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Sleep is a fundamental biological process that all humans exhibit, and there is much evidence that people suffer adverse health outcomes from insufficient sleep. Despite this evidence, much research demonstrates significant heterogeneity in the amounts that people sleep across cultures. This suggests that despite serving fundamental biological func...
Citations
... [12] However, a study in the United States reported no significant impact on CPAP adherence during the COVID-19 lockdown. [15] Differences in CPAP adherence during the COVID-19 lockdown may be attributed to cultural variations in sleep habits, [25,26] lockdown procedures, access to CPAP suppliers, and access to medical services. This is supported by studies that underscore the influence of cultural factors, such as socioeconomic status, health literacy, self-efficacy, and race/ethnicity, on CPAP adherence among patients with OSA. ...
BACKGROUND
This study aimed to examine the impact of the COVID-19 lockdown on adherence to continuous positive airway pressure (CPAP) therapy among Saudi patients with obstructive sleep apnea (OSA). It also sought to assess the influence of demographic variables and comorbidities on CPAP adherence.
METHODS
A prospective cohort study was conducted at the University Sleep Disorders Center at King Saud University Medical City. The study included 67 OSA patients who exclusively used CPAP for treatment across three distinct intervals prelockdown, during lockdown, and postlockdown. Adherence to CPAP therapy was objectively measured using “mask-on on-time monitoring” data from the CPAP machines.
RESULTS
The study found a significant decrease in the number of days with CPAP usage during the lockdown period, which persisted postlockdown. Approximately half of the patients adhered to CPAP treatment throughout the three study intervals. The decrease in CPAP usage days during lockdown was particularly noticeable among patients younger than 50 and older than 65 years of age. The presence of comorbidities, body mass index, and sex did not significantly influence CPAP treatment adherence.
CONCLUSION
The COVID-19 lockdown significantly impacted CPAP treatment adherence among OSA patients, with a decrease in adherence persisting postlockdown. This highlights the need for interventions to support CPAP adherence during challenging times such as a pandemic. Further research is needed to understand the long-term effects of the pandemic on CPAP therapy adherence.
... In the Asian context, societal norms prioritize academic achievement and competition, leading to reduced sleep duration (Schmidt & Van der Linden, 2015). In contrast, Western students often enjoy longer sleep durations because of less academic pressure and better work-life balance (Cheung et al., 2021). These differences underscore how cultural expectations influence students' sleep patterns, along with their cognitive readiness for learning. ...
Aim/Purpose: This study investigates the relationship between time of class and the academic performance of Master of Business Administration (MBA) students with ‘group engagement’ serving as the moderator. Notably, ‘group engagement’ is measured using a novel computer vision-based deep learning approach. Background: Generally, the first year of MBA programs is a critical phase for students, marked by academic and personal growth challenges. The timing of MBA classes, particularly morning sessions, can disrupt students’ circadian rhythms, leading to decreased engagement and academic performance. Existing literature highlights the potential benefits of active learning methods, such as blended learning and collaborative learning, in improving individual student engagement. However, there is a gap in understanding the impact of these methods on group engagement and how this, in turn, influences academic performance. Methodology: We collated video-recorded data from 54 first-semester MBA students when they were attending their morning and afternoon classes. Notably, we adopted blended and collaborative learning methods in the morning classes to check their impact. The study variables included time of class, group engagement, and academic performance. While we measured academic performance through proctored exams, group engagement was estimated using a vision-based system, whereby we analyzed facial expressions from the recorded videos, employing a Convolutional Neural Network (CNN) model. We trained the CNN model to measure group engagement by categorizing specific emotions (sleepy, bored, yawning, frustrated, confused, and focused). We used these emotions to assess group engagement levels (i.e., low, medium, and high). Contribution: This study establishes a definite link between morning classes with blended and collaborative learning methods, resulting in improved academic performance. Besides, through group engagement moderation, we get crucial insights into how high group engagement effectively enhances academic performance. Based on the findings, we propose strategies for educators to optimize their teaching methods and foster a conducive learning environment by leveraging insights from students’ affective states. Findings: Broadly, the results indicate that students performed better in morning classes in which both blended and collaborative learning methods were used. The average marks in morning classes increased to 18.74 compared to 15.39 in afternoon classes. There was a high level of group engagement in the mornings, significantly impacting the relationship between class time and academic performance. However, switching from morning to afternoon classes decreased the effect (academic performance) from 0.03 to -5.42. This shows that the use of blended and collaborative learning methods and the presence of high group engagement in morning classes are essential for better educational outcomes. Recommendations for Practitioners: We recommend integrating active learning methods, such as blended and collaborative learning, into morning MBA classes to optimize academic performance. Our results show that implementing technology-driven group engagement measurement tools enhances real-time insight into emotional states. Educators can use this information to tailor teaching approaches and foster a positive learning environment. Recommendation for Researchers: Additional research should explore the longitudinal impact of AI-based engagement measurement. Studies could also investigate the scalability and applicability of group-focused strategies across diverse educational settings. Impact on Society: This study highlights the need to improve teaching methods and group engagement in MBA education. It offers tools for active learning and AI-based engagement tracking. The findings would help both educators and policymakers create better learning experiences. Future Research: Future research should include more diverse samples to enhance external validity. Studies can explore various learning methods across different cultural contexts. Researchers can develop hybrid systems integrating physiological sensors with computer vision to provide more comprehensive results.
... The association between poor sleepers and attentional bias, as examined in Study 1, confirms that both the A-I-E pathway and Harvey's model demonstrate the critical role of distorted cognitive components in insomnia symptoms [7,9]. Despite differences in sleep habits between Eastern and Western individuals, both models exhibit cross-regional applicability [42], making them effective in explaining sleep-related attentional bias in Chinese populations. ...
Background
Attentional bias is a salient manifestation of insomnia. Digital cognitive therapy for insomnia (dCBT-I) has been validated as effective in alleviating this cognitive dysfunction. However, the effect of dCBT-I on attentional bias among Chinese individuals with insomnia remains undiscussed. This research sought to investigate this effect via a pictorial dot-probe task.
Methods
In Study 1, the pattern of attentional bias among poor sleepers (N = 52) and normal sleepers (N = 56) was assessed by the dot-probe task. In study 2, dCBT-I and conventional education were received by the experimental group (N = 42) and control group (N = 25), respectively. The dot-probe tasks and sleep quality assessments were completed at baseline and post-test.
Results
The results of Study 1 indicated that poor sleepers exhibited significant attentional bias, characterized by increased attentional vigilance. Compared to normal sleepers, they showed heightened attentional vigilance toward sleep-related cues. The results of Study 2 showed that both dCBT-I and conventional education led to improvements in PSQI scores. However, only dCBT-I training alleviated attentional vigilance toward sleep-related cues. Additionally, dCBT-I was uniquely effective in reducing feelings of fatigue.
Conclusions
Poor sleepers had a significant attentional bias, marked by heightened vigilance toward sleep-related cues. Digital CBT-I effectively reduced attentional vigilance and fatigue, suggesting that dCBT-I targets the cognitive distortions associated with insomnia.
Trial registration
ChiCTR2100053172 (registered 13/11/2021).
... First, this study found that the average total sleep time for university students was 359.71 (SD = 58.62) min, based on objective sleep measurements using a wearable tracker, which is consistent with a previous study (Cheung et al., 2021) finding the average total sleep time of Japanese university students being only about 6 hr. While Hirshkowitz et al. (2015) report that 6 hr of sleep is acceptable for young adults (18-25 years old), and less than the recommended amount of sleep may not cause adverse effects, they stress that individuals who intentionally restrict sleep over a prolonged period may be compromising their health and well-being. ...
The transition from high school to university is characterized by changes in students' social and learning environments, potentially impacting sleep and learning behaviors. To examine the sleep characteristics of university students, this study aimed to (a) measure sleep in a living environment using a wearable tracker; (b) use a self‐administered questionnaire to examine the relationship between objective and subjective sleep; and (c) examine how psychological aspects are related to objective and subjective sleep. Fifty undergraduate and graduate students participated, with 310 sleep records obtained. The objective means total sleep time showed a moderately positive correlation with sleep quantity in the 3‐Dimensional Sleep Scale. Furthermore, we found that mental health, trait anxiety, and quality of life do not correlate with objective total sleep time but are significantly moderately correlated with subjective sleep quantity. The combination of wearable trackers and subjective reports may provide a more precise understanding of university students' actual sleep patterns and how different aspects of sleep behavior are associated with health outcomes.
... The night prior to the control session, participants averaged 6.6 ± 0.8 h of sleep, similar to previous reports regarding the sleep habits of Canadian university students (e.g., Papaconstantinou et al., 2020;Cheung et al., 2021). Across the three nights prior to the control and sleep-deprived sessions, participants rated their sleep as restful (scores of 3.9 ± 0.3 and 4.0 ± 0.4, respectively on a 1-5 Likert scale, with 5 = very restful). ...
Sleep deprivation alters cognitive and sensorimotor function, but its effects on the control of standing balance are inconclusive. The vestibular system is critical for standing balance, and is modified by sleep deprivation; however, how sleep deprivation affects vestibular-evoked balance responses is unknown. Thus, this study aimed to examine the effect of 24 h of sleep deprivation on the vestibular control of standing balance. During both a well-rested (i.e., control) and sleep deprivation condition, nine females completed two 90-s trials of bilateral, binaural stochastic electrical vestibular stimulation (EVS) and two 120-s trials of quiet stance on a force plate. Quiet stance performance was assessed by center of pressure displacement parameters. Mediolateral ground reaction force (ML force) and surface electromyography (EMG) of the right medial gastrocnemius (MG) were sampled simultaneously with the EVS signal to quantify vestibular control of balance within the frequency (gain and coherence) and time (cumulant density) domains. Twenty-four hours of sleep deprivation did not affect quiet stance performance. Sleep deprivation also had limited effect on EVS-MG EMG and EVS-ML Force coherence (less than control at 8–10.5 Hz, greater at ~ 16 Hz); however, gain of EVS-MG EMG (< 8, 11–24 Hz) and EVS-ML force (0.5–9 Hz) was greater for sleep deprivation than control. Sleep deprivation did not alter peak-to-peak amplitude of EVS-MG EMG (p = 0.51) or EVS-ML force (p = 0.06) cumulant density function responses. Despite no effect on quiet stance parameters, the observed increase in vestibular-evoked balance response gain suggests 24-h sleep deprivation may lead to greater sensitivity of the central nervous system when transforming vestibular-driven signals for standing balance control.
... Cross-cultural analysis in infant, children, and adolescents showed that bedtime routines and habits change between counties (including Asia, Europe, North America, Australia, and the Middle East region) [41]. Moreover, sleep patterns and beliefs and attitude about sleep also show cultural differences in college students (e.g., between Japan and Canada) [42]. More data are needed in different cultural contexts to have a clearer picture of pre-sleep behaviours in college students. ...
... There is, indeed, an opportunity to fill this gap by delivering psychoeducation that gives skills to cope with sleep difficulties when therapeutic options are not available or achievable. Younger populations, especially college students, have less access to evidencebased psychological treatment for insomnia symptoms, particularly Cognitive-Behavioural Therapy for Insomnia (CBT-I) which is the first-line treatment for insomnia disorder [42]. Digitally delivered CBT-I, which has also been recommended together with face-to-face delivery by European Guidelines [6], could be a more viable approach for chronic sleep difficulties in this population. ...
College students often experience sleep–wake alterations. Different factors can contribute to insomnia symptoms in this population. The present study aims at investigating pre-sleep behaviours and strategies used to aid sleep onset in young college students and their association with insomnia symptoms. A total of 548 Italian college students (mean age = 23.48 years, range = 19–30 years, 80.5% female) completed a web-based survey on pre-sleep behaviours and sleep-onset facilitators, insomnia symptoms and sleep hygiene, anxiety and depression, and coping strategies. The use of electronic devices at bedtime and as a sleep-onset facilitator was predominant. Students using specific behaviours as sleep-onset facilitators were characterised by more psychological difficulties and poorer sleep. In multivariable linear regression analysis, the frequency of using medications and melatonin, regardless of motivations, was associated with higher insomnia symptoms. The use of specific sleep-onset facilitators positively correlated with the severity of insomnia symptoms. Many students engage in behaviours that are considered sleep-interfering and that are often employed in an attempt to facilitate sleep onset without benefits. Overall, the motivational factors behind pre-sleep behaviours need to be addressed in preventive programs targeting young college students.
... As parents serve as role models for their children, their sleep habits are observed and could be replicated. This could be understood by social learning theory (Bandura & Walters, 1977), which posits that individ- (Cheung et al., 2021;Giannotti et al., 2005;Jeon et al., 2021). Therefore, understanding cultural diversities is essential for helping healthcare institutions and professionals develop culturally sensitive and appropriate sleep interventions and educational programmes. ...
Aims
To consolidate adolescents' perspectives regarding various aspects of sleep and offer insights to promote healthier sleep habits during their critical developmental years.
Methods/Data Sources
Six electronic databases (PubMed, CINAHL, Embase, Scopus, PsycINFO and Web of Science) were searched from their inception dates to June 2023. Data were extracted and meta‐summarised using Sandelowski and Barroso's approach and synthesised using Thomas and Harden's thematic analysis framework.
Results
Meta‐synthesis from 11 peer‐reviewed published studies identified four main themes: (1) Awareness and understanding of sleep's significance, (2) The shadows and radiance of slumber, (3) Traversing the sleepscape: trouble bubbles and (4) Illuminating the path: Guiding lights to enhanced sleep.
Conclusion/Implications
Our review findings suggest a lack of awareness and guidance regarding the significance of sleep and the cultivation of good sleep habits among adolescents. Identified barriers to adequate sleep encompass various factors, including overthinking, poor habits, family/environmental influences, extensive technology use, peer pressure, the fear of missing out, academic demands and involvement in extracurricular activities. Strategies to improve adolescents' sleep health involve multiple sleep strategies, including sleep education, workshops/seminars, parental involvement, incorporating digital well‐being practices, the promotion of relaxation techniques and the provision of essential resources. Prioritising sleep health and implementing targeted interventions are key steps to empower adolescents, create supportive environments and shape a healthier future generation. Future research endeavours should focus on evaluating the effectiveness of interventions and exploring the influence of cultural factors.
Impact
There exists a notable lack of awareness and guidance regarding the significance of sleep and the cultivation of good sleep habits among adolescents.
Barriers to achieving adequate sleep among adolescents include overthinking, poor habits, family/environmental influences, extensive technology use, peer pressure, the fear of missing out, academic demands and involvement in extracurricular activities.
The collaboration between healthcare institutions, professionals and educational institutions is crucial to facilitate (1) the implementation of sleep education workshops/seminars targeting adolescents, (2) increased parental involvement and role‐modelling to instil good sleep practices among adolescents and (3) enhanced integration of digital well‐being practices, the promotion of relaxation techniques and accessibility to essential sleep hygiene resources.
Reporting Method
Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines.
Patient or Public Contribution
No patient or public contribution.
Trial and Protocol Registration
This review was registered on the Prospective Register of Systematic Reviews (CRD42023403775).
... A study conducted among 630 Spanish pregnant women has revealed that maternal anxiety, maternal stress, and sleep quality disturbances are prevalent throughout their pregnancy and further compromised over gestation [27]. Hence, poor sleep quality is experienced by more than half of pregnant women who have possible depression of varying severity [28]. These findings may be attributed to the hidden fear of the impending birth of the child in women who experience pregnancy for the first time. ...
Background
Sleep is a vital requirement during pregnancy for the betterment of the fetus and the mother. Sleep quality could vary due to pregnancy-specific psychological and physiological changes. To introduce a tailored programme to enhance the sleep quality of mothers, it is paramount to assess the sleep quality and determinants of sleep. Therefore, this study aimed to assess the determinants of sleep quality among pregnant women in a selected institution in the Southern province of Sri Lanka.
Methods
Hospital-based cross-sectional study was carried out with 245 antenatal women, selected using a systematic random sampling method. A pretested self-administered questionnaire was used to collect data which contains four parts. Below variables were involved and both continuous and categorical data were collected as required. ‘Maternal sleep quality, socio-demographic data and gestational age, maternal depression and anxiety.’ Data were analyzed using IBM SPSS version 25.0 for Windows by using descriptive statistics, Pearson’s Chi-square test, and independent sample T-test (p < 0.05). Logistic regression analysis was used to find the relationship with sleep quality and other variables. P-value of less than 0.05 was considered statistically significant, at 95% CI.
Results
The majority of women (60.8%) had good sleep quality and they didn’t have either depressive symptoms (63.4%) or anxiety (64.2%). Aged between 34–41 years and third-trimester women had higher rates of poor sleep quality. Varying quality of sleep was identified among three-trimesters with subjective sleep quality, sleep latency, habitual sleep efficiency, and sleep disturbances. In comparison with the first and second trimester, pregnant women in the third trimester had higher score of global PSQI (5.22 ± 2.35), subjective sleep quality (1.23 ± 0.70), sleep latency (1.25 ± 0.86), habitual sleep efficiency (0.14 ± 0.43), and sleep disturbances (1.39 ± 0.58). There was a significant association between gestational age (P = .006), maternal age (P = .009), antenatal depression (P = .034), and anxiety (P = .013) with sleep quality. However, multinomial logistic regression revealed that only gestational age affected on quality of sleep. The first trimester was a protective factor for good quality sleep (Adjusted OR = 3.156) compared to the other two trimesters.
Conclusion
This study revealed that the majority of women had good sleep quality but quality of sleep was deprived with gestational age. It is expected that the findings of this research will be helpful for health and social care policymakers when formulating guidelines and interventions regarding improving the quality of sleep among pregnant women in Sri Lanka.
... Studies have consistently shown shorter sleep durations (Ackermann & Angus, 2017;Soldatos et al. 2005;Tozer, 2018), but a lower prevalence of sleep problems (Léger et al., 2008;Leger & Poursain, 2005) in Japan compared to the rest of the world. In line with this, recent research by Cheung et al. (2021) discovered that despite shorter sleep durations, Japanese participants reported better subjective health and fewer negative consequences of shorter sleep on daytime functioning when compared to Canadian participants. Cultural variability in sleep practices could explain why Japanese participants prefer to sleep less (Cheung et al. 2021;Steger, 2006), as common attitudes towards sleep in a culture are known to be related to people's sleep behaviours (Arslan et al., 2015;Jeon et al., 2021;Worthman & Melby, 2002). ...
... In line with this, recent research by Cheung et al. (2021) discovered that despite shorter sleep durations, Japanese participants reported better subjective health and fewer negative consequences of shorter sleep on daytime functioning when compared to Canadian participants. Cultural variability in sleep practices could explain why Japanese participants prefer to sleep less (Cheung et al. 2021;Steger, 2006), as common attitudes towards sleep in a culture are known to be related to people's sleep behaviours (Arslan et al., 2015;Jeon et al., 2021;Worthman & Melby, 2002). However, the consequences of shorter sleep duration did not necessarily translate into worse sleep outcomes, therefore, it could be speculated that the better sleep outcomes in Japan may be a function of under-reporting because of the possible cultural reticence among Japanese people to associate sleep problems and psychiatric disorders (Leger & Poursain, 2005). ...
Diet has been repeatedly shown to affect mental and sleep health outcomes. However, it is well known that there are cross-cultural differences in dietary practices as well as the prevalence of mental and sleep health outcomes. Given that the dietary inflammatory potential of diets has been linked to mental and sleep health outcomes, in the current study we sought to assess the inflammatory status of habitual diets and examine its relationship with mental and sleep health outcomes in both the United Kingdom and Japan. Our aim was to determine if the associations between the dietary inflammation index (DII) score and these health outcomes could elucidate any potential cross-cultural differences in health. Online survey data was collected from 602 participants (aged 18-40 years) in the United Kingdom (n = 288) and Japan (n = 314). Participants self-reported their dietary intakes, as well as current mental health and sleep patterns. The DII score was calculated (score range - 2.79 to 3.49) We found that although participants in the United Kingdom reported better overall mental wellbeing, participants in Japan reported less severe depression, anxiety and stress and better subjective sleep quality, less sleep disturbances and daytime dysfunction, despite sleeping shorter, and a better adherence to an anti-inflammatory diet. Moreover, across the United Kingdom and Japan, adherence to more anti-inflammatory diets predicted higher levels of subjective sleep quality, fewer sleep disturbances, less use of sleep medicine and less daytime dysfunction. In conclusion, there are several differences between mental and sleep health outcomes in the United Kingdom and Japan, which could be attributable to the inflammatory potential of respective regional diets. Future studies are warranted to examine the mental and sleep health benefits of adhering to anti-inflammatory traditional Japanese diets in clinical and subclinical cohorts.
... sleep time) and beliefs about sleep (e.g. perceived relation between sleep and health) (Cheung et al., 2021). ...
... The disparities in the prevalence of poor sleep quality among university students may be primarily due to differences in the courses offered, sample population background, and curriculum structures across these universities. In addition, research has identified variations of sleep duration among individuals of different cultures, suggesting that sleep patterns vary substantially among different cultural populations (Cheung et al., 2021). A meta-analysis of adolescent sleep data across 23 countries from the past 30 years showed that total sleep time in Asian countries was 40-60 min shorter than in North America, and 60-120 min shorter than in Europe and Australia (Olds et al., 2010). ...
Background
Good sleep quality is crucial for dental students as they must have optimal cognitive function, memory, and decision-making to accomplish their learning requirements. This study aims to determine sleep quality, its associated factors, and the association between sleep quality and academic performance among dental students in Malaysia.
Methods
This cross-sectional study involved dental students at four public universities in Malaysia. A validated Pittsburgh Sleep Quality Index (PSQI) questionnaire was used to assess their sleep quality. An additional self-administered questionnaire was employed to obtain the students’ sociodemographic profile, lifestyle, and academic performance. The data were analysed using descriptive, chi-square, and multiple logistic regression.
Results
Three hundred eighty-four dental students participated in this study. About half of the dental students (51.6%) have poor sleep quality. The mean of sleep hours per night was 5.72 (SD 1.06). The sleep quality was significantly poor among Malay students ( P = 0.023), students who stayed at hostel ( P = 0.002), and those who consumed caffeinated drinks ( P = 0.028). Multiple logistic regression analysis revealed that the poor sleep quality was significantly associated with self-perceived poor academic performance (Adjusted Odds Ratio (AOR) 2.95, 95% CI [1.25–6.96], P -value = 0.013) and students skipping class (AOR 1.70, 95% CI [1.00–2.91], P -value = 0.046).
Conclusions
Most of the dental students in Malaysia have poor sleep quality. Ethnicity, accommodation, and caffeine consumption were significantly associated with sleep quality. Awareness to sleep quality among dental students is needed to ensure they are able to cope with the challenging dental school learning environment.
