR132\" class=\"CitationRef\"\u003e132\u003c/span\u003e). Such perseverance (sometimes referred to as \u0026ldquo;grit\u0026rdquo; in the literature, or \u0026ldquo;perseverance and passion for long-term goals\u0026rdquo; (\u003cspan citationid=\"CR130\" class=\"CitationRef\"\u003e130\u003c/span\u003e)) has long term implications, with an ultimate potential outcome of improved overall general and psychological well-being (\u003cspan citationid=\"CR130\" class=\"CitationRef\"\u003e130\u003c/span\u003e, \u003cspan citationid=\"CR133\" class=\"CitationRef\"\u003e133\u003c/span\u003e, \u003cspan citationid=\"CR134\" class=\"CitationRef\"\u003e134\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eUnderlying principled behaviors, self-discipline, and perseverance is motivation, which drives personal initiative and, in turn, is dependent on personal autonomy (\u003cspan citationid=\"CR135\" class=\"CitationRef\"\u003e135\u003c/span\u003e, \u003cspan citationid=\"CR136\" class=\"CitationRef\"\u003e136\u003c/span\u003e). However, given the social nature of humans, and that personal autonomy does not exclude social interaction and community (including, but not limited to, family), but rather includes healthy social relationships while preserving the capacity for self-determination (\u003cspan citationid=\"CR137\" class=\"CitationRef\"\u003e137\u003c/span\u003e, \u003cspan citationid=\"CR138\" class=\"CitationRef\"\u003e138\u003c/span\u003e), the cooperation of individuals is necessary in order to maximize the impact of self-discipline. While personal effort is imperative on the side of the individual (e.g., student, employee, etc.) to be self-disciplined (e.g., getting proper sleep, studying, etc.), community support and reinforcement (e.g., in policy-making, in education, by university administration, professors, parents, etc.) is essential. In effect, self-discipline needs to become \u0026ldquo;everyone\u0026rsquo;s reality\u0026rdquo; (\u003cspan citationid=\"CR125\" class=\"CitationRef\"\u003e125\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec30\" class=\"Section2\"\u003e \u003ch2\u003e4.5 Limitations\u003c/h2\u003e \u003cp\u003eThe primary limitation of our study is that associations with measures of mental health such as depression, anxiety and stress cannot be made given a direct measure of mental health (e.g., DASS-21) was not included. However, the study did investigate impulsivity, which is an underlying characteristic of various mental health disorders (e.g., 139, 140) and reflects a dysfunctional corticolimbic dynamic which is documented extensively clinically and in the scientific literature as underlying psychopathology/psychiatric disorders (e.g., 141, 142).\u003c/p\u003e \u003cp\u003eA consideration pertaining to the interpretation of the results and their implications is the necessity to also consider the limitations (which continue to be debated, most especially in the field of psychology) of any research design and the optimal statistical methods utilized. This is particularly relevant in relation to the more complex analyses such as mediation analysis. However, while caution is always necessary when implying causation, the reality of the complexity of human behavior and the multidirectional and multicomponent relationships that most investigated human behaviors involve (i.e. the rarity of unidirectional relationships) need to be considered, as well as the consistency and logic of any findings with those of existing research and human experience, which we sought to consider in the discussion of our findings.\u003c/p\u003e \u003cp\u003eAdditionally, while our study consisted of a sample size representative of our population, a larger sample size or alternative design (e.g., longitudinal study) could potentially have provided further clarity on certain statistical outcomes that were bordering on significance such as the impulsivity subscales in relation to their potential mediating role. Moreover, while our study included a sample from a single university student population, the findings should be considered in the context of the fundamental consistencies that exist within human behavior across cultures/societies, and the congruity between the findings in our samples and other scientific literature pertaining to university students and the general population.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec31\" class=\"Section2\"\u003e \u003ch2\u003e4.6 Conclusions\u003c/h2\u003e \u003cp\u003eThe levels of poor sleep quality and impulsivity reported both in our study and previous literature are of particular concern, given their potential to negatively impact an individual\u0026rsquo;s physiological/physical and psychological well-being, which can ultimately influence behaviors, including interpersonal functioning (as indicated by our findings), with the potential to further impact the well-being of the individual. This is particularly important given the continued deterioration in mental health despite the increased resources being made available. Overall, our findings suggest that sleep quality and its relationship with impulsivity, specifically attentional impulsivity, have the potential to impact an individual\u0026rsquo;s interpersonal functioning. As appears to be the case in most circumstances in life, in order to achieve overall well-being, it is ideal that a \u003cem\u003eproactive long-term\u003c/em\u003e solution is considered, rather than a reactive short-term approach. However, when an issue is already present, the solution/treatment should seek to address the root of the issue, rather than simply targeting the phenotypic \u0026ldquo;symptoms\u0026rdquo; of any potential negative consequences resulting from the issue. In regard to the current findings, rather than simply seeking to \u003cem\u003eminimize the negative consequences\u003c/em\u003e associated with lower interpersonal functioning, it would appear to be more beneficial to \u003cem\u003emaximize preventative constructive behaviors\u003c/em\u003e (such as improving sleep quality and minimizing impulsivity, i.e., addressing the root of the issue) that build character/virtue and strengthen the individual, including through self-discipline and perseverance.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePSQI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePittsburgh Sleep Quality Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBIS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e11-Barratt Impulsiveness Scale Version 11\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAttImp\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAttentional Impulsiveness\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMotImp\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMotor Impulsiveness\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNpImp\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNon-planning Impulsiveness\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFIAT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eQ-SF-Functional Idiographic Assessment Template-Questionnaire-Short Form\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAvdInt\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAvoidance of Interpersonal Intimacy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eArgDis\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eArgumentativeness or Disagreement\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eConRec\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConnection and Reciprocity\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eConAve\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConflict Aversion\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEmoExp\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEmotional Experience and Expression\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eExcExp\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eExcessive Expressivity\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThe study involved human participants and was reviewed and approved by the Franciscan University of Steubenville Institutional Review Board (IRB: #2022-4). The participants provided informed consent to participate in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e: The data underlying this article will be shared on reasonable request to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This research was funded by small, private individual, restricted donations made to Franciscan University as a 501(c)3 organization and specifically designated for work currently conducted by SS. Funding for the SurveyMonkey® subscription and gift card drawings was provided to SS by Franciscan University of Steubenville. Neither the donors nor the university had any role in the study design, data collection and analysis, interpretation of results, decision to publish, or preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e: SS supervised the study. BJF and SS contributed to the conception, design and conducting of the study. SS, CC, RWE performed the statistical analyses and contributed to the writing of the first draft of the manuscript. All authors contributed to the revisions of the manuscript and read and approved the submitted version.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eThe authors would also like to acknowledge the assistance provided by Nathan Martin, Paul Gantz, Paul Marlowe, and Rose Prezzia and other members of the Franciscan University psychology club.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBeiter R, Nash R, McCrady M, Rhoades D, Linscomb M, Clarahan M, et al. The prevalence and correlates of depression, anxiety, and stress in a sample of college students. Journal of Affective Disorders. 2015;173(0):90-6.\u003c/li\u003e\n \u003cli\u003eBruffaerts R, Mortier P, Kiekens G, Auerbach RP, Cuijpers P, Demyttenaere K, et al. Mental health problems in college freshmen: Prevalence and academic functioning. 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J Clin Exp Neuropsychol. 2000;22(3):325-38.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"Franciscan University of Steubenville","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"sleep-science-and-practice","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssap","sideBox":"Learn more about [Sleep Science and Practice](http://sleep.biomedcentral.com)","snPcode":"41606","submissionUrl":"https://submission.nature.com/new-submission/41606/3","title":"Sleep Science and Practice","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"sleep quality, impulsivity, interpersonal functioning, self-discipline, university students, cross-sectional","lastPublishedDoi":"10.21203/rs.3.rs-3970668/v2","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3970668/v2","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Amid the current mental health pandemic, research continues to investigate potential contributors associated with increasing levels of negative mental health. Among such contributors is sleep, which is vital for physiological and psychological functioning with potential downstream behavioral consequences, including in relation to impulsivity and social functioning. Given the significant rates of poor sleep quality reported in the literature, our study sought to investigate the relationship between sleep quality, impulsivity and interpersonal functioning among university students.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: An anonymous online survey was administered to university students (Ages 18+; N=526; 33% male, 67% female) addressing demographics, sleep quality, impulsivity, and interpersonal functioning.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Our findings indicate a substantial proportion of students reporting poor sleep quality and impulsivity. Moreover, higher levels of impulsivity and lower interpersonal functioning were associated with poor sleep quality. Mediation analysis revealed a significant mediating role of attentional impulsivity in the relationship between sleep quality and interpersonal functioning.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: Repeated reports of significant levels of impulsivity underlying numerous psychiatric disorders, its prevalence socially, and the fundamental issue that impulsivity reflects (i.e., lack of self-control/self-discipline), suggests a necessity to reorient therapeutic efforts towards the root of the problem. Thus, efforts should seek to maximize preventative behaviors that build character/virtue and strengthen the individual (e.g., improving sleep quality and minimizing impulsivity), including through self-discipline and perseverance, in order to reduce negative outcomes (e.g., dysfunctional interpersonal functioning).\u003c/p\u003e","manuscriptTitle":"Impulsivity Mediates the Relationship between Sleep Quality and Interpersonal Functioning: A Cross-sectional Study in a Sample of University Students","msid":"","msnumber":"","nonDraftVersions":[{"code":2,"date":"2024-04-12 18:13:45","doi":"10.21203/rs.3.rs-3970668/v2","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-05-28T19:41:11+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-05-14T02:30:50+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-05-02T14:46:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"c7206586-b31b-4cc8-a34c-11d0d5a57b70","date":"2024-04-23T03:22:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"0a4ef571-ae95-4f3d-b6f1-8a7fa6acd948","date":"2024-04-19T20:15:35+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-04-16T17:43:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-04-04T13:18:54+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-04-04T13:18:54+00:00","index":"","fulltext":""},{"type":"submitted","content":"Sleep Science and Practice","date":"2024-04-03T15:24:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"sleep-science-and-practice","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssap","sideBox":"Learn more about [Sleep Science and Practice](http://sleep.biomedcentral.com)","snPcode":"41606","submissionUrl":"https://submission.nature.com/new-submission/41606/3","title":"Sleep Science and Practice","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ff343dab-8287-4378-b605-3e8b5347bd6f","owner":[],"postedDate":"April 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-09-30T15:59:06+00:00","versionOfRecord":{"articleIdentity":"rs-3970668","link":"https://doi.org/10.1186/s41606-024-00113-8","journal":{"identity":"sleep-science-and-practice","isVorOnly":false,"title":"Sleep Science and Practice"},"publishedOn":"2024-09-25 15:56:55","publishedOnDateReadable":"September 25th, 2024"},"versionCreatedAt":"2024-04-12 18:13:45","video":"","vorDoi":"10.1186/s41606-024-00113-8","vorDoiUrl":"https://doi.org/10.1186/s41606-024-00113-8","workflowStages":[]},"version":"v2","identity":"rs-3970668","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3970668","identity":"rs-3970668","version":["v2"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}