Factors Influencing Excessive Daytime Sleepiness among Undergraduate Nursing Students: A Cross-Sectional Study from North Sulawesi, Indonesia
DOI:
https://doi.org/10.33755/jkk.v11i3.873Keywords:
COVID-19, Demographic Factors, Excessive Daytime Sleepiness, Nursing Students, IndonesiaAbstract
Background: Excessive daytime sleepiness (EDS) is a common yet underrecognized concern among nursing students, potentially impairing academic performance and clinical readiness. Identifying factors associated with EDS is essential to inform preventive strategies and promote optimal student functioning.
Objective: This study aimed to identify the factors influencing EDS among undergraduate nursing students in North Sulawesi, Indonesia.
Methods: A descriptive correlational, cross-sectional design was employed. This study involved 101 students from a university in North Sulawesi Province, Indonesia, selected through consecutive sampling. Data were collected using the Epworth Sleepiness Scale (ESS) and analyzed using descriptive statistics, the Mann–Whitney U test, Kruskal–Wallis H test, Spearman’s correlation, and multiple linear regression.
Results: The mean ESS score was 12.98 (SD=4.07), with 71 respondents (70.3%) classified as experiencing EDS. Caffeine consumption (B=3.458, β=0.295, 95% CI [1.232, 5.684], p=0.003) significantly predicted EDS, accounting for 14.9% of the variance.
Conclusion: These findings highlight the need to address modifiable lifestyle factors, particularly caffeine intake, to reduce EDS among nursing students. Nurse educators and academic institutions should implement sleep health education and promote healthy coping strategies to mitigate daytime sleepiness. Early intervention may enhance students’ academic performance and clinical competence, ultimately improving patient safety and quality of care in future nursing practice.
References
1. Shimamoto H, Eastwood P, Anderson M, Mizuno K. Prevalence of excessive daytime sleepiness and its association with daily life factors in Japanese first-year university students. Sleep Biol Rhythms [Internet]. 2024;22(1):33–40. Available from: https://doi.org/10.1007/s41105-023-00470-4
2. Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, DonCarlos L, et al. National sleep foundation’s sleep time duration recommendations: Methodology and results summary. Sleep Heal [Internet]. 2015;1(1):40–3. Available from: http://dx.doi.org/10.1016/j.sleh.2014.12.010
3. Demir G. Daytime sleepiness and related factors in nursing students. Nurse Educ Today [Internet]. 2017 Dec;59(August):21–5. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0260691717301909
4. Lemola S, Perkinson-Gloor N, Brand S, Dewald-Kaufmann JF, Grob A. Adolescents’ electronic media use at night, sleep disturbance, and depressive symptoms in the smartphone age. J Youth Adolesc [Internet]. 2015 Feb 10;44(2):405–18. Available from: http://link.springer.com/10.1007/s10964-014-0176-x
5. Alanazi EM, Alanazi AMM, Albuhairy AH, Alanazi AAA. Sleep hygiene practices and its impact on mental health and functional performance among adults in Tabuk city: A cross-sectional study. Cureus [Internet]. 2023 Mar;15(3):1–12. Available from: https://www.cureus.com/articles/133351-sleep-hygiene-practices-and-its-impact-on-mental-health-and-functional-performance-among-adults-in-tabuk-city-a-cross-sectional-study
6. Wang Y, Guo M, Li J, Zhang Y, Cheng J, Zhao L, et al. Association between sleep quality and living environment among Chinese older persons: A cross-sectional study. Sleep Biol Rhythms [Internet]. 2024 Jul;22(3):323–31. Available from: https://link.springer.com/10.1007/s41105-023-00510-z
7. Fernández-Pascual MD, Reig-Ferrer A, Santos-Ruiz AM, Martínez-Rodríguez L. Spirituality in managing perceived stress and promoting self-care: A descriptive study on nursing students in Spain. J Relig Health [Internet]. 2025;64(April):882–98. Available from: https://link.springer.com/10.1007/s10943-024-02232-z
8. Yousofvand V, Torabi M, Oshvandi K, Kazemi S, Khazaei S, Khazaei M, et al. Impact of a spiritual care program on the sleep quality and spiritual health of Muslim stroke patients: A randomized controlled trial. Complement Ther Med [Internet]. 2023;77(June):1–8. Available from: https://doi.org/10.1016/j.ctim.2023.102981
9. Chen S, Li H, Wen D. Social support and daytime sleepiness among Chinese medical students: Mediating roles of loneliness and problematic smartphone use. Psychol Res Behav Manag. 2023;16(September):4083–93.
10. Exelmans L, Van den Bulck J. Bedtime mobile phone use and sleep in adults. Soc Sci Med [Internet]. 2016;148:93–101. Available from: http://dx.doi.org/10.1016/j.socscimed.2015.11.037
11. Hershner SD, Chervin RD. Causes and consequences of sleepiness among college students. Nat Sci Sleep. 2014;6(June):73–84.
12. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006–14.
13. Cellini N, Canale N, Mioni G, Costa S. Changes in sleep pattern, sense of time and digital media use during COVID-19 lockdown in Italy. J Sleep Res. 2020;29(4):1–5.
14. Townsend L, Dyer AH, Jones K, Dunne J, Mooney A, Gaffney F, et al. Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection. Madeddu G, editor. PLoS One [Internet]. 2020 Nov 9;15(11):1–12. Available from: http://dx.doi.org/10.1371/journal.pone.0240784
15. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149–60.
16. Huang CF, Yang LY, Wu LM, Liu Y, Chen HM. Determinants of daytime sleepiness in first-year nursing students: A questionnaire survey. Nurse Educ Today [Internet]. 2014;34(6):1048–53. Available from: http://dx.doi.org/10.1016/j.nedt.2013.11.005
17. Johns MW. A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep. 1991;14(6):540–5.
18. Taber KS. The use of Cronbach’s alpha when developing and reporting research instruments in science education. Res Sci Educ. 2018;48(6):1273–96.
19. Nagata JM, Al-Shoaibi AAA, Leong AW, Zamora G, Testa A, Ganson KT, et al. Screen time and mental health: A prospective analysis of the Adolescent Brain Cognitive Development (ABCD) Study. BMC Public Health [Internet]. 2024 Oct 7;24(October):1–13. Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-024-20102-x
20. Owens J, Drobnich D, Baylor A, Lewin D. School start time change: An in-depth examination of school districts in the United States. Mind, Brain, Educ. 2014;8(4):182–213.
21. Thomas CM, McIntosh CE, Lamar RA, Allen RL. Sleep deprivation in nursing students: The negative impact for quality and safety. J Nurs Educ Pract. 2017;7(5):87–93.
22. Ibrahim FM, Salmi RN, Saif MA, Mohammed A. Sleep disorders’ prevalence and impact on academic performance among undergraduate nursing students in a selected university, United Arab Emirates. SAGE Open Nurs. 2024;10(August):1–9.
23. Gallego-Gómez JI, González-Moro MTR, González-Moro JMR, Vera-Catalán T, Balanza S, Simonelli-Muñoz AJ, et al. Relationship between sleep habits and academic performance in university Nursing students. BMC Nurs [Internet]. 2021 Dec 17;20(June):1–8. Available from: https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-021-00635-x
24. Yosep I, Sakti DW, Mardhiyah A, Maulana I, Hernawaty T, Lukman M. Screen fatigue during online learning among first grade of nursing students. J Keperawatan Komprehensif (Comprehensive Nurs Journal) [Internet]. 2024 Apr 30;10(2). Available from: https://journal.stikep-ppnijabar.ac.id/index.php/jkk/article/view/631
25. Xi Y, Lin Q, Yang Q, Li F, Liu H, Luo J, et al. Association between free sugars intake and excessive daytime sleepiness among chinese adolescents. Nutrients. 2021;13(11):1–15.
26. Jun N, Lee A, Baik I. Associations of caffeinated beverage consumption and screen time with excessive daytime sleepiness in Korean high school students. Clin Nutr Res. 2017;6(1):55–60.
27. Berger M, Hirotsu C, Haba-Rubio J, Betta M, Bernardi G, Siclari F, et al. Risk factors of excessive daytime sleepiness in a prospective population-based cohort. J Sleep Res. 2021;30(2):1–17.
28. Clark I, Landolt HP. Coffee, caffeine, and sleep: A systematic review of epidemiological studies and randomized controlled trials. Sleep Med Rev [Internet]. 2017;31(February):70–8. Available from: http://dx.doi.org/10.1016/j.smrv.2016.01.006
29. Ogeil RP, Phillips JG. Commonly used stimulants: Sleep problems, dependence and psychological distress. Drug Alcohol Depend [Internet]. 2015;153(August):145–51. Available from: http://dx.doi.org/10.1016/j.drugalcdep.2015.05.036
30. Jabeen F, Nursing C, Rawalpindi A. Impact of sleep quality on academic performance of undergraduate nursing students: An analytical cross-sectional study in Pakistan. Soc Med. 2025;18(2):103–9.
31. Blome M, Johnson M, Beck M, Jones M. Obligations and behaviors that impact sleep in prelicensure baccalaureate nursing students. Nurse Educ. 2022;47(1):E12–7.
32. Mellon P, Montemurro G, Yang S, Sulz L, Torrance B, Storey K. Students’, parents’ and teachers’ perspectives on comprehensive school-based sleep promotion. Health Educ J. 2024;83(7):796–808.
33. Haylı ÇM, Chung S, Avcı MZ, Kösem DD. Examining the effect of sleep hygiene education given to nursing students on sleep quality. Med del Lav. 2024;115(4):1–9.
34. Arfianto MA, Haqqiyah SN, Widowati S, Ibad MR. Corelation of spiritual well-being and stress level in college students: A correlational study. IJNP (Indonesian J Nurs Pract. 2023;7(1):26–36.
35. Reena TY, Velayudhan B, Yesodharan R. Spiritual well-being, mindfulness, and emotional regulation among nursing students. HIV Nurs [Internet]. 2023;23(3):1533–7. Available from: https://www.hivnursing.net/index.php/hiv/article/view/1986/1832
36. Parviniannasab AM, Bijani M, Dehghani A. The mediating role of psychological capital in relations between spiritual well-being and mental health among nursing students. BMC Psychol [Internet]. 2022;10(1):1–7. Available from: https://doi.org/10.1186/s40359-022-00935-0
37. Kim C, Moon JY, Kim SH, Kim SH, Chang Y, Cho WH, et al. Prevalences and interrelationships of post COVID-19 fatigue, sleep disturbances, and depression in healthy young and middle-aged adults. J Clin Med. 2024;13(10):1–12.
38. Alzueta E, Perrin PB, Yuksel D, Ramos-Usuga D, Kiss O, Iacovides S, et al. An international study of post-COVID sleep health. Sleep Heal [Internet]. 2022 Dec;8(6):684–90. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2352721822001127
39. Seighali N, Abdollahi A, Shafiee A, Amini MJ, Teymouri Athar MM, Safari O, et al. The global prevalence of depression, anxiety, and sleep disorder among patients coping with post COVID-19 syndrome (long COVID): A systematic review and meta-analysis. BMC Psychiatry [Internet]. 2024;24(February):1–13. Available from: https://doi.org/10.1186/s12888-023-05481-6.
40. Mashfufa EW, Sari RK, Marina NS, Aini N, Setyowati L, Marta OF. The Interactions of Nutrition and Sleep Quality Focus on Melatonin Synthesis: A literature Review. Jurnal Keperawatan Komprehensif. 2022 Apr 30;8(2):273-82.
