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The Effects of Sleep Deprivation on College Students The Effects of Sleep Deprivation on College Students
Natalie Guadiana
Dominican University of California
Taylor L. Okashima
Dominican University of California
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! 1
The Effects of Sleep Deprivation on College Students
Natalie Guadiana and Taylor L. Okashima
Department of Nursing, Dominican University of California
NURS 4500: Nursing Research and Senior Thesis
Dr. Patricia Harris
Nov. 23, 2020
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Abstract
The body requires adequate sleep in order to maintain proper physiological health,
psychological health, and cognitive function. In the healthcare field, sufficient sleep is imperative
to ensure optimal patient care. Sleep deprivation can result in greater procedural errors, which
places the clients at risk. Insufficient sleep negatively affects the nervous system, resulting in
poor brain function. Because of the cognitive decline that is associated with sleep deprivation,
academic performance is often decreased. In order to combat the phenomenon of sleep
deprivation, positive lifestyle behaviors and sleep hygiene should be maintained. For students,
academic and financial demands can contribute to physiological stress, which may cause
impaired sleep quality. In particular, poor sleep quality, insomnia, and daytime sleepiness are
reportedly prevalent in college students. Therefore, it is crucial that the effects of sleep
deprivation in university students be further studied and interventions to alleviate the problem be
explored.
Through a thorough review of the research literature and a proposal for further research,
this thesis investigates the questions:
● How will sleep deprivation affect college students, specifically their physiological health,
psychological health, and cognitive function?
● How will ongoing sleep deprivation impact students' academic performance through their
four years at university?
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Table of Contents
Abstract............................................................................................................................................2
Introduction......................................................................................................................................4
Problem Statement...............................................................................................................4
Research Questions..............................................................................................................5
Literature Review.............................................................................................................................5
Sleep Deprivation and Physiological Health..........................................................................6
Sleep Deprivation, Psychological Health, and Sleep Hygiene.............................................10
Sleep Deprivation, Cognitive Health, and Academic Performance......................................14
Overall Discussion of Literature Review.......................................................................................23
Research Proposal..........................................................................................................................25
Theoretical Framework.........................................................................................................25
Research Design....................................................................................................................26
Population of Study...............................................................................................................27
Data Analyses.......................................................................................................................27
Ethical Considerations..........................................................................................................28
Conclusion.....................................................................................................................................28
References......................................................................................................................................30
Appendix........................................................................................................................................32
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Introduction
In order for human beings to function properly, sufficient sleep each night is vital. Adults
need on average eight hours of sleep (Okano et al., 2019). Sleep deprivation occurs when an
adequate amount of sleep is not being maintained. Focusing on the college student population,
sleep deprivation is extremely prevalent. As nursing students, countless sleepless nights have
been experienced due to work schedules, required coursework, and clinical rotations. It has been
found that “up to 60% of all college students suffer from a poor sleep quality” (Schlarb et al.,
2017, p. 1). Overtime, a lack of sleep can negatively affect a person’s physiological health,
psychological health, and cognitive function. Therefore, it is important to investigate how sleep
impacts the human body and look into ways to combat the issue of sleep deprivation.
Problem Statement
Pertaining to the physiological effects of sleep deprivation on the body, the autonomic
response and parasympathetic nervous system become altered when experiencing exceedingly
high levels of distress and not acquiring sufficient hours of sleep. The sympathetic nerves overly
activate while the parasympathetic nervous system becomes inhibited (Hasegawa et al., 2015).
Stress is an influential factor that contributes to the activation of the autonomic nervous activity
(Hasegawa et al., 2015). Hence, insufficient sleep and stress affect both psychological and
physical functioning.
College students have a particularly high risk for impaired sleep quality. Academic demands
contribute to stressors that impact the body and may play a role in sleep deprivation. Focusing on
nursing students, exams, coursework, projects, and clinical rotations place tremendous stress on
the body. As the individual progresses through their program, students are faced with additional
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stressors (Hasegawa et al., 2015). These stressors may result in the college student experiencing
an altered circadian rhythm (an individual’s internal sleep-wake cycle), which can lead to
inconsistent sleep schedules. Consistent sleep is important because “specific synaptic
connections that were active during awake-periods are strengthened during sleep” (Okano et al.,
2019, p. 1). These synaptic connections play a significant role in academic performance,
specifically with regards to cognition, memory, and attention span. For an individual who has
been awake for 17 hours, their cognitive function is equally comparable to someone who has a
blood alcohol content of 0.05% (Okano et al., 2019). Furthermore, sleeping eight hours a night is
necessary for a college student to have full cognitive function in order to adequately perform in
their academic studies.
Research Questions
How will sleep deprivation affect college students, specifically their physiological health,
psychological health, and cognitive function? How will ongoing sleep deprivation impact their
academic performance throughout their four years at university?
Literature Review
Sleep deprivation commonly occurs amongst college students. Lack of sleep can impact
one's overall health and performance both in the classroom and the workplace (post-graduation).
If sleep is not properly maintained, it can have negative effects on the body physiologically,
psychologically, and cognitively. Concerning the identified problem of sleep deprivation, it is
important to understand why adequate sleep is required.
Through the Dominican University of California Library, the following articles for the
research literature were acquired from PubMed, Iceberg, and UpToDate. Regarding the effects of
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sleep deprivation, twelve articles were compiled from these databases. Keywords such as “sleep
deprivation,” “college students,” “nursing,” and “physiological, psychological, and cognitive”
were input into the databases to identify articles that correlated to our specific topic.
This literature review will be divided into three categories related to sleep deprivation: 1)
physiological health; 2) psychological health and sleep hygiene; and 3) cognitive health and
academic performance. Three articles will focus on the topic of physiological health, three
articles on psychological health and sleep hygiene, and six articles on cognitive health relating to
academic performance.
Sleep Deprivation and Physiological Health
Articles in this category are based on sleep and how it affects physiological health.
Autonomic nervous system function, sleep deprivation, napping in college students, and
psychomotor performance amongst night-shift nurses were assessed. Within these three articles,
they were all quantitatively designed with the addition of a quasi-experimental and non-
experimental study. These quantitative studies assessed how sleep deprivation affected both
university students and registered, night-shift nurses. Furthermore, the articles in this section are
relevant because they take into account multiple aspects of sleep, as sleep deprivation can
negatively affect one’s health and performance.
In the “Assessment of Autonomic Nervous System Function in Nursing Students Using an
Autonomic Reflex Orthostatic Test by Heart Rate Spectral Analysis,” Hasegawa et al. (2015)
focused on the function of the autonomic nervous system in 121 nursing students at the Kyoto
Prefectural University of Medicine. Participants standing load were assessed and evaluated using
an autonomic reflex orthostatic tolerance test in which their heart rate variability was analyzed.
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An electrocardiogram was administered to measure their autonomic reflex over the span of
approximately five minutes. These measurements were obtained while the participant remained
sitting for two minutes, standing for two minutes, and in a resting position for one minute. It was
hypothesized that fourth-year students experience higher levels of demand in regard to
academics (Hasegawa et al., 2015). Therefore, these participants would have an abnormal
autonomic nervous system functioning.
Regarding fourth-year students, it was found that their resting state was low while their
parasympathetic nervous system resulted in hypotension (Hasegawa et al., 2015). In comparison
to first-year students, the fourth-year students presented with a high sympathetic nervous system
function and a high standing state concerning autonomic nervous system function. Activation of
the sympathetic nerves was induced from stress while it inhibited the parasympathetic nervous
system. Meanwhile, the standing position resulted in a high autonomic nervous system response
in regard to fatigue. Furthermore, stress is an influential factor on the autonomic nervous system,
especially in fourth-year students. Additionally, it has been found that sympathetic nerve activity
is decreased by sleep (Hasegawa et al., 2015). With this study, there were two limitations. One
limitation was the small population, and another limitation was the isolated geographic location.
Focusing on college students, Schlarb et al. (2017), in “Sleep Problems in University
Students - an intervention,” utilized a multicomponent sleep strategy to improve sleep amongst
the 27 student participants. The combination of Cognitive Behavioral Therapy for insomnia and
Hypnotherapy for insomnia were implemented for the refinement of insomnia symptoms and
nightmares. In addition, Studieren wie im Schlaf (SWIS) was utilized as a sleep training tool for
university students who suffered from irregular sleep-wake cycles. Students participated in the
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study in which questionnaires were administered to measure the pre and post design of the study.
Other measurement tools include the Pittsburgh Sleep Quality Index (PSQI), sleep logs, and
actigraphy. Daytime sleepiness, sleep-related personality traits, and sleep cognition were
assessed as well (Schlarb et al. (2017).
It was found that insomnia and insomnia related disorders were present in 27% of
participants. According to the fifth edition of Diagnostic and Statistical Manual of Mental
Disorders, it revealed that 51.9% of participants met the criteria for insomnia (Schlarb et al.,
2017). Although students suffered from sleep problems, there were improvements in subjective
sleep quality, sleep-related personality traits, and objective sleep measurements. There were
several limitations within this study. One limitation was the small sample size, and another
limitation was due to the missing control group. The positive effects that were obtained could
potentially be the result of other factors and not attributable from SWIS. In addition, the absence
of a follow-up measurement hindered the long-term effects of the investigation.
In “Sleep Deprivation and Psychomotor Performance Among Night-Shift Nurses,” Johnson
et al. (2010) studied night-shift nurses and their sleeping habits. In order to better understand
how sleep impacts psychomotor performance, the nurses were examined under normal work
conditions. It is hypothesized that sleep deprived health care providers are at higher risk for
making errors while at work.
This study used a non-experimental design. Pertaining to the participants, 289 people were
recruited through flyers, announcements, and posters. Eligibility requirements for participants
included being a full-time employee, having at least one year of experience in the hospital
setting, and not having an existing sleep disorder diagnosis. Between midnight and four in the
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morning, participants were given a packet of information. The packet contained a demographic
data sheet and a d2 Test of attention (Johnson et al., 2010). The demographic data questions
focused on the nurses’ current shift, past years working as a nurse, and their experience with
working the night-shift. Using a 48-hour sleep recall diary, participants wrote down how many
hours of sleep they felt they needed, as well as how much sleep they actually got. The d2 Test of
Attention, which measured psychomotor performance, was a timed test. This test was
administered after a nurse had been on the floor for about five to nine hours, and it was proctored
by an investigator. This test is one page long and lasted about eight minutes. In order to calculate
the overall score and to determine the total number of errors, errors of commission and errors of
omission were added together (Johnson et al., 2010). A high number of errors indicated poor
performance. When the entire packet of information was completed, it was sealed into an
envelope and secured in a locked file. To compare sleep deprivation and psychomotor
performance, a general linear model was used.
A major finding of this study was that 56% of the nurses were sleep deprived, and they
only received an average of 3.9 hours of sleep. In contrast, 43% of the nurses in the study
received an adequate amount of sleep, as they slept on average 6.78 hours (Johnson et al., 2010).
A higher performance score indicated inadequate psychomotor performance and was found to be
associated with nurses who slept an insufficient number of hours. For both sleep deprived and
non-sleep deprived participants, poor psychomotor performance scores were found.
Physiological changes occurred amongst nurses working 24-hour shifts, and it resulted in their
psychomotor performance being diminished. Sleep deprivation influences physiological changes,
as a lack of sleep inhibits neuronal transfer of chemicals and impairs psychomotor performance.
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This resulted in the poor d2 Test of Attention outcomes (Johnson et al., 2010). Psychomotor
performance, in night-shift nurses, can be improved by implementing naps. Napping could
enhance patient safety because it helps to maintain optimal psychomotor performance and brain
function.
Limitations of this study include collecting data only one time and not over a period of
time, as well as not taking into account other social factors that could impact sleep. In addition,
when gathering information on sleep deprivation, a self-report was used. A physiologic measure
would have been more accurate and provided more reliable information (Johnson et al., 2010).
Furthermore, chronic sleep deprivation may have led to the underestimation of how much sleep
is needed to be fully rested.
Sleep Deprivation, Psychological Health, and Sleep Hygiene
Articles in this category are based on sleep and how it affects psychological health and
sleep hygiene (referring to creating an environment conducive to sleep). Quality of sleep,
lifestyle behaviors, and sleep hygiene are further assessed in the following studies. A cross-
sectional, quantitative, and experimental study were conducted among the three articles. All of
these articles are relevant to our research question because they examine how sleep impacts
overall health.
In “Quality of Sleep and Anxiety are related to Circadian Preference in University
Students,” Silva et al (2020) studied university students to identify anxiety levels, quality of
sleep, and different chronotypes. The relationship between these characteristics were assessed in
103 undergraduate student participants. This study was conducted in the city of Santo Antonio de
Jesus, Bahia, Brazil. Although there were 103 volunteers, only 96 students participated in the
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activities from seven in the morning to six in the evening. These participants are students,
ranging from 18 to 25 years of age, enrolled in the courses of the Centro de Ciências da Sau´de
(Silva et al., 2020). Additional criteria included having no prior history or diagnosis of a
psychiatric disease and not taking controlled medications. Three questionnaires were completed
by the participants to assess their preferred time to complete the activities, anxiety levels, and
quality of sleep. These tools included the Morningness-Eveningness Questionnaire (MEQ),
State-Trait Anxiety Inventory (STAI), and the Pittsburgh Sleep Quality Index (PSQI).
There were several findings in this study. Anxiety and sleep quality appeared to be worse in
those with an evening chronotype. Alert levels were increased in evening students with a peak at
ten hours rather than at seven hours. Approximately 90% of students reported partial sleep
deprivation on workdays with daytime sleepiness occurring during the week. Because of this, the
students later compensated for the lack of sleep over the weekend, which is also known as social
jet lag (Silva et al., 2020). Compensation for sleep deprivation during the week was found to
occur amongst those with an early work schedule. It was found that morning students had a
lowered anxiety level and a better quality of sleep in comparison to the evening participants.
Meanwhile, evening students had a more irregular sleep-wake cycle and anxious personality trait
(Silva et al., 2020). A limitation within the study includes the small sample size that may limit
the conclusion of this research. Additional factors needed to be controlled in regard to anxiety,
such as anxiety the participant is encountering, academic stressors, social limitations, potential
substance use, changes in living environment, and financial conditions.
In the article, “Associations Between Sleep and Lifestyle Behaviours Among Australian
Nursing Students: A Cross-Sectional Study,” Binks et al. (2020) studied the association of
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negative lifestyle behaviors and sleep. The examined lifestyle behaviors include poor diet,
physical inactivity, and alcohol consumption. Focusing on Bachelor of Nursing students in
Australia, it is believed that poor lifestyle behaviors are connected with poor sleep quality.
While 500 participants were recruited through the use of convenience and snowballing
methods, only data from 470 students was analyzed (Binks et al., 2020). Various methods, such
as email, flyers, university online learning platforms, and classroom presentations, were utilized.
Eligibility requirements for participants include being at least eighteen years of age, enrolled at a
Bachelor of Nursing program, and not pregnant or breastfeeding. This study collected data by
sending out an online questionnaire via SurveyMonkey to the participants. In a total of 165
questions, participants were asked about socio-demographics, medical history, food and dietary
habits, physical activity, alcohol consumption, cigarette smoking, and sleep.
It was found that approximately 77.8% of nursing students sleep poorly (Binks et al.,
2020). Overall, students who frequently skipped meals, consumed non-nutrient foods, drank
alcohol, and smoked experienced inadequate sleep quality. A significant relationship between
physical activity and sleep was not found in this study. Based on the results of this study,
preexisting health conditions and poor lifestyle behaviors negatively impacted sleep, which
ultimately led to reduced academic and clinical performance (Binks et al., 2020). This is because
sleep deprivation is known to reduce cognitive performance, daytime functioning, work
productivity, and attention. Because data was collected via a survey and used self-reported
measures, there is a chance of potential bias, specifically in recall and reporting. This is a
limitation because bias can lead to distorted reports and wrong conclusions. Another limitation
would be that this study did not study how stress impacts sleep quality. Moreover, the study did
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not examine cause and effect. A longitudinal study would have also been beneficial to better
understand how lifestyle behaviors and sleep are related overtime.
In the “Effects of a Sleep Hygiene Text Message Intervention on Sleep in College
Students,” Gipson et al (2019) assessed sleep hygiene and sleep improvement in college students
between the ages of 18 to 26 years old. It was hypothesized that the college students from a
Southwestern University would report improved sleep knowledge, sleep hygiene, self-efficacy
for sleep hygiene, and sleep quality following a text-message intervention.
The 96 participants were divided into two groups (pretest and posttest). Over the course of
six weeks, students were assigned to receive text messages twice a week about sleep hygiene or
healthy behaviors. Participants who received text messages about sleep hygiene were the
intervention group while those who received text messages about healthy habits in general were
a part of the control group. Survey questions were utilized to assess the baseline for the posttest
results in regard to sleep knowledge, sleep hygiene, self-efficacy for sleep hygiene, and sleep
quality (Gipson et al., 2019).
There was no significant improvement in scores for sleep knowledge, sleep hygiene, self-
efficacy for sleep hygiene, and sleep quality in the experimental group. Therefore, the hypothesis
was not supported. It was found that time management improved in those in the sleep
intervention group and not in the attention control group (Gipson et al., 2019). However, the
sleep intervention group showed an improvement in the disruptive subscale score while it
remained the same for the attention control group. Although the experimental group received text
messages related specifically to sleep, their sleep scores did not significantly improve. In regard
to sleep hygiene, it was reportedly improved in those in the control group in comparison to the
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intervention group. In contrast, there was no significant difference in improvement for the
experimental group despite sleep quality improvement in both groups. There was no significant
improvement in score for either group in regard to self-efficacy for sleep hygiene. Furthermore,
time management was most related to sleep quality and significantly related to both sleep
hygiene and knowledge. In this study, stress was found to impact quality of sleep, sleep hygiene,
and time management (Gipson et al., 2019). Overall, sleep quality improved for both the control
group and intervention group while the hours of sleep decreased from the baseline posttest.
Limitations of the study were the use of unreliable tools to assess the reliability of results
amongst the target population. Potential controlling factors were not measured in the research
that could have played a role in the effects of sleep quality, including extraneous activities and
stressful coursework. Participants were enrolled in additional courses that could have
predisposed them to information that influenced their sleep behaviors. Although the participants
were divided into two separate groups, they could have discussed interventions with one another,
altering the results (Gipson et al., 2019). Furthermore, the data from the posttest of participants
who dropped out of the study were still included in the analysis, which could have provided a
false high result. Students were not equally represented in regard to gender across university
demographics. Regarding improved sleep scores rather than just the text message intervention,
preexisting knowledge about sleep hygiene may have influenced scores over time (Gipson et al.,
2019). Overall, the results are not applicable to the greater population of young adults because
the study focused on students from one Southwestern University.
Sleep Deprivation, Cognitive Health, and Academic Performance
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Articles in this category are based on sleep and how it affects cognitive function and
academic performance. Sleep quality, sleep disruption, gender differences, and sleep deprivation
are further assessed regarding how it affects academic performance. Amongst these articles, a
systematic review and meta-analysis, a cross sectional, cohort, or case-control study, and cross-
sectional study were conducted, respectively. These studies assessed how sleep deprivation
affects academic performance in both college and medicine students along with nurses working
shifts. In addition, gender is evaluated in its relationship between sleep disturbance and academic
performance along with procedural errors as a result of sleep deprivation.
In the article, “Sleep Quality, Duration, and Consistency are Associated with Better
Academic Performance in College Students,” Okano et al. (2019) performed a research study
that focused on the effect sleep has on academic performance by tracking the sleep of 88
participants via a Fitbit. The Fitbit device is an accessory that can be utilized to trace activity
such as steps, heart rate, and sleep duration. A second aim was focused on the difference between
gender and its role in sleep and academic performance. The researchers hypothesized females
showing an advantage in grades, which contributed to gender differences (Okano et al., 2019).
Participants were students from MIT who were enrolled in The Solid State Chemistry class
during the fall semester. The 88 participants were provided with a Fitbit and were assigned to a
specific section that fit their schedule. The participants were not allowed to participate in other
sections. Participants were tested on content covered in the course by completing quizzes,
midterms, and a final exam. Leading up to the quiz date, weekly quizzes were conducted to test
the knowledge of the participants. Students were required to complete three midterms covering
three to four weeks of content leading up to the exam date. A cumulative final exam was
! 16
administered that tested the content that was covered throughout the semester (Okano et al.,
2019).
The study had several findings. Better performance and grades were correlated with
improved quality of sleep that was longer in duration. Although better sleep consistency resulted
in better grades, there was no relationship between sleep quality the night before an exam and
test performance. However, sleep duration correlated with better grades when sleep quality was
improved for the month and week before a test (Okano et al., 2019). Limitations involve the
wearable activity device. A Fitbit device can estimate sleep stages, but there is no published
evidence that the activity tracker can accurately predict sleep quality. The relationship between
sleep and academic performance can also be limited by factors not taken into account, such as
stress, anxiety, motivation, personality traits, and gender roles that can affect sleep.
In “Napping in College Students and Its Relationship with Nighttime Sleep,” Ye et al.
(2017) examined how napping impacts one’s sleep at night. When investigating the relationship
between naps and nighttime sleep, it is important to know how frequently naps are taken, how
long one naps, and when a nap usually takes place during the day. An understanding of these
factors will help researchers to better determine the benefits and consequences that result from
napping, specifically how napping affects overall health and academic performance. A known
benefit is that short naps can improve alertness, as well as neurobehavioral performance.
Moreover, longer naps are thought to promote grogginess and confusion, which in turn may lead
to poor cognitive or academic performance (Ye et al., 2017) .
The study was conducted with 440 random, undergraduate college students in order to
examine the relationship between napping and sleep quality. Participants were recruited using
! 17
email, and an anonymous survey was sent to the undergraduate students. The survey utilized
both multiple choice and open-ended questions. Using a self-rating questionnaire called the
Pittsburgh Sleep Quality Index (PSQI), sleep quality and disturbances were assessed in students
over a period of one month. Questions that were asked focused on napping frequency, length,
and timing. Other question topics include demographics, general health, sleep satisfaction,
academic performance, weekday and weekend sleep schedules, and sleep routines.
Based on the Pittsburgh Sleep Quality Index, this study found that 59.7% of students in the
sample suffered from poor sleep quality (Ye et al., 2017). The results of the study indicate that
evening and long naps are actually harmful, as they can reduce cognitive performance and
subjective alertness. Individuals who napped more than three times per week and for longer than
two hours were reported to have the worst sleep quality. In addition, students slept for shorter
periods of time at night when they took a nap between the hours of six to nine o’clock at night.
Overall, participants who consistently napped for extended periods of time late in the day
reported poor sleep quality at night, as well as symptoms of sleep deprivation. As a result, these
participants demonstrated reduced daily function and cognitive performance, which in turn
negatively impacted their academic performance (Ye et al., 2017). Some limitations of this study
include the self-reports of napping and sleep patterns, omission of number of naps per day or
description of the napping experience, and the utilization of unreliable and invalidated survey
questions. Furthermore, as a result of the data collected from the cross-sectional survey, a causal
relationship cannot be found between napping and nighttime sleep quality.
In the article, “Sleep Disruption in Medicine Students and its Relationship with Impaired
Academic Performance: A Systematic Review and Meta-Analysis,” Seoane et al. (2020) focused
! 18
on the relationship between sleep deprivation and its association with academic performance.
Twenty-nine studies were assessed in which 5,646 out of 14,170 students reported poor sleep
quality. It was hypothesized that rapid-eye movement (REM) sleep would enhance long-term
memory performance. Meanwhile, declarative memory such as recall of events and facts would
be linked to non-REM sleep (Seoane et al., 2020).
The participants were a mixed sample of health-related careers such as medical, nursing,
and kinesiology students. Students’ sleep quality, sleep duration, or diurnal sleepiness were
covered over the span of more than a single night. Participants' quality of sleep were assessed
during the normal school time frame. Academic performance was measured through the use of
questionnaires, standardized tests, and grade point average (Seoane et al., 2020).
The article compiled the results from several studies. In some studies, it was found that
shorter sleep was associated with medical students performing better. Sleep-deprived participants
could benefit from a periodic sleep assessment along with a psychiatric evaluation. As a result,
quality of life and academic performance might be improved. Although poor sleep quality and
excessive daytime sleepiness were mild, it was highly associated with impaired academic
performance (Seoane et al., 2020).
Limitations of the study include an overrepresentation of female medical students. Sleep
characteristics of objective measures were not included within any of the studies in this research.
However, there is a correlation between sleep quality and academic performance. This
correlation was found to be significantly higher in the Middle east and Asia/Oceania regions, in
studies conducted in 2012 or after, and in those in which women comprised more than 50% of
the sample (Seoane et al., 2020). Since insufficient data was extracted from demographics and
! 19
comorbidities, it cannot be concluded whether there is a relationship. In other words, there is no
sufficient data to allow for moderator analyses.
Marta et al. (2020), in the article titled “Gender Differences in the Relationship Between
Sleep Disturbances and Academic Performance Among Nursing Students,” studied how gender
plays a role in sleep disturbances and academic performance. In nursing students, it is
hypothesized that gender can affect both sleep and academic performance. Additionally, based on
past studies, it has been found that females experience worse sleep quality than males (Marta et
al., 2020).
Four hundred ninety-two students participated in this study that ran from July 1, 2018 to
September 30, 2018. All of the participants were enrolled in an undergraduate program in
Indonesia during the 2017 to 2018 academic school year, and they ranged from first-year to
fourth-year students. Data on sleep was collected using bio demographic characteristics, the
Pittsburgh Sleep Quality Index, the Insomnia Severity Index, the Epworth Sleepiness Scale, the
Morningness-Eveningness Questionnaire, and the Beck’s Depression Inventory (Marta et al.,
2020). The instruments used to collect information on sleep consisted of questions that focused
on factors that have been known to affect sleep, sleep quality and disturbances, insomnia in
males and females, daytime sleepiness, circadian rhythm preferences, and severity of depression
symptoms. Once the sleep surveys were completed, grade point averages during the 2017 to
2018 academic school year were used to gather data on academic performance. Data analyses
were conducted using SPSS Version 23.0, independent T-Tests, chi-square tests, and the odds
ratio. A logistic regression model and multivariate logistic regression model were utilized in
! 20
order to determine the relationship between a certain event, such as poor or good academic
performance, and two different groups (Marta et al., 2020).
The study found that poor sleep quality, insomnia, and daytime sleepiness were prevalent
among both male and female nursing students. Approximately a quarter of the participants
reported experiencing daytime sleepiness (Marta et al., 2020). This finding was commonly
observed in students who suffered from insomnia and poor sleep quality. Moreover, the results of
the study indicate that nursing students in general often suffer from poor sleep quality and
insomnia. Additionally, female nursing students, who had insomnia, were more likely to perform
poorly in academics. However, no correlation between insomnia and academic performance was
found in male nursing students (Marta et al., 2020). Three limitations of this study include the
subjective self-administered questionnaires, the sample population being from a single nursing
school, and the cross-sectional design. Another longitudinal, prospective study needs to be
conducted in order to further validate the results.
It is believed that sleep deprivation is a major cause of errors, especially in healthcare. In
“Effects of Sleep Deprivation on the Cognitive Performance of Nursing Working in Shift,”
Kaliyaperumal et al. (2017) studied how sleep deprivation impacts cognition in night-shift
nurses. This study took place between August 2016 and September 2016. The participants,
ranging from 20 years old to 50 years old, were staff nurses who had been on a rotating schedule
for at least one year. They would work the day shift for one month and then night-shift for the
next one. These nurses worked at Peelamedu Samanaidu Govindasamy Hospitals, Tamil, Nadu,
India (Kaliyaperumal et al., 2017). In order to participate in this study, the nurses had to work six
days a week and do eight-hour shifts. In addition, all of the nurses in the study did not have any
! 21
existing medical or mental illnesses, did not work overtime, and did not work another job. After
weaning out the participants who did not meet the eligibility requirements, there were 97 female
and 3 male participants. Cognition and executive function were measured using the Montreal
Cognitive Assessment (MoCA) Version 7.3, the Stroop test, and Memoryze. Mobile applications,
such as the Vigilance Test, simple reaction time test, and a timed math test, were used to measure
attention, reaction time, photographic memory, and numerical cognition or mental speed. SPSS
Version 19.0 was used to analyze data, and non-parametrical values were compared using the
Wilcox Signed Ranktest (Kaliyaperumal et al., 2017). Throughout the study, sleep deprivation
prevalence is indicated by percentage values, and it was assessed by the Epworth Sleepiness
Scale (ESS).
Using the Epworth Sleepiness Scale, Kaliyaperumal et al. (2017) found that 69% of the
nurses in this study were experiencing sleep deprivation. General intellect and attention were
found to be worse at night than during the day. In contrast, mental speed and reaction time were
found to be better at night. Based on the Montreal Cognitive Assessment (MoCA) Version 7.3,
cognition was better in nurses who worked the day shift. Moreover, as a result of sleep
deprivation, this study found that execution, memory, response time, and mental speed relating to
numerical cognition were also increased during the day shift and decreased during the night-shift
(Kaliyaperumal et al., 2017). Therefore, sleep deprivation does impair cognitive performance.
One limitation is the small sample population, which may increase the margin of error
and affect the reliability and variability of this study. In addition, this study did not explore all of
the domains of cognition. Regarding limitations with the data measurements, the Epworth
Sleepiness Scale was used to measure sleep quality and sleep deprivation. An actigraph or
! 22
actimetry sensor would have provided more accurate measurement and detection (Kaliyaperumal
et al., 2017). Furthermore, the mobile application software was unable to measure its claim due
to resource restraints.
Concentrating on the role of memory maintenance, in the article, “Effects of Sleep
Deprivation on Procedural Errors. Journal of Experimental Psychology: General,” Stepan et al.
(2019) studied how sleep deprivation affects error rates in procedural tasks. This study examined
sleep deprivation and procedural errors in 234 Michigan State University students, ranging from
18 to 25 years of age. These students were undergraduates and native English speakers.
Additionally, all of the participants did not have any existing memory or sleep disorders, were
not color blind, did not have any major sleep disturbances, and did not have a strong preference
for either the morning or the evening. As compensation, the participants received course credit
(Stepan et al., 2019).
Stepan et al. (2019) conducted the study in groups of up to eleven people and in two
testing rooms. The night before the study the participants were told to get at least six hours of
sleep and to wake up at nine o’clock in the morning. Before coming to the laboratory and during
the 24 hours before the study, these students were not allowed to nap or consume caffeine,
alcohol, or drugs. The study commenced at ten o’clock at night. Everyone completed sleepiness
and mood assessments, the UNRAVEL task (performance of a series of tasks in a looped,
specific order in response to a stimulus), and various cognitive and personality measures when
they arrived (Stepan et al., 2019). After these tasks were completed, the group was randomly
divided under double blind conditions into two groups (a sleep and sleep deprivation group). One
group was given a Fitbit to monitor sleep activity and told to go home and sleep, and the other
! 23
group was required to stay awake overnight in the laboratory. Every two hours, the sleep
deprived participants were asked to complete sleepiness and mood assessments. The students
who slept at home arrived at the laboratory the next day at eight-forty-five o’clock in the
morning. Both groups then completed sleepiness and mood assessments, the UNRAVEL test, and
cognitive tasks. Relating to the UNRAVEL test, results of the experiment were measured by
looking at sequence errors and non-sequence errors (Stepan et al., 2019).
This study found that individuals who are sleep deprived should not perform procedural
tasks, especially when associated with interruptions and costly errors. Sleep deprived participants
were less willing or unable to perform the same tasks that they completed the night before. With
the sleep deprived individuals who were able to complete the tasks, higher rates of error were
observed. The errors were mainly due to memory failures, especially when tasks were timed
(Stepan et al., 2019). This study had one limitation, as it did not explore the need for
accommodations among the sleep-deprived individuals as they performed procedural tasks.
Overall Discussion of Literature Review
The evidence from twelve different research articles reveals that sleep deprivation can
negatively impact multiple health domains. Pertaining to physiological health, stress affects the
autonomic nervous system, the sympathetic nervous system, and the parasympathetic nervous
system. Lack of sleep resulted in inadequate psychomotor performance and poor brain function.
In order to combat the effects of sleep deprivation on one’s physiological health, napping for a
short period of time and early in the day can be used to maintain optimal brain function. In
regard to psychological health, individuals who experience daytime sleepiness tend to
compensate by excessively sleeping on the weekends. Management of sleep is important, as it
! 24
improves sleep quality. Therefore, poor lifestyle behaviors can influence sleep quality and
ultimately reduce academic performance. Concerning cognitive function, a lack of sleep is
known to reduce academic performance and contribute to more procedural errors. It is more
important to maintain a consistent and adequate sleeping schedule than to receive sufficient sleep
solely on the day before an exam. Furthermore, because cognition was found to be reduced at
night in sleep deprived individuals, lack of sleep leads to more procedural errors. Overall, quality
of life and academic performance can be improved with adequate sleep.
In general, limitations found amongst the articles were the small sample size, bias when
conducting self-administered surveys, and not taking into account controlling factors that may
affect sleep. Common themes found for strengths were a large sample size, randomization of
participants, and the research being the first to study a topic or intervention.
Several tools and materials were utilized within the study to assess and measure results.
Reliable instruments, such as the Cognitive Behavior Therapy, were used to assess for insomnia.
Studieren wie im Schlaf (SWIS) was used as a sleep training tool to assess irregular sleep
patterns. Other measurement tools include the Pittsburgh Sleep Quality Index (PSQI), the
Diagnostic and Statistical Manual of Mental Disorders, and a d2 Test of Attention for
psychomotor performance. Additional tools include the Morningness-Eveningness Questionnaire
(MEQ), the State-Trait Anxiety Inventory (STAI), Epworth Sleepiness Scale and the Beck’s
Depression Inventory, Montreal Cognitive Assessment (MoCA) Version 7.3, and the Stroop test.
Studies utilized within the research provided evidence on the importance of sleep; however,
there are additional topics that can be further explored. For example, how does sleep affect the
body over a span of several years rather than just a semester or the length of a short experiment?
! 25
A longitudinal study could be conducted to assess how sleep deprivation during young adulthood
affects performance later in life. In addition, factors contributing to poor sleep quality need to be
further investigated and included within the research.
Research Proposal
Patient safety is critical for healthcare providers to maintain. The literature review
examined the effects of sleep deprivation on the body in the clinical and academic setting. In the
clinical setting, insufficient sleep contributes to medical errors and reduces brain function. Most
of the studies in the literature review resulted in a similar outcome: adequate sleep is necessary in
order to provide optimal care for patients. Sleep was found to affect performance among
undergraduate university students and professional medical workers. Therefore, the primary aim
of the study is to determine how sleep deprivation will impact university students, specifically
their physiological, psychological, and cognitive health, over the course of four years during
their undergraduate studies. A second aim is to study the effect of continuous sleep deprivation
on specifically academic and clinical performance. The third aim will be to compare the sleep
quality and performance of nursing students with students who are studying other disciplines.
Theoretical Framework
Sister Callista Roy created a model known as Roy’s Adaptation Model (RAM). She
theorized that all individuals are biopsychosocial beings who constantly adapt to various stimuli
(Akinsanya, 1994). These three stimuli include focal, contextual, and residual stimuli. In order to
cope with a changing environment, this theory utilizes a problem-solving approach. The goal is
for the individual to adaptively respond to environmental changes. Adaptive responses and level
of stimuli both influence one another.
! 26
Pertaining to the three categories of stimuli, this theory describes the manner in which an
individual responds to changes in their environment. Focal stimuli occur rapidly and require the
individual to respond immediately. Contextual stimuli and focal stimuli work together, and they
influence the overall response of the individual. Residual stimuli refer to past experiences,
beliefs, or attitudes rather than immediate ones. Together these types of stimuli allow the
individual to create the skills and reflexes needed to adapt to their environment (Akinsanya,
1994).
Concerning sleep deprivation and environmental examples of stimuli, sleep deprivation
would be considered a focal stimulus. Sleep deprivation can immediately impact responses to an
individual's environment, as it can affect quality of life and overall health. Contextual stimuli
would contribute to lack of sleep. Examples of this type of stimuli are related to sleep hygiene,
such as loud noises, bright rooms, consumption of caffeine, and use of electronic devices.
Residual stimuli are additional stressors that result from personal conditions or events. With an
understanding of Roy’s Adaptation Model (RAM), researchers can focus on how to combat sleep
deprivation by targeting the three types of environmental stimuli that impact sleep.
Research Design
The design of this study will be mixed methods, using both quantitative and qualitative
questions in an online survey. First demographic information will be obtained. Questions will
include age, gender, grade level (Freshman, Sophomore, Junior, or Senior), and major area of
study. Additionally, participants will be asked to provide their most up to date grade point
average (GPA).
! 27
A Likert Scale and the Pittsburgh Quality Sleep Index (PQSI) will be utilized, and an
online survey with approximately ten questions will be asked (Buysse et al., 1989). Questions
such as “Do you feel like you perform better after eight hours of sleep?” will be answered with a
five point scale. The scale includes the following options: strongly disagree, disagree, neutral,
agree, and strongly agree. Regarding academic performance, an open-ended questionnaire will
be conducted via the same online platform. For example, participants will be asked to respond to
“How do you feel your sleep quality has affected your academic and clinical performance?”.
Population of Study
The proposed convenience sample size will be at least 100 undergraduate university
students. Participants will be recruited through email and social media (Facebook and
Instagram). Inclusion criteria incorporate the need to be 18 years or older to participate and to
have no pre-existing health conditions or sleep disorders.
Data Analyses
Descriptive statistics will be used to assess the demographic data. First, the data will be
analyzed to determine any correlation between sleep deprivation and physiological,
psychological, and cognitive health over four years during their undergraduate studies, using a
Multiple Logistic Regression. The correlation between sleep and academic performance will also
be examined through the use of a multiple logistic regression model. A t-test will be used to
compare differences between groups, such as nursing majors and non-nursing majors.
Moreover, in order to evaluate the open-ended responses, a content analysis will be
conducted. The analysis will look for common words and phrases, which will then be organized
into categories. Themes will be derived from the categories.
! 28
Ethical Considerations
Potential ethical issues include the need for consent. Students can be considered a
vulnerable population due to the risk of coercion. Therefore, students will be assured that
participation will be strictly confidential. Their choice to participate or refrain from the study will
not affect their grades or progress in any university program. Furthermore, students will be
advised that they can skip any question and discontinue their participation at any time. Because
the survey will be conducted online, a statement will be included stating that the submission of
the survey will be considered as consent.
Another ethical consideration would be the potential of self-reporting bias. This study has
been presented to the Dominican University of California ethical review board. Data collection
will not begin until the study has been approved by the Internal Review Board (IRB).
Conclusion
The evidence shows that sufficient sleep quantity is necessary to function adequately as an
undergraduate college student and as an individual in the hospital workplace. Our review of the
literature reveals that lack of sleep can negatively affect academic and clinical performance, as
well as generate problems, such as an increase in medication and procedural errors. Sleep
deprivation can have a profound impact on brain function, mental health, and psychomotor
performances.
Our proposal for further study has the potential to add to our body of knowledge and aims
to help nurses and university students sleep better. The proposed research can lay the
groundwork for future studies on the topic of sleep deprivation. Once our proposed study has
been completed, we hope the findings will serve to improve the quality of sleep for healthcare
! 29
workers and students, resulting in improvement in patient care and performance in both the
academic and clinical setting. By studying quality of sleep and its effects, researchers can
examine ways to ensure university students and healthcare professionals get adequate sleep each
night. Interventional studies can be conducted to analyze how specific sleep measures can
enhance one’s sleep quality. Sleep quality is critical for optimal health, mental acuity, and
performance; therefore, it is essential that further research be conducted in order to mitigate the
impact of sleep deprivation and promote healthful, restful sleep.
! 30
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Action. Nursing Models in Action. Palgrave, London. https://doi.org/
10.1007/978-1-349-12896-9_2.
Binks, H., Vincent, G. E., Irwin, C., Heidke, P., Vandelanotte, C., Williams, S. L., & Khalesi, S.
(2020). Associations between sleep and lifestyle behaviours among Australian nursing
students: A cross-sectional study. Collegian. https://doi-org.dominican.idm.oclc.org/
10.1016/j.colegn.2020.02.013.
Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The
Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research.
Psychiatry Research, 28(2), 193–213. https://doi-org.dominican.idm.oclc.org/
10.1016/0165-1781(89)90047-4.
Gipson, C. S., Chilton, J. M., Dickerson, S. S., Alfred, D., & Haas, B. K. (2019). Effects of a
sleep hygiene text message intervention on sleep in college students. Journal of American
College Health, 67(1), 32–41. https://doi-org.dominican.idm.oclc.org/
10.1080/07448481.2018.1462816.
Johnson AL, Brown K, & Weaver MT. (2010). Sleep deprivation and psychomotor performance
among night-shift nurses. AAOHN Journal, 58(4), 147–154.
https://doi-org.dominican.idm.oclc.org/10.3928/08910162-20100316-02.
Kaliyaperumal, D., Elango, Y., Alagesan, M., & Santhanakrishanan, I. (2017). Effects of Sleep
Deprivation on the Cognitive Performance of Nurses Working in Shift. Journal of Clinical
& Diagnostic Research, 11(8), 1.
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Kana Okano, Jakub R. Kaczmarzyk, Neha Dave, John D. E. Gabrieli, & Jeffrey C. Grossman.
(2019). Sleep quality, duration, and consistency are associated with better academic
performance in college students. Npj Science of Learning, 4(1), 1–5. https://doi-
org.dominican.idm.oclc.org/10.1038/s41539-019-0055-z.
Mao Hasegawa, Azusa Hayano, Atsushi Kawaguchi, & Ryuya Yamanaka. (2015). Assessment of
autonomic nervous system function in nursing students using an autonomic reflex
orthostatic test by heart rate spectral analysis. Biomedical Reports, 3(6), 831–834. https://
doi.org/10.3892/br.2015.512.
Marta, O. F. D., Kuo, S.-Y., Bloomfield, J., Lee, H.-C., Ruhyanudin, F., Poynor, M. Y.,
Brahmadhi, A., Pratiwi, I. D., Aini, N., Mashfufa, E. W., Hasan, F., & Chiu, H.-Y. (2020).
Gender differences in the relationships between sleep disturbances and academic
performance among nursing students: A cross-sectional study. Nurse Education Today, 85.
https://doi-org.dominican.idm.oclc.org/10.1016/j.nedt.2019.104270.
Schlarb, A. A., Friedrich, A., & Claßen, M. (2017). Sleep problems in university students - an
intervention. Neuropsychiatric disease and treatment, 13, 1989–2001. https://doi.org/
10.2147/NDT.S142067.
Seoane, H. A., Moschetto, L., Orliacq, F., Orliacq, J., Serrano, E., Cazenave, M. I., Vigo, D. E.,
& Perez-Lloret, S. (2020). Sleep disruption in medicine students and its relationship with
impaired academic performance: A systematic review and meta-analysis. Sleep Medicine
Reviews, 53. https://doi-org.dominican.idm.oclc.org/10.1016/j.smrv.2020.101333.
Silva, V. M., Magalhaes, J. E. de M., & Duarte, L. L. (2020). Quality of sleep and anxiety are
related to circadian preference in university students. PLoS ONE, 15(9), 1.
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Stepan, M. E., Fenn, K. M., & Altmann, E. M. (2019). Effects of sleep deprivation on procedural
errors. Journal of Experimental Psychology: General, 148(10), 1828–1833. https://doi-
org.dominican.idm.oclc.org/10.1037/xge0000495.supp (Supplemental).
Ye, L., Hutton Johnson, S., Keane, K., Manasia, M., & Gregas, M. (2015). Napping in
College Students and Its Relationship With Nighttime Sleep. Journal of American
College Health, 63(2), 88–97.
https://doi-org.dominican.idm.oclc.org/10.1080/07448481.2014.983926.
! 32
Appendix
Authors/Citation
Samp
le -
Popul
ation
of
intere
st,
sampl
e size
Study Design
Study
Methods
Major
Finding(s)
Strengths
Limitations
Authors:
Binks, H., Vincent,
G. E., Irwin, C.,
Heidke, P.,
Vandelanotte, C.,
Williams, S. L., &
Khalesi, S.
Citation:
Binks, H., Vincent,
G. E., Irwin, C.,
Heidke, P.,
Vandelanotte, C.,
Williams, S. L., &
Khalesi, S.
(2020). Associations
between sleep and
lifestyle behaviours
among Australian
nursing students: A
cross-sectional
study. Collegian.
https://doi-
org.dominican.idm.
oclc.org/10.1016/
j.colegn.
2020.02.013.
N=
470
- Cross-
sectional
design
- A
questionnaire
assessing sleep
and lifestyle
behaviors was
completed by
470 nursing
students.
-To determine
the relationship
between
variables
several
regression
testing were
utilized such as
a one-way
ANOVA, t-
tests, and a
Pearson’s
bivariate
correlation.
- Inadequate
sleep was
experienced by
78% of nursing
students.
- Indicators of
inadequate
sleep include
irregular eating
patterns and
smoking, as
well as excess
consumption of
discretionary
foods and
alcohol.
- A lower
global sleep
quality score
was associated
with a lunch
consumption
that occurred
between four
to seven times
per week.
- Poor sleep
quality was
associated with
an alcohol
score with a
high global
sleep quality
despite
adjusting for
confounding
variables.
-A significant
association
between sleep
and physical
activity level
were not
found.
- The large
sample size of
470 nursing
students was a
strength of the
study.
- The nursing
students
utilized an
online self-
reported
questionnaire.
This has the
potential for
self-reporting
bias in recall
and reporting.
- The influence
stress has on
sleep quality
was not
evaluated and
cannot be
determined if it
affects the
severity of
sleep
deprivation
within this
sample.
- The impact
psychological
stress can have
on sleep
quality should
be considered
for future
research.
-To further
understand the
relationship
between sleep
and lifestyle, a
longitudinal
study needed
to be utilized
for the sample
population
along with
interventions
on an as
needed basis.
! 33
Authors:
Gipson, C. S.,
Chilton, J. M.,
Dickerson, S. S.,
Alfred, D., & Haas,
B. K.
Citation:
Gipson, C. S.,
Chilton, J. M.,
Dickerson, S. S.,
Alfred, D., & Haas,
B. K. (2019).
Effects of a
sleep hygiene text
message
intervention on
sleep in college
students. Journal of
American College
Health, 67(1), 32–
41. https://doi-
org.dominican.idm.
oclc.org/
10.1080/07448481.
2018.1462816.
N=96
- Experimental
design
-Participants
were a part of a
two-group
pretest-posttest
design.
Biweekly text
messages were
received by the
participants for
six weeks. The
messages
contained
information
about sleep
hygiene or
healthy
behaviors.
- The
experimental
design
compared an
intervention
group and an
attention
control group.
- Text
messages
containing
information
about sleep
hygiene were
sent out to the
intervention
group.
- The text
messages that
were sent to
the control
group were
about healthy
habits.
- At baseline
and posttest,
participants
were asked to
complete a
survey with
questions on
sleep quality,
sleep hygiene,
sleep hygiene
self-efficiency,
and sleep
knowledge.
-In comparison
to the
intervention
group the
experimental
group did not
have a higher
score for sleep
knowledge,
sleep hygiene,
self-efficacy
for sleep
hygiene, and
sleep quality.
Therefore, the
hypothesis was
not supported.
- Scales are
influenced by
the
improvement
of sleep
knowledge,
sleep hygiene,
sleep quality,
and sleep.
- The
intervention
group
improved their
time
management
but the
attention
control group
did not
improve on
time
management.
- The sleep
intervention
group showed
an
improvement
in the
disruptive
influences
scale while no
changes
occurred
among the
attention
control group.
- Although text
messages were
sent to
experimental
group about
sleep, there
were no
significant
improvements
in sleep scores.
- The control
group reported
an improved
sleep hygiene
in comparison
to the
intervention
group.
-The quality of
- Strengths
within the
study include
its
experimental
design,
randomization
of participants,
and the
utilization of
an attention
control group.
-The use of
text messages
is commonly
used among
young adults,
is widely used,
and is low in
cost to
implement
within the
study.
- The attrition
rate of 20%
was acceptable
in this study.
Several
instruments
used within the
study did not
demonstrate
reliability
because it was
not specifically
aimed at the
young adult
population.
- Factors that
could have had
an impact on
the quality of
sleep were not
considered in
the current
study. This
includes
extraneous
activities,
school related
assignments/
exams/
coursework,
and other
interactions.
- The students
may have had
access to
additional
information via
enrollment of
other courses
throughout the
university. This
may have
influenced
their
knowledge on
sleep beyond
the information
provided in the
study.
- The
participants
that were
recruited
consisted of
undergraduate
students. These
students are a
part of the
treatment
group and
could
contaminate
the results by
discussing the
interventions
with the
control group.
- The posttests
of the students
who dropped
out of the study
were still
incorporated
which could
affect the
! 34
Authors:
Johnson AL, Brown
K, & Weaver MT.
Citation:
Johnson AL, Brown
K, & Weaver MT.
(2010). Sleep
deprivation and
psychomotor
performance among
night-shift nurses.
AAOHN Journal,
58(4), 147–154.
https://doi-
org.dominican.idm.
oclc.org/
10.3928/08910162-
20100316-02
N=28
9
-
Nonexperiment
al correlational
design
-Nurses who
were recruited
worked in the
hospital. They
worked 40
hours per
week; eight,
ten-, or twelve
hour shifts in
the hospital
setting.
-A minimum of
one year
experience in
the hospital
setting was
required from
participants
with not
existing sleep
disorder
diagnosis.
- The analysis
included 289
total surveys
from qualified
participants. -
Hospital and
participants
were identified
by a given
number. A
case/code
number was
assigned to all
the data that
was collected.
- Participants
received a
packet of
information
from midnight
to four in the
morning, five
to nine hours
into the
assigned shift.
The
information
provided
contained a
demographic
data sheet and
a d2 Test of
Attention.
- The d2 Test
of Attention
was
administered
before other
instruments
because it is a
timed test. The
investigators
monitor the
time.
- Instruments
were returned
in an envelope
to be placed in
a locked file by
the investigator
- Among the
sample of
nurses,
approximately
56% were
deprived of
sleep.
- Sleep-
deprived
nurses slept a
mean of 3.9
hours.
- Among the
sample of
nurses,
approximately
43% were not
deprived of
sleep.
- Non-sleep
deprived
nurses slept a
mean of 6.78
hours.
- Regarding
psychomotor
performance,
both sleep-
deprived and
non-sleep
deprived
nurses
performed
similarly.
- A high
performance
score is an
indication of
poor
psychomotor
performance.
Nurses who
slept very few
hours had a
higher
performance
score.
- The sample
of nurses slept
less than the
optimal hours
of sleep in
order to
maintain
adequate
psychomotor
performance.
- The findings
of the study
supported
hypothesis
number two.
- Poor
performance
was indicated
by the inverse
relationship
that was found
between hours
of sleep and
psychomotor
performance.
- Strengths of
the study
include the
large sample
size of 289
nurses.
- The d2 Test
of Attention
was used to
measure
attention,
concentration,
processing
speed, and
performance
quality of
psychomotor
performance.
- Psychomotor
performance
was measured
only once in
the field setting
because of the
nurses’ time
constraints and
work
responsibilities
.
-The sample
nurses’ had
time
constraints and
work
responsibilities
which only
allowed for
one
measurement
of
psychomotor
performance.
-Factors that
may affect
sleep were not
assessed.
-Since self-
reporting was
used, there is
the potential
for bias
because a
physiologic
measure was
not used.
-The hours of
sleep needed to
feel rested may
have been
underestimated
if the nurses
were
chronically
sleep deprived.
! 35
Authors:
KALIYAPERUMA
L, D., ELANGO,
Y., ALAGESAN,
M., &
SANTHANAKRIS
HANAN, I.
Citation:
KALIYAPERUMA
L, D., ELANGO,
Y., ALAGESAN,
M., &
SANTHANAKRIS
HANAN, I. (2017).
Effects of Sleep
Deprivation on the
Cognitive
Performance of
Nurses Working in
Shift. Journal of
Clinical &
Diagnostic
Research, 11(8), 1–
3. https://doi-
org.dominican.idm.
oclc.org/10.7860/
JCDR/
2017/26029.10324
N =
96
- Cross-
sectional study
- The study
took place
between
August 2016 to
September
2016.
- The
participants of
the study were
all staff nurses,
who work on a
rotating
schedule at
Peelamedu
Samanaidu
Govindasamy
Hospitals,
Coimbatore,
Tamil, Nadu,
India.
- The staff
worked the
night shift for
one month.
The same staff
worked the day
shift the
following
month.
- SPSS
(version
19.0)was used
to analyze the
data.
- Sleep
deprivation
was conveyed
as a
percentage.
- Non-
parametrical
values were
compared with
the use of a
Wilcox Signed
Rankstest.
- Disturbed
sleep patterns
were found
among 69% of
the nurses due
to shift work
based on the
scores obtained
from ESS.
-The ESS score
resulted in an
average of
9.37.
-Amongst 42%
of the nurses,
they were
found to have
mild SD. A
mild SD is
considered
with an ESS
score of eight
to eleven.
-General
intellect and
attention mean
scores
decreased
during the
night.
Meanwhile, the
mean scores
for mental
speed and
reaction time
increased
during night
hours.
-In comparison
to night shift
hours, day shift
hours had both
a higher MoCA
test score and
higher
execution/
memory test.
- The study
included staff
nurses from
Medicine
Surgery, OBG,
Paediatrics,
etc. These
nurses worked
eight hour
shifts per day
for six days a
week, did not
suffer from any
known medical
or mental
illness, and had
a previous
work
experience of
at least one
year in rotating
shift work.
- ESS can
reliably
measure the
quality of sleep
however, it is
not equally as
accurate as an
actigraph or
actimetry in
regards to the
detection of
SD.
- Within this
study, all
domains of
cognition were
not tested.
- The mobile
application
software used
to test
cognition was
subjected to
internal face
validation
because of
asset
restrictions.
- The small
sample
population of
96 participants.
! 36
Authors:
Kana Okano, Jakub
R. Kaczmarzyk,
Neha Dave, John D.
E. Gabrieli, &
Jeffrey C.
Grossman.
Citation:
Kana Okano, Jakub
R. Kaczmarzyk,
Neha Dave, John D.
E. Gabrieli, &
Jeffrey C.
Grossman. (2019).
Sleep quality,
duration, and
consistency are
associated with
better academic
performance in
college students.
Npj Science of
Learning, 4(1), 1–5.
https://doi-
org.dominican.idm.
oclc.org/10.1038/
s41539-019-0055-z.
N=88
- Qualitative
- Quantitative
Study
- A total of 88
participants
were chosen
from an MIT
class offered in
the fall
semester. They
were chosen
from The Solid
State
Chemistry
class.
- A wearable
activity tracker
was provided
to each
student. The
students were
assigned a
specified
section to
attend and
were not
allowed to
attend other
sections. This
ensures the
same TA was
used
throughout the
semester.
- The students
took a weekly
quiz, three
midterms
approximately
three to four
weeks before
the exam date,
and a final
exam covering
content from
the entire
semester.
- Poorer grades
were
associated with
worse quality,
shorter
duration, and
less
consistency of
sleep.
- Improved
sleep quality
prior to taking
a test did not
correlate to
better test
performance.
-However,
improving both
the length and
quality of sleep
for a month
and a week
before a test
did correlate to
better grades.
-
Approximately
25% of the
academic
variances were
a result from
sleep
measures.
- Gender
differences is a
mediating
factor taken
into
consideration
in regards to
grades
- Gives new
knowledge
about the
circumstance
of the
connection
among sleep
and academic
performance.
- Sleep quality
measures were
made with
proprietary
algorithms.
Fitbit gadgets
can precisely
determine
sleep stages
however, there
is no proof
that Fitbit's
1~10 rest
quality scores
speak to a valid
evaluation of
sleep quality.
- There are
several factors
that can affect
the relationship
between sleep
and academic
performance.
This may
include stress,
anxiety,
motivation,
personality
traits, and
gender roles.
- The findings
from this
sample are
only applicable
to the student
population
enrolled in a
specified
course at MIT.
It cannot be
applied to the
generalized
population or
to other
courses at MIT.
! 37
Authors:
Mao Hasegawa,
Azusa Hayano,
Atsushi Kawaguchi,
& Ryuya Yamanaka.
Citation:
Mao Hasegawa,
Azusa Hayano,
Atsushi Kawaguchi,
& Ryuya Yamanaka.
(2015). Assessment
of autonomic
nervous system
function in nursing
students using an
autonomic reflex
orthostatic test by
heart rate spectral
analysis.
Biomedical Reports,
3(6), 831–834.
https://doi.org/
10.3892/br.
2015.512.
N=12
1
- Quantitative
Study
- Participants
consisted of
121 nursing
students who
were enrolled
at the Kyoto
Prefectural
University of
Medicine.
- The
autonomic
reflex
orthostatic
tolerance test
was used to
assess the
active standing
load of the
student
participants.
This analyzed
their
autonomic
nervous
function.
- The
variability of
the
participants'
heart rate were
measured and
analyzed for
the autonomic
nervous
system.
- The
participants
had to remain
sitting for two
minutes,
standing for 2
minutes, and
remain in a
resting position
for 1 minute.
This was done
in order to
obtain
electrocardiogr
am
measurements
for the
autonomic
reflex
orthostatic
tolerance test.
Resting rates:
- In
comparison to
first-year
students,
fourth-year
students have a
lower activity
of the
autonomic
nervous system
(CVRR).
-Fourth-year
students tended
to have a
higher
sympathetic
nervous system
activity (LF/
HF) in
comparison to
other students
from different
grade levels.
- In
comparison to
third-year
students,
fourth-year
students had a
lower
parasympatheti
c nervous
system activity
(CCVHF).
Standing rates:
-Fourth-year
students had a
higher
autonomic
nervous system
(CVRR) in
comparison to
other students
from different
grade levels.
- Fourth-year
students had a
lower nervous
system
response (LF/
HF) in
comparison to
other students
from different
grade levels.
Autonomic
nervous system
functions:
- Compared
with first- to
third-year
students,
fourth-year
students had a
lower activity
of the
autonomic
nervous system
(CVRR) of
- Valuable
information is
provided
among nursing
students
concerning the
autonomic
nervous system
dysfunction.
- Limitations
of the study
include the
relatively small
number of 121
participants.
- The study
was tailored
toward a
specified
geographic
location.
! 38
Authors:
Marta, O. F. D.,
Kuo, S.-Y.,
Bloomfield, J., Lee,
H.-C., Ruhyanudin,
F., Poynor, M. Y.,
Brahmadhi, A.,
Pratiwi, I. D., Aini,
N., Mashfufa, E.
W., Hasan, F., &
Chiu, H.-Y.
Citation:
Marta, O. F. D.,
Kuo, S.-Y.,
Bloomfield, J., Lee,
H.-C., Ruhyanudin,
F., Poynor, M. Y.,
Brahmadhi, A.,
Pratiwi, I. D., Aini,
N., Mashfufa, E.
W., Hasan, F., &
Chiu, H.-Y. (2020).
Gender differences
in the relationships
between sleep
disturbances and
academic
performance among
nursing students: A
cross-sectional
study. Nurse
Education Today,
85. https://doi-
org.dominican.idm.
oclc.org/10.1016/
j.nedt.2019.104270.
N=49
2
- Cross-
sectional study
design
- Data was
collected from
July 1, 2018 to
September 30,
2018.
-
Biosociodemo
graphic
characteristic
data was
collected.
- Using the
Pittsburgh
Sleep Quality
Index (PSQI),
the Insomnia
Severity Index,
the Epworth
Sleepiness
Scale, and the
Morningness-
Eveningness
Questionnaire,
sleep was
assessed.
- Depression
was measured
using the Beck
Depression
Inventory.
- Based on
grade point
averages from
the 2017-2018
academic year,
academic
performance
was measured.
- In order to
analyze the
data collected,
a multivariate
logistic
regression
model was
utilized.
- Both male
and female
nursing
students
suffered from
poor sleep
quality and
insomnia,
which resulted
in daytime
sleepiness.
- In
comparison
with female
nursing
students with
insomnia,
female nursing
students
without
insomnia had a
lower risk of
poor academic
performance.
- In male
students with
insomnia and
without
insomnia, there
was no
difference in
academic
performance.
- Regarding the
male nursing
students, more
than 60% had
intermediate
and morning
chronotypes.
- Pertaining to
the female
nursing
students, more
than 50% had
intermediate
and morning
chronotypes.
- Taking into
consideration
gender
differences,
this study is
the first to
examine the
relationship
between sleep
disturbances
and academic
performance in
nursing
students.
- A prospective
study is needed
to confirm
results.
- In order to
measure sleep
disturbances,
questionnaires
were self-
administered
and subjective.
- The
participants
were from one
nursing school
in Indonesia,
which may
have limited
the external
generalizability
of the study.
! 39
Authors:
Schlarb, A. A.,
Friedrich, A., &
Claßen, M.
Citation:
Schlarb, A. A.,
Friedrich, A., &
Claßen, M. (2017).
Sleep problems in
university students -
an intervention.
Neuropsychiatric
disease and
treatment, 13,
1989–2001. https://
doi.org/10.2147/
NDT.S142067.
N=27
- Quasi-
experimental
study
- In this study
(pre-post
design), there
were 27
students that
participated.
-
Questionnaires
were used to
measure
acceptance and
feasibility.
- Sleep was
measured
using the
Pittsburgh
Sleep Quality
Index
(PSQUI), sleep
logs, and
actigraphy.
- Further
factors
incorporated
daytime
drowsiness,
personality
traits
associated with
sleep, and
sleep
cognitions.
- 27% of the
participants
reported
experiencing
symptoms of
insomnia, as
well as
insomnia
disorder.
- Based on the
fifth edition of
the Diagnostic
and Statistical
Manual of
Mental
Disorders
51.9% of the
participants in
the study met
the criteria for
insomnia
disorder.
- The
Pittsburgh
Sleep Quality
Index (PSQI)
identified that
the participants
were
experiencing
clinically
relevant sleep
problems.
- Regarding
subjective
sleep quality,
objective sleep
measures, and
sleep-related
personality
traits, this
study found
clinically
significant
improvements.
- In this study,
acceptance
assessments
were
anonymous,
and sleep was
also measured
objectively.
- There were
27 participants
in this study,
which is
considered a
small sample
size.
- This is a
feasibility
study.
- The goal of
the study was
to test the
acceptance of
the program, as
well as its
effectiveness.
- This is a
quasi-
experimental
design study.
- Because a
control group
was missing,
SWIS may not
be solely
responsible for
causing the
positive effects
seen in the
study.
- There was no
follow-up
measurement.
! 40
Authors:
Seoane, H. A.,
Moschetto, L.,
Orliacq, F., Orliacq,
J., Serrano, E.,
Cazenave, M. I.,
Vigo, D. E.,
& Perez-Lloret, S.
Citation:
Seoane, H. A.,
Moschetto, L.,
Orliacq, F., Orliacq,
J., Serrano, E.,
Cazenave, M. I.,
Vigo, D. E.,
& Perez-Lloret, S.
(2020).
Sleep Medicine
Reviews, 53. https://
doi-
org.dominican.idm.
oclc.org/10.1016/
j.smrv.2020.101333.
N =
14,
170
- Systematic
review and
meta-analysis
- Cross
sectional,
cohort or case -
control studies
were accepted
- In this study,
there was a
mixed sample
of participants
with various
medical related
careers, such
as medical,
kinesiology,
and nursing
students.
- During the
regular school
period, the
participating
students were
assessed.
- At any rate
unvalidated or
validated,
subjective or
objective, sleep
quality
measurement,
duration of
sleep, or
sleepiness
during the day,
covering more
than one
evening.
-
Questionnaire,
standardized
tests, and grade
point averages
were used to
assess
academic
performance.
- In some
studies, it was
found that
medical
students who
slept for
shorter periods
of time
performed
better.
- In sleep
deprived
students,
academic
performance
and quality of
life can be
improved with
occasional
sleep
assessments
and psychiatric
evaluations.
- Impaired
academic
performance
was associated
with poor sleep
quality, as well
as excessive
daytime
sleepiness.
- The study
consisted of
14,170 medical
students, which
is considered a
large sample
size.
- There may
have been an
overrepresentat
ion of female
medical
students.
- This study
did not
measure sleep
characteristics
objectively.
- In studies
with half of the
sample
population
being females
and in studies
conducted after
2011 in Asia/
Oceania
regions, there
was a stronger
correlation
between sleep
quality and
academic
performance.
- Moderator
analyses were
not allowed
because a
sufficient
enough amount
of data was not
able to be
collected in
terms of
demographics
and
comorbidities.
! 41
Authors:
Silva, V. M.,
Magalhaes, J. E. de
M., & Duarte, L. L.
Citation:
Silva, V. M.,
Magalhaes, J. E. de
M., & Duarte, L. L.
(2020). Quality of
sleep and anxiety
are related to
circadian preference
in university
students. PLoS
ONE, 15(9), 1.
N=96
- Cross-
sectional study
with a
quantitative
approach
- The study
was conducted
at the Centro
de Ciências da
Sau´de of the
Universidade
Federal do
Recoˆncavo da
Bahia, in the
city of Santo
Antoˆnio de
Jesus, Bahia,
Brazil.
- Activities
stated at seven
in morning and
ended at six in
the evening.
There were no
night classes.
- While there
were 103
volunteers,
there were only
96 participants.
- Participants
consisted of 57
females and 39
males with the
mean ages
being 22 years
and 23.15,
respectively.
- Participants
in this study
were students
who are
enrolled in
courses at
Centro de
Ciências da
Sau´de,
between the
ages 18 and 25
years old, do
not have a
diagnosis of
psychiatric
diseases, and
do not take
controlled
medications.
- Individuals
with an
evening
chronotype are
more likely to
have higher
trait and
anxiety states,
as well as have
poorer sleep
quality.
- Evening
individuals
have three
times as high
of alert levels
at the tenth
hour than at
seventh hour.
- On work
days,
approximately
90% of the
participants
suffered from
partial sleep
deprivation
because they
went to bed
late and had to
wake up early
in the morning.
- Late
chronotypes
who have early
work schedules
often do not
sleep enough
during the
week, which
results in
having to
compensate by
increasing
sleep on the
weekends. This
is known as
social jet lag.
- Compared to
morning
students,
evening
students have
higher levels of
anxiety and
have poorer
sleep quality.
- In
comparison
with other
chronotypes.
evening
chronotypes
have sleep-
wake cycles
that are more
irregular
because of
their higher
levels of
anxiety in
relation to
- This study
was the first to
find an
association
between
anxiety and
evening people
in a non-
clinical setting.
- The study
brings needed
attention to the
conduction of
specific
studies, such as
ones that
examine how
modification of
class start
times in
universities
can reduce
anxiety in
students.
- The scope of
conclusions
might be
limited because
this study
collected data
using a cross-
sectional
design and had
a small sample
population.
- All
contributing
factors to
anxiety were
not controlled,
such as living
environments,
economic
conditions,
social
restrictions,
academic rigor,
and substance
use.
! 42
Authors:
Stepan, M. E., Fenn,
K. M., & Altmann,
E. M.
Citation:
Stepan, M. E., Fenn,
K. M., & Altmann,
E. M. (2019).
Effects of sleep
deprivation on
procedural errors.
Journal of
Experimental
Psychology:
General, 148(10),
1828–1833. https://
doi-
org.dominican.idm.
oclc.org/10.1037/
xge0000495.supp
(Supplemental).
N=23
4
- Cross-
sectional study
- Groups were
made up of a
maximum of
eleven
students.
- This study
placed the
groups in two
different
testing rooms.
- As
compensation,
participants
received course
credit.
- Requirements
for participants
in this study
include being a
native English
speaker and an
undergraduate
at Michigan
State
University.
- Participants
who have been
diagnosed with
a memory or
sleep disorder,
have major
sleep
disturbances,
are color blind,
or have a
strong
preference for
either the
morning or the
evening were
not included in
this study.
- Participants
were asked to
get at least six
hours of sleep
and to wake up
by nine in the
morning the
night before
the study.
- Before the
study,
participants
were not
allowed to nap.
- For the 24
hours prior to
the study,
participants
were not
allowed to
consume
caffeine,
alcohol, or
drugs.
- Individuals
who are sleep
deprived
should refrain
from
undertaking
procedural
tasks,
especially
those that have
interruptions
and costly
errors.
- If an
individual who
is sleep
deprived
cannot avoid
performing
procedural
errors, it would
be beneficial to
only do the
tasks for a
limited amount
of time.
- Individuals
who are sleep
deprived have
a higher
chance of
having a
general
breakdown in
ability, as well
as they are
more unwilling
to complete
tasks.
- With
participants
who were sleep
deprived, there
was an
increased rate
of errors.
- With tasks
that required
memory and
took more
time, sleep-
deprived
participants
made more
errors.
- This is the
largest study
that examined
the effect of
sleep
deprivation on
higher-order
cognition.
- There were
two groups in
the study (the
sleep and the
deprivation
group).
- Group
assignments
were random.
- In order to
design a
system that can
accommodate
operators who
are sleep-
deprived, the
empirical
pattern needs
to be better
understood and
theoretically
detailed.
! 43
Authors:
Ye, L., Hutton
Johnson, S., Keane,
K., Manasia, M., &
Gregas, M.
Citation:
Ye, L., Hutton
Johnson, S., Keane,
K., Manasia, M., &
Gregas, M. (2015).
Napping in
College Students
and Its Relationship
With Nighttime
Sleep. Journal of
American
College Health,
63(2), 88–97.
https://doi-
org.dominican.idm.
oclc.org/
10.1080/07448481.
2014.983926.
N =
440
- Cross-
sectional study
- Students were
asked three
questions.
- The questions
were based on
frequency,
length, and
timing of
napping.
- The study
focused on
students’
napping during
the past month.
- In order to
measure sleep
quality, the
Pittsburgh
Sleep Quality
Index (PSQI)
was used.
- The
participants in
this study self-
reported their
napping habits.
- Among the
nap-frequency
group and the
nap-length
group, there
was a
significant
difference
between PSQI
scores.
- It was found
that poorest
sleep quality is
associated with
individuals
who nap for
longer than
two hours and
for those who
take naps more
than three
times a week.
- Nap time
played a role in
the duration of
sleep. On
school nights,
students slept
for shorter
periods if they
took a nap
between six
and nine in the
evening.
- Frequent,
long, and late
napping is
associated with
an increased
risk of poor
sleep quality
during the
night, as well
as sleep
deprivation
that is more
severe.
- The sample
size is large
(440 students).
- Regarding
future
investigations,
this study can
be used for
reference when
developing a
valid and
reliable
questionnaire
on napping
habits and
behavior.
- The study
used an
anonymous,
online survey.
- This study
consisted of a
random sample
of participants
in regard to
sex, race, and
school
enrollment.
- The
participants
were all
undergraduate
students.
- A cross-
sectional study
was conducted,
but a causal
relationship
cannot be
deduced based
on the
collected data.
- The study
used
retrospective
subjective
reports in order
to analyze
napping and
sleep patterns.
- The study did
not examine all
aspects of
napping. It
would be
beneficial to
study the
number of naps
taken per day,
as well as the
napping
experience, in
future studies.
- Females
scores were
higher because
females
answered the
survey
questions more
than the males.
- The questions
on napping
habits, sleep
habits, mood/
energy level,
and overall
health were not
tested for
reliability or
validity.
- As
confirmation of
the findings,
the findings in
this study need
to be further
examined.