Sleep Quality among College Students in Kathmandu Valley, Nepal

Introduction: Many college students suffer from sleep disorders, including insomnia, and sleep deprivation, resulting in a poor sleep quality. Students are at risk for sleep disorders, and those at risk may also be at risk for academic failure. The main aim of the study is to assess the level of sleep quality among college students in Kathmandu, Nepal. Methods: A cross-sectional study was conducted with 504 students of class 11 and 12 of any faculties among selected colleges of Kathmandu. Simple random sampling was used for selection of colleges. Ethical approval was taken before data collection. Participants with chronic medical illness and mental disorders were excluded from the study. A semi-structured questionnaire was used to collect the information related to socio-demography, and Pittsburgh sleep quality index was used to assess the sleep quality in college students. All data extracted from questionnaires were entered and analyzed using SPSS version 20. Results: Out of 504 students, 40.9% were found to have good sleep quality, whereas, 59.1% were found to have poor sleep quality. 55.21% of male students and 65.78% of female students had poor sleep quality. 58.30% of science students and 59.85 % of management students had poor sleep quality. Conclusions: The quality of sleep among Nepalese college students was found to be poor. Many colleges are unaware of the risks or issues to the students.


INTRODUCTION
Good sleep is essential for the overall development of body, however, many college students suffers from various sleep disorders, including insomnia and sleep deprivation, resulting in a poor sleep quality; people may experience poor concentration and bad work quality because of insomnia. [1][2][3] Many college students are at risk for sleep disorders, and those at risk may also be at risk for academic failure. 4 Very few research studies have been conducted in Nepal regarding sleep quality. Many of the college students may have the chance of being physically and emotionally disturbed. Moreover, the quality of sleep in Nepalese college students may be poor as there is ineffectiveness of education system in addition to the further practical courses. The main aim of the study is to assess the level of quality of sleep among college students in Kathmandu, Nepal.

METHODS
A cross-sectional study was conducted among 504 students (age ranging from 16 to 21 years, mean age = 17.12 years) of class 11 and 12 of any faculties among selected colleges of Kathmandu. Nine colleges were selected using simple random sampling. Data were collected from January 2019 to February 2019. Ethical approval was taken from Nepal Health Research Council. Approval for data collection was taken from respective colleges. Signed informed consent was taken from students before their participation. Parental consent was taken for the students who were under 18 years of age.
Study population were the students of grade 11 and 12 of any faculties. Students were selected conveniently. Taking high non-response rate of 30%, the total sample size was 500. The total sample collected was 504. Both male and female college students of grade 11 and grade 12 of any faculties were included. Participants with chronic medical illness and mental disorders were excluded in the study.
The tool used for data collection in the study was semi structured questionnaire with Pittsburgh sleep quality index. Semi-structured questionnaire consisted of socio-demographic profile. The Pittsburgh Sleep Quality Index (PSQI) is a self-report questionnaire that assesses sleep quality over a 1-month time interval. The measure consists of 19 individual items, creating 7 components that produce one global score, and takes 5-10 minutes to complete. The global score of PSQI can range from 0 to 21. The score of 5 or more indicates poor sleep quality.
The questionnaire was translated to Nepali language. For reliability, data was pretested on 10% of the sample size which was the representative study population other than the sample. Other additional editing to questionnaire were done according to the comments and response from the pre-test. The questionnaires were self-administered by the students in the class.
Data were entered and analysed in SPSS version 20.0.
Descriptive analysis was done and presented using frequency and percentage.

RESULTS
Out of 504 students, 206 students (40.9%) were found to have good sleep quality, whereas 298 students (59.1%) were found to have poor sleep quality. Gender wise analysis showed that 55.21% of male students and 65.78% of female students had poor sleep quality. Furthermore, 58.30% of science students and 59.85 % of management students had poor sleep quality  Table 2 shows the socio demographic information of the respondents. Out of 504 samples, the population between the ranges from the age group 15-16 was found to be 21.6%, and 17-18 was found to be 73.2% respectively. The percentage of male population was found to be 62.9% and the percentage of female was found to be 37.1%. Among the total population, 31.2% were Brahmin, 33.3% were Chhetri, 16.5% were Newar, while 18.1% were Janajati. Also, majority of the population was of Hindu religion i.e. 85.9% while only 12.1% of the population was found to be Buddhist, remaining 1.2% were from Christian, and 0.8% were from Muslim religions. The total percentage of population in science and management discipline was found to be 46.6% and 53.4% respectively. 62.1% of the total population were from grade 11 while 37.9% of the total population were from grade 12. Among the total population, highest level of income was 44.6% of NRS 20,000 to 50,000 and lowest level of income was 4.8% below NRS 10,000.

DISCUSSION
The primary purpose of this research was to assess the level of quality of sleep among high school students, Kathmandu. The study showed that 298 (59.1%) students were found to have bad quality of sleep. A previous Nepalese study also revealed that 31.5% of Nepalese medical students suffered from sleep deprivation due to late night internet surfing. 5 A global study conducted on medical students showed that in Brazil, 28.2% of medical students had insomnia; females had more difficulty in maintaining sleep than males, and males were more likely to report "falling asleep later". 6 Our study also demonstrated the female students had worse sleep quality than male students. In Mexico, 24% of first year medical students (mean age 18 years) reported some sleep difficulties in the week prior to the survey, and the insomnia symptoms were associated with various measures of psychological health on the Symptoms. 6 Similarly, Chinese medical students reported that more than 90% of the undergraduates had experienced excessive sleepiness in class, with more males than females affected. 70% of Hong Kong medical students reported sleep deprivation. Malaysian medical students revealed that daytime sleepiness occurred in 35.5% and poor sleep quality was reported by 16%. In a similar study, among 244 Iranian medical students, 40.6% students reported poor sleep quality; this was significantly associated with lower grades, economic and marital status, and type of training. 6 With all these research study, clearly showed that sleep quality of college students is found to be poor and associated with many factors which is similar to our study that shows 59.1% students with bad quality sleep.
Previous studies demonstrated that the sleep quality is affected by variety of factors, ranging from the surroundings to the deep psychological conflicts. 7 In a recent study seeing the correlations between internet addiction, depressive symptoms and sleep quality, 35.4%, 35.4% and 21.2% of students scored above validated cut off scores for poor sleep quality, internet addiction and depression respectively which also supports our study that the most of the college students are not getting good quality of sleep which may hamper their academic performances and daily life schedules. 8

CONCLUSIONS
The quality of sleep among Nepalese college students were found to be poor. Many colleges are unaware of the risks or issues to the students. So, it would be more fruitful if the respected authorities and government prioritize on the psycho-social aspects of the students that may be hampering the sleep quality of the students.