Knowledge and Healthy Habits Among Nursing Students Regarding Obstructive Sleep Apnea: A Cross-Sectional Study

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It is associated with a variety of complications such as cardiovascular problems, poor sleep quality, and daytime fatigue. Objectives This study aimed to assess knowledge of obstructive sleep apnea and the prevalence of healthy sleep habits among nursing students at the University of Basrah. Methods A descriptive cross-sectional study was conducted among nursing students at the College of Nursing, University of Basrah. A non-probability (purposive sampling) method was employed to collect data from 150 students via self-reported questionnaires. The research period was prolonged from November 1, 2024, to April 1, 2025. The constructed self-administered questionnaire consisted of three sections: demographic characteristics, knowledge about obstructive sleep apnea, and sleep-related habits. Data were analyzed using SPSS, with results presented in frequencies and percentages. Results The results showed that 64% of participants had good knowledge about obstructive sleep apnea, 28% had moderate knowledge, and only 8% demonstrated poor knowledge. In terms of sleep habits, most of the students have good, healthy habits. Conclusion Most students have poor knowledge. These findings suggest a need for enhanced educational programs focusing on healthy habits and knowledge of obstructive sleep apnea among nursing students. 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F1000Research 2025, 14 :1451 ( https://doi.org/10.12688/f1000research.174242.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Knowledge and Healthy Habits Among Nursing Students Regarding Obstructive Sleep Apnea: A Cross-Sectional Study [version 1; peer review: awaiting peer review] Eman Rahi 1 , Zahraa Mahmoud Hussain Al-Hejaj 1 , Ali Malik Tiryag https://orcid.org/0000-0002-5240-8652 2 , Zainab Alaa Abdulateef Almusawi 1 Eman Rahi 1 , Zahraa Mahmoud Hussain Al-Hejaj 1 , Ali Malik Tiryag https://orcid.org/0000-0002-5240-8652 2 , Zainab Alaa Abdulateef Almusawi 1 PUBLISHED 24 Dec 2025 Author details Author details 1 Basic Science Department, College of Nursing, University of Basrah, Basrah, Basra Governorate, 61004, Iraq 2 Fundamentals of Nursing, College of Nursing, University of Basrah, Basrah, Basra Governorate, 61004, Iraq Eman Rahi Roles: Conceptualization, Investigation, Validation Zahraa Mahmoud Hussain Al-Hejaj Roles: Resources, Supervision, Visualization Ali Malik Tiryag Roles: Writing – Original Draft Preparation, Writing – Review & Editing Zainab Alaa Abdulateef Almusawi Roles: Investigation, Resources, Validation OPEN PEER REVIEW REVIEWER STATUS AWAITING PEER REVIEW This article is included in the Fallujah Multidisciplinary Science and Innovation gateway. Abstract Background A severe sleep disorder called obstructive sleep apnea is typified by recurrent bouts of upper airway obstruction while you’re asleep. It is associated with a variety of complications such as cardiovascular problems, poor sleep quality, and daytime fatigue. Objectives This study aimed to assess knowledge of obstructive sleep apnea and the prevalence of healthy sleep habits among nursing students at the University of Basrah. Methods A descriptive cross-sectional study was conducted among nursing students at the College of Nursing, University of Basrah. A non-probability (purposive sampling) method was employed to collect data from 150 students via self-reported questionnaires. The research period was prolonged from November 1, 2024, to April 1, 2025. The constructed self-administered questionnaire consisted of three sections: demographic characteristics, knowledge about obstructive sleep apnea, and sleep-related habits. Data were analyzed using SPSS, with results presented in frequencies and percentages. Results The results showed that 64% of participants had good knowledge about obstructive sleep apnea, 28% had moderate knowledge, and only 8% demonstrated poor knowledge. In terms of sleep habits, most of the students have good, healthy habits. Conclusion Most students have poor knowledge. These findings suggest a need for enhanced educational programs focusing on healthy habits and knowledge of obstructive sleep apnea among nursing students. READ ALL READ LESS Keywords Knowledge, Healthy Habits, Nursing Students, Obstructive Sleep Apnea Corresponding Author(s) Ali Malik Tiryag ( [email protected] ) Close Corresponding author: Ali Malik Tiryag Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Rahi E et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Rahi E, Mahmoud Hussain Al-Hejaj Z, Malik Tiryag A and Alaa Abdulateef Almusawi Z. Knowledge and Healthy Habits Among Nursing Students Regarding Obstructive Sleep Apnea: A Cross-Sectional Study [version 1; peer review: awaiting peer review] . F1000Research 2025, 14 :1451 ( https://doi.org/10.12688/f1000research.174242.1 ) First published: 24 Dec 2025, 14 :1451 ( https://doi.org/10.12688/f1000research.174242.1 ) Latest published: 24 Dec 2025, 14 :1451 ( https://doi.org/10.12688/f1000research.174242.1 ) Introduction A third of a normal person’s life is spent sleeping, and sleep is a vital indicator of bodily health and function. The most prevalent of the numerous respiratory problems linked to sleep that disrupt regular sleep cycles is obstructive sleep apnea (OSA). 1 , 2 It is a clinical condition that causes repetitive bouts of total or partial blockage of the upper airway lasting over 10 seconds in spite of the continued respiratory attempts. Other than loud snoring accompanied by choking or gasping for air, OSA causes frequent fragmentation of sleep and recurrent arousal. This disturbance of the continuity of sleep produces additional outcomes, such as tiredness, headache, and intellectual weakness. 3 , 4 In addition, frequent airway obstruction may result in hypoxia and hypercapnia, which leads to an extreme impact on the metabolism and cardiovascular systems of the body. OSA has also been further suggested to be a risk factor for an acute myocardial infarction when undiagnosed or untreated. 5 Healthy habits consist of practices, both physical, mental, and emotional, and are associated with overall good health. This involves nutrition, exercise, sleep, mental health, and social ties habits. These habits can help in the long-term health and prevent chronic illness. 6 Craniofacial anatomical variables also increase the number of craniofacial variables that decrease upper airway patency and possibly lead to the development of OSA. It has been reported that 25-30 percent of men and 9-17% of women in the United States satisfy the conditions of obstruction of sleep apnea. 7 Its prevalence is more common among Hispanic, Black, and Asian groups. The prevalence also rises with age, and at the age of 50 years or even above, more women than men develop the disorder. The growing trends of OSA are attributed to the rising trend of obesity, which is between 14% to 55%. Obesity and the upper airway’s soft tissue structure are among the risk factors that are genetically inherited. 8 Assessment of existing knowledge will be useful as it will allow educational institutions to determine the gaps in the nursing curriculum in the case of sleep disorders. This will be able to result in improved training and resources regarding OSA and other communicable conditions. The research on health habits could offer information in the way in how future nurses take care of their own health, including sleep disturbance. 9 This is relevant because an insufficient sleep routine may interfere with their school results and general health. Being informed about OSA, nursing students will be able to bring better care outcomes to the patients with a sleeping disorder by means of successful management and care strategies. 10 This study aimed to determine the level of knowledge with regard to obstructive sleep apnea and the prevalence of healthy sleep habits among nursing students at the University of Basrah. Methods A descriptive cross-sectional study aimed to assess Knowledge and Healthy Habits Among Nursing Students Regarding Obstructive Sleep Apnea. The research period was prolonged from November 1, 2024, to April 1, 2025. Formal administrative approvals were acquired before data collection for the project. This study has been performed in accordance with the principles stated in the Declaration of Helsinki. Each participant has voluntarily signed the written formal approval. This study has approval from the Research Ethical Approval Committee at the College of Nursing/University of Basrah, as the Institutional Review Board (IRB) with date 29 October and order 7/18/1451. It was determined that the research maneuver would cause no real or prospective injury to the study sample. The study was conducted at the University of Basrah/College of Nursing. One hundred and sixty nursing students were collected through a self-reported questionnaire by using a non-probability (purposive sampling method). Ten students did not include samples from the pilot study. Students (male and female) who consent to engage in this study are among the inclusion requirements. Students who declined to take part in the research were not included. Based on a careful analysis of pertinent literature and earlier research, the researcher created a questionnaire to accomplish the goals. Data for Healthy Habits and Obstructive Sleep Apnea were then gathered using this questionnaire. It consists of four parts. Part (I): Questionnaire Related to the Demographic. This section is focused on collecting basic demographic data. Data was collected from students via direct interviews and included the following items: gender, stage, type of study, and age. Part (II): Questionnaire Related to related to Obstructive Sleep Apnea. The purpose of this section was to evaluate the students’ knowledge of obstructive sleep apnea. There were eighteen items in all. Section III: Survey Concerning Nursing Students’ Healthy Lifestyles: This section was created to evaluate nursing students’ knowledge of obstructive sleep apnea-related healthy behaviors. There were eight items in all. Using the Statistical Package for Social Science Program (SPSS), the reliability of the test’s thirty items was examined using Cronbach’s Alpha. A constructive knowledge questionnaire was used by the researcher to gather data, and direct interviews were used to get the answers. The date of the data collection was moved from November 27, 2024, to February 27, 2025. Three 3 three-point Likert scales, with a range of 1 to 3, were employed. The 31 items that make up this scale were scored using a three-point Likert scale, with 1 denoting “don’t know,” 2 denoting “uncertain,” and 3 denoting “know.” Each student was given ten to fifteen minutes to complete the test. Each knowledge scale item’s assessment level was determined by determining the cut-off point for the score mean, and the results were scored as follows: The researcher identified moderate knowledge as 1.67–2.33, high knowledge as 2.34–3, and poor knowledge as 1–1.66. Results The sociodemographic details of the nursing students participating in this study are displayed in Table 1 . The age group was more than 30 years (44.7%), most of them were female (59.3%), most of the students were from the fourth stage (72%), and more than half of the students were from morning study (53.3%). Table 1. Demographic data of the nursing students. Demographic data Data Classes Frequency Percent Age Years 18-22 31 20.7 23-30 52 34.7 More than 30 67 44.7 Total 150 100.0 Sex Male 61 40.7 Female 89 59.3 Total 150 100.0 Stage Second 14 9.3 Third 28 18.7 Fourth 108 72.0 Total 150 100.0 Type of Study Morning 70 46.7 Evening 80 53.3 Total 150 100.0 According to Table 2 , most of the students answered true to all questions regarding Obstructive Sleep Apnea (with good assessment in all questions except in Q2, Q3, Q7, Q12, and Q14, with moderate assessment). Table 2. Nursing students’ knowledge regarding obstructive sleep apnea for each question. Nursing students’ knowledge regarding obstructive sleep apnea for each question Items Answer N = 150 Mean Score Sd Assessment F % 1. One prevalent sleep ailment is obstructive sleep apnea (OSA). False 19 12.7 2.56 0.709 Good Don't Know 28 18.7 True 103 68.7 Total 150 100.0 2. OSA is defined as recurrent bouts of upper airway blockage, either partial or total, lasting at least 60 seconds and accompanied by breathing attempts. False 55 36.7 2.13 0.924 Moderate Don't Know 20 13.3 True 75 50.0 Total 150 100.0 3. Women are more likely than men to have OSA. False 38 25.3 2.28 0.844 Moderate Don't Know 32 21.3 True 80 53.3 Total 150 100.0 4. OSA leads to sleep fragmentation and hyperoxia False 19 12.7 2.57 0.709 Good Don't Know 27 18.0 True 104 69.3 Total 150 100.0 5. Untreated OSA may be linked to cardiac arrhythmias. False 10 6.7 2.63 0.607 Good Don't Know 35 23.3 True 105 70.0 Total 150 100.0 6. Untreated or undiagnosed OSA could predispose patients to systemic hypertension. False 16 10.7 2.60 0.676 Good Don't Know 28 18.7 True 106 70.7 Total 150 100.0 7. Uvulo-palate pharyngoplasty (Surgery) is curative for most patients with OSA. False 5 3.3 2.66 0.541 Moderate Don't Know 41 27.3 True 104 69.3 Total 150 100.0 8. The most common cause of obstructive sleep apnea in children is the presence of large tonsils and adenoids. False 9 6.0 2.64 0.594 Good Don't Know 36 24.0 True 105 70.0 Total 150 100.0 9. Can OSA be treated with herbs or supplements. False 16 10.7 2.57 0.679 Good Don't Know 32 21.3 True 102 68.0 Total 150 100.0 10. Is there a relationship between age and OSA? False 10 6.7 2.65 0.604 Good Don't Know 33 22.0 True 107 71.3 Total 150 100.0 11. Snorting and gasping during sleep are symptoms of OSA. False 17 11.3 2.61 0.684 Good Don't Know 25 16.7 True 108 72.0 Total 150 100.0 12. Is there a link between OSA and obesity? False 40 26.7 2.19 0.833 Moderate Don't Know 41 27.3 True 69 46.0 Total 150 100.0 13. Can OSA lead to psychological issues like depression or anxiety? False 17 11.3 2.59 0.687 Good Don't Know 28 18.7 True 105 70.0 Total 150 100.0 14. Can lifestyle changes reduce the severity of OSA? False 47 31.3 2.25 0.904 Moderate Don't Know 19 12.7 True 84 56.0 Total 150 100.0 15. Does OSA impact daily performance and focus? False 35 23.3 2.34 0.834 Good Don't Know 29 19.3 True 86 57.3 Total 150 100.0 16. Is there a relationship between OSA and blood pressure? False 13 8.7 2.67 0.631 Good Don't Know 24 16.0 True 113 75.3 Total 150 100.0 17. Is OSA in children different from sleep apnea in adults? False 9 6.0 2.73 0.566 Good Don't Know 23 15.3 True 118 78.7 Total 150 100.0 18. Can OSA increase the risk of diabetes or other metabolic disorders? False 16 10.7 2.64 0.668 Good Don't Know 22 14.7 True 112 74.7 Total 150 100.0 The results of Table 3 show that, about the mean score and standard deviation (2.51 + 0.705), the majority of students (89.3%) have good knowledge about obstructive sleep apnea, 10.7% have moderate knowledge, and none have poor knowledge. Table 3. Nursing students’ knowledge regarding obstructive sleep apnea (Total). Nursing students’ knowledge Item Frequency Percent Scale Total MS Sd Assessment Poor 0 0 1 – 1.66 2.51 0.705 Good Moderate 16 10.7 1.67 – 2.33 Good 134 89.3 2.34 – 3 Total 150 100.0 According to Table 4 , most of the students answered sometimes to all questions regarding healthy habits regarding Obstructive Sleep Apnea (good healthy habits in all questions). Table 4. Health habits regarding obstructive sleep apnea. Nursing students’ health habits regarding obstructive sleep apnea for each question Items Answer N = 150 Mean score Sd Assessment F % 1. Smoking status is associated with an elevated risk for OSA No 13 8.7 2.65 0.634 Good Rarely 26 17.3 Sometimes 111 74.0 Total 150 100.0 2. Exposure to secondhand smoke at home or workplace risk for OSA No 9 6.0 2.70 0.576 Good Rarely 27 18.0 Sometimes 114 76.0 Total 150 100.0 3. Aerobic physical activity No 11 7.3 2.68 0.606 Good Rarely 26 17.3 Sometimes 113 75.3 Total 150 100.0 4. Frequency of eating out No 108 3.3 2.69 0.533 Good Rarely 37 24.7 Sometimes 5 72.0 Total 150 100.0 5. Breakfast skipping No 111 9.3 2.65 0.646 Good Rarely 25 16.7 Sometimes 14 74.0 Total 150 100.0 6. Use of nutrition labeling No 13 8.7 2.65 0.634 Good Rarely 26 17.3 Sometimes 111 74.0 Total 150 100.0 7. Having caffeinated drinks throughout the day No 18 12.0 2.65 0.685 Good Rarely 16 10.7 Sometimes 116 77.3 Total 150 100.0 8. Sleep hours (weekday) 8 hours 69 46.0 Total 150 100.0 Based on the mean score and standard deviation (2.51 + 0.705), the results of Table 5 show that all students (100%) have good, healthy habits regarding obstructive sleep apnea. Table 5. Nursing students’ health habits regarding obstructive sleep apnea (Total). Nursing students’ health habits Item Frequency Percent Scale Total MS Sd Assessment Good 150 100.0 1.51-3 2.60 0.646 Good Total 150 100.0 This table’s results demonstrate a substantial correlation (P-value = 0.000) between nursing students’ sex and their knowledge of obstructive sleep apnea. The results of Table 6 demonstrate that, at a P-value > 0.05, there is no significant correlation between nursing students’ knowledge of obstructive sleep apnea and their sex, college, stage, or type of study. Table 6. Relationships of Demographic Variables with Nursing Students’ Knowledge. Relationships of demographic variables with nursing students’ knowledge Variables Classes Knowledge Significant Moderate Good Total Age 18-22 0 31 31 Fisher’s Exact Test = 10.049 Df = 2 P-Value = 0.000 S 23-30 3 49 52 More than 30 13 54 67 Total 16 134 150 Sex Male 9 52 61 Chi-Square Test = 1.803 Df = 1 P-Value = 0.179 NS Female 7 82 89 Total 16 134 150 Stage Second 2 12 14 Fisher’s Exact Test = 0.701 Df = 2 P-Value = 0.673 NS Third 2 26 28 Fourth 12 96 108 Total 16 134 150 Type of Study Morning 5 65 70 Chi-Square Test= 1.710 Df = 1 P-Value = 0.191 NS Evening 11 69 80 Total 16 134 150 Discussion The findings showed that the majority of the respondents were aged above 30 (44.7%), female (59.3%), and at a fourth-stage academic level (72%). This age distribution implies a rather developed and mature group and may increase their knowledge level about such complicated health issues as Obstructive Sleep Apnea (OSA). Chung et al. 10 also posit that academic maturity positively affects the level of awareness of chronic conditions among healthcare students. Most of the students (89.3%) were good in terms of their knowledge about OSA, with none having poor knowledge. This finding underscores the usefulness of nursing education in raising awareness of sleep-related disorders. Young et al. 11 also established that early education on OSA is of paramount importance to enhance the diagnosis and reduce the complications. Nonetheless, certain topics, such as evidence of association between obesity and OSA and the impact of lifestyle changes on the severity of OSA, demonstrated a moderate level of understanding, which is consistent with Bahammam et al., 12 who also identified the same knowledge gaps even in the healthcare provider group. The respondents indicated that they all maintained good health habits that were linked to lowering the risk of OSA, such as engaging in physical activities, minimizing exposure to smoking, and being mindful of their eating behaviors. Peppard et al. 13 highlighted that lifestyle changes, including healthy weight and physical exercise, are some of the major preventive measures of OSA. However, quite a significant proportion (29.3%) slept less than six hours during weekdays, and this might predispose them to sleep disorders, as Medic et al. 14 highlight. The correlation was significant between age and knowledge on OSA (p = 0.000), with younger students (18-22 years) having a high degree of knowledge. No important correlations were found about sex, level of study, or even the study type (morning/evening). The findings are in accordance with those of Al-Ghanim et al., 15 who observed that age and clinical exposure had a considerable influence on the knowledge of healthcare students with relation to respiratory conditions. The knowledge bases and positive health behaviors of students can be explained by: A well-organized nursing curriculum that focuses on chronic disease understanding, Clinical training opportunities that emphasize theoretical learning, and Modern trends in health education that suggest the inclusion of sleep health in the main courses. Conclusion This paper has shown that nursing students have a good understanding and a healthy lifestyle in relation to OSA, which makes them important resources in the societal health awareness and early-stage diagnosis campaigns. Nevertheless, specific educational programs should be implemented to enhance the knowledge of some risk factors and the lifestyle influence on OSA. Ethics and consent This study has been performed in accordance with the principles stated in the Declaration of Helsinki. Each participant has voluntarily signed the written formal approval. This study has approval from the Research Ethical Approval Committee at the College of Nursing/University of Basrah, as the Institutional Review Board (IRB) with date 29 October and order 7/18/1451. Data availability statement (DAS) The data is available on Zendo through this link ( https://zenodo.org/records/17741061 ) with DOI: https://doi.org/10.5281/zenodo.17741061 . Data are available under the terms of the Creative Commons Zero “No rights reserved” data waiver ( CC0 1.0 Public domain dedication ). 16 Acknowledgments A lot of thanks to every student who participated in this study. References 1. Kryger M: The mystery of sleep: Why a good night’s rest is vital to a better, healthier life. New Haven: Yale University Press; 2017. 2. Moosavi-Movahedi F, Yousefi R: Good sleep as an important pillar for a healthy life. Rationality and Scientific Lifestyle for Health. Cham: Springer International Publishing; 2021; pp. 167–195. 3. Alzahrani MM, Alghamdi AA, Alghamdi SA, et al. : Knowledge and attitude of dentists towards obstructive sleep apnea. Int. Dent. J. 2022; 72 (3): 315–321. PubMed Abstract | Publisher Full Text | Free Full Text 4. Banner Health: Managing obstructive sleep apnea with CPAP therapy.2024. 5. Gonzaga C, Bertolami A, Bertolami M, et al. : Obstructive sleep apnea, hypertension, and cardiovascular diseases. J. Hum. Hypertens. 2015; 29 (12): 705–712. Publisher Full Text 6. Ortiz-Cermeño E: Educational strategies for healthy habits in secondary school: promoting integral health. Environ. Soc. Manag. J. 2024; 18 (11). Publisher Full Text 7. Vorster AP, van Someren EJ , Pack AI, et al. : Sleep health. Clin. Transl. Neurosci. 2024; 8 (1): 8. Publisher Full Text 8. Slowik JM, Sankari A, Collen JF: Obstructive sleep apnea. [Updated 2024 Mar 21]. StatPearls. Treasure Island (FL): StatPearls Publishing; 2024. 9. Badran SF, Kaddumukasa M: A study on knowledge, attitudes, and practices regarding sleep apnea among healthcare workers. Eur. J. Intern. Med. 2015; 26 (3): 182–186. 10. Chung F, Subramanyam R, Liao P, et al. : High STOP-Bang score indicates a high probability of obstructive sleep apnea. Br. J. Anaesth. 2016; 116 (5): 632–638. 11. Young T, Peppard PE, Gottlieb DJ: Epidemiology of obstructive sleep apnea: a population health perspective. Am. J. Respir. Crit. Care Med. 2002; 165 (9): 1217–1239. Publisher Full Text 12. Bahammam AS, Alrajeh MS, Al-Ibrahim FS, et al. : Knowledge and attitude of primary health care physicians towards sleep disorders. Saudi Med. J. 2015; 36 (7): 857–861. 13. Peppard PE, Young T, Palta M, et al. : Sleep position and its effect on obstructive sleep apnea. J. Sleep Res. 2019; 28 (3): e12759. 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Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 24 Dec 2025 ADD YOUR COMMENT Comment Author details Author details 1 Basic Science Department, College of Nursing, University of Basrah, Basrah, Basra Governorate, 61004, Iraq 2 Fundamentals of Nursing, College of Nursing, University of Basrah, Basrah, Basra Governorate, 61004, Iraq Eman Rahi Roles: Conceptualization, Investigation, Validation Zahraa Mahmoud Hussain Al-Hejaj Roles: Resources, Supervision, Visualization Ali Malik Tiryag Roles: Writing – Original Draft Preparation, Writing – Review & Editing Zainab Alaa Abdulateef Almusawi Roles: Investigation, Resources, Validation Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 24 Dec 2025, 14:1451 https://doi.org/10.12688/f1000research.174242.1 Copyright © 2025 Rahi E et al . 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