|Year : 2018 | Volume
| Issue : 2 | Page : 169-174
Survey of sleep practice and sleep-related problems among a sample of Egyptian youths
Magda A Ahmed1, Nevin F.W Zaki2, Nesreen E Morsy1, Nabil J Awadalla3, Muhammed A Hammad4, Nihal M Saleh4, Sarah A.E Elhefnawi4
1 Department of Chest Medicine, Faculty of Medicine, Mansoura University Sleep Center, Mansoura, Egypt
2 Sleep Research Unit, Department of Psychiatry, Faculty of Medicine, Mansoura University Sleep Center, Mansoura, Egypt
3 Department of Public Health and Community Medicine, Faculty of Medicine Mansoura, Mansoura University, Mansoura, Egypt
4 Medical Students, Fifth year, Faculty of Medicine Mansoura, Mansoura University, Mansoura, Egypt
|Date of Submission||03-Jan-2018|
|Date of Acceptance||13-Mar-2018|
|Date of Web Publication||14-Jun-2018|
Magda A Ahmed
Department of Chest Medicine, Faculty of Medicine, Mansoura University, PO Box: 35111, Gomhoria Street, Mansoura, 35111
Source of Support: None, Conflict of Interest: None
Introduction Research into sleep practice of Egyptian youths is scanty and poorly disseminated, and therefore, relatively deficient data are available to put into practice. Adequate sleep practice is useful for both physical and mental health and improves the overall performance. It can also delay neurodegenerative changes in elderly.
Aim The aim was to survey sleep practice and sleep-related problems among the Egyptian youths and to put the question of sleep education in practice.
Participants and methods A cross-sectional study was conducted including 594 Egyptian youths randomly selected from university students and social club attendants in Mansoura, Egypt. An anonymous self-report questionnaire was prepared to elicit data on participants’ demography, sleep practice, and disorders.
Results Of the 594 youths examined, 59.6, 29.5, and 12.1% reported insomnia, daily sleepiness, and sleep deprivation, respectively. Smoking was significantly associated with insomnia and high risk of obstructive sleep apnea. The median values for the time of getting into bed and sleep duration in working day and weekend were 1:00 a. m., 8 h, and 10 h, respectively. Approximately 50% reported afternoon naps with median duration of 2 h.
Conclusion Sleep problems constitute a significant issue in youths. Sleep education and counseling for appropriate lifestyle and proper sleep practice may minimize the magnitude and effects of these problems.
Keywords: Egyptian youths, sleep education, sleep practice, sleep-related problems
|How to cite this article:|
Ahmed MA, Zaki NF, Morsy NE, Awadalla NJ, Hammad MA, Saleh NM, Elhefnawi SA. Survey of sleep practice and sleep-related problems among a sample of Egyptian youths. Egypt J Chest Dis Tuberc 2018;67:169-74
|How to cite this URL:|
Ahmed MA, Zaki NF, Morsy NE, Awadalla NJ, Hammad MA, Saleh NM, Elhefnawi SA. Survey of sleep practice and sleep-related problems among a sample of Egyptian youths. Egypt J Chest Dis Tuberc [serial online] 2018 [cited 2020 Feb 17];67:169-74. Available from: http://www.ejcdt.eg.net/text.asp?2018/67/2/169/234169
| Introduction|| |
Youth is the cycle of life events between childhood and adulthood. The United Nations (UN) defined youth as the duration of a human’s life from 15 to 24 years . The UN are also aware that this concept may vary for other age groups according to the perception of other authors such as the age group of 18–30 years. A useful peculiarity within the UN itself can be made between teenagers (i.e. those between the ages of 13 and 19 years) and young adults (those between the ages of 18 and 32 years). The UN are also aware that numerous other concepts exist for youth within UN entities, for example, youth habitat (15–32 years) and the African Youth Charter .
Youth lifestyles encompassing daily routine school or college obligations and spare time activities, homework, and evening outings or priorities (e.g. watching TV, video gaming, and surfing the internet), in addition weekend social duties and, perhaps, a job, as well excess internet and social media usage and elongated time spent on smart devices like mobile phones and iPads, all of which are known and lead to sleep deprivation and sleep disorders (which constitute an abnormal quantity or quality of sleep) .
The causes of sleep disorders in youth can be classified as sleep deficiency, or the absence of a high-quality sleep according to the third International Classification of Sleep Disorders (ICSDs) . Sleep problems that are of particular distress for youth such as insomnia, inadequate sleep duration, nighttime worries, nightmares, and delayed sleep phase syndrome are common among this population . Late bedtime hours are not only caused by the tendency of youth to stay awake late watching TV or surfing the internet but also are mainly owing to the shift in the chronotype preference of this age group. With the commencement of puberty, adolescents begin to experience a delay in the ‘phase’ of their biological clock . Therefore, they are more likely to late circadian rhythm, which as a result makes it hard for them to wake up early for school. Actually, the timing of the release of melatonin, the sleep hormone, is delayed. No doubt, even though not having enough hours of sleep, youths seem to not be able to sleep earlier in the evening, even if obligated to go to their bedrooms .
To our knowledge, the characteristics of sleep and sleep disorders among Egyptian youths are not well studied, so we conducted this study to screen for sleep profile in youths, especially considering cultural diversity, environment, and social habits, which can give a different pattern among Egyptian youths differentiating it from other countries. We also documented the prevalence of sleep disorders among the Egyptian youths and studied their sleep characteristics, hoping to put the question of sleep hygiene education in practice through this survey.
| Participants and methods|| |
This cross-sectional study was carried out in the Sleep Disordered Breathing Unit, Chest Department, and Sleep Research Unit at Psychiatry Department of Mansoura University in collaboration with well-trained medical students from October 2016 to October 2017. After approval from the institutional review board (IRB) Of Faculty of Medicine Mansoura University. During the first 3 months, the research team prepared the study protocol and the study questionnaire. Training workshops were tailored for the participating medical students to develop skills regarding the method of data collection and communication skills to approach target participants easily, together with explanation and comprehension of the survey questions. The following 3 months happened to coincide with the world sleep day on March 27. The Egyptian celebration of the day took part in Gezeret Elward sport club. The research team used the opportunity to collect data from community member from both Mansoura University students and Gezeret Elward Sport Club members. This was followed by 3 months of data entry and statistical calculations.
Sample size calculation was done by using the WHO manual for sample size determination in health studies . A random convenient sample of youths from Mansoura medical students was recruited. The rule of thumb was applied taking the presumed prevalence of inadequate sleep practice as 50%. Using the WHO manual for sample size determination in health studies at 95% CI, with a conservative estimate of 50%, the sample size required for the study was calculated to be 377. To avoid the potential selection bias from the possible nonresponse, a total sample size of 600 youths was initially planned to be contained in the present study.
During data collection, the researchers presented themselves to the youths and explained them the study objectives. Oral consent was obtained from each participant. Confidentiality and anonymity were granted to the participants. Youths who agreed to participate spent 15–30 min in completing the questionnaire.
Unnamed, self-reported questionnaire was used to collect data. The questionnaire includes demographic, Arabic version of Epworth  for evaluation of daytime sleepiness, Arabic version of Berlin Questionnaire  to evaluate sleep apnea, Arabic translated definition of insomnia , Arabic translated American Academy of Sleep Medicine Diary, and Arabic translated Periodic Limb Movement Diagnostic Criteria . Use of social media was classified into high and low according to youth perception. Weight and height were measured for all participants using a standardized weight-height scale, and then BMI was calculated according to the WHO manual. A BMI score of less than 18.5 was considered as underweight, 18.5 and less than 25 was considered as average weight, equal to or greater than 25 was considered overweight, and above 30 was considered obese .
The data were entered and analyzed using SPSS Statistical Software (IBM SPSS, version 20; IBM, Armonk, New York, USA). Categorical data were presented as numbers and percentages and compared by χ2-test. Continuous variables were summarized as mean and SD and compared by Student’s t-tests and Mann–Whitney U-test for parametric and nonparametric data, respectively. Two-sided P values were used. P value of less than 0.05 was considered statistically significant.
| Results|| |
This study included 594 Egyptian youths. [Table 1] describes their personal characteristics. The age range of the study group was between 15 and 25 years, with a mean age of 20.30±2.50 years. Most of them were female (61.40%) and of average BMI (58.9%). Only 8.8% were smokers.
Self-reported sleep practices are presented in [Table 2]. The means of time of getting into bed ranged from 21:00 to 6:00, with a median of 1:00 in 24-h time system. The means of sleep duration (hr : min) in working day and weekend ranges from 3:00 to 12:00, with a median of 8:00, and 4:00 to 14:00, with a median of 10:00, respectively. Approximately 50% of the study group reported afternoon naps. The time spent in naps ranges from half an hour to 4 h with the median of 2 h and average of 2:11±1:24.
The most common sleep problem was insomnia (59.6%), followed by excessive daily sleepiness (29.5%) and sleep deprivation (12.1%). On the contrary, nightmares were the most frequently reported symptom among the study youths (7%), followed by sleep talking (5%) ([Figure 1] and [Figure 2]).
|Figure 1 Frequency of sleep problems among studied youths. OSA, obstructive sleep apnea; RLS, restless legs syndrome.|
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|Figure 2 Frequency of most distressing sleep symptoms among studied youths.|
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Studying the factors associated with the reported sleep problems revealed that insomnia was significantly higher in the age group 15–20 years old (P=0.005), smokers (P=0.02), and in non-napping group (P=0.007). Restless legs syndrome was significantly more common in age group 15–20 years old (P=0.02) and females (P=0.001). The frequency of high-risk obstructive sleep apnea was significantly higher among smokers (P=0.002) and obese youths (P=0.005). On the contrary, excessive daytime sleepiness and sleep deprivation were significantly associated with daytime naps (P=0.001 and 0.04, respectively) as shown in [Table 3].
|Table 3 Factors associated with the reported sleep problems among the studied youths (n=594)|
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| Discussion|| |
Even though the fact that sleep disorders act on all age groups, youth and early adulthood is a sensitive transitional duration, as essential psychosocial and developmental changes occur during this period . The WHO define the age period from 10 to 19 years as adolescence; this life cycle in human growth is between childhood and adulthood. Consequently, the attendants comprising the sample in this research are under the process of becoming adults and, in such a way, are confronting significant biological changes, including a natural impulse toward becoming evening persons . The findings of this study showed that younger participants (age 15–20 years) sleep later and longer than older ones (20–25 years) as detected from [Table 2]. It was also found that males sleep later than female students and take longer naps during the day more than female students. The prevalence of poor sleep quality in medical students is generally more prevalent, as more than half of the students participating in this study (59%) were complaining of insomnia. Moreover, prevalence of complaint regarding this problem was more in female students than male students (61%). These results are consistent with Byrd et al.  in Nigeria. Good sleep quality is supposed to be associated with a wide range of positive correlates such as better health status, less tendency of daytime sleepiness, greater sense of well-being, and better psychological functioning. On the contrary, poor sleep quality is one of the defining features of chronic insomnia. Although the review of the empirical literature suggests that the actual definition of sleep quality is not yet understood .
However, some studies reported a different prevalence of sleep complaints like that of Steptoe et al, 2007 , who found no relationship between sleep profile (various features characterizing individual sleep) and age. The variation between results from different studies may be related to differences in cultural traits, socioeconomic levels, and university characteristics of each country. In the other words, in studies that have examined students’ sleep during examination periods, the situation was worse.
The data finding of this study revealed that the mean sleeping time of the included participants was less than recommended sleep hours (normal 7–9 h) as found by the National Sleep Foundations, indicating that participants in this study where either sleep deprived or having as short sleep duration. Obviously from previous studies, many health problems are associated with short sleep duration ,,,, mainly coronary heart disease, diabetes, hyperlipidemia, hypertension, obesity, and a lot more . Based on these results, we assume that sleep hygiene practices for males were lower than seen in females, because they slept less number of hours. Sleep hygiene practices are behaviors that promote sufficient rest . The student’s knowledge about sleep hygiene practices is deficient and they might not have enough knowledge about healthy sleep practices or else their sleep profile would have been better than detected, thereby improving sleep quality. In reality, implementing and practicing these principles would help to enhance sleep quality. A study in India by Sharma and Sharma  showed that structured psychoeducation programs regarding sleep hygiene and sleep disorders were effective in increasing knowledge among preuniversity students.Current study results showed that in the study, senior students had worse sleep quality. Poor quality of sleep in senior students can be owing to their disrupted sleep schedules resulting from larger study duties and chaotic hygiene practices. Moreover, it is assumed that junior students may have developed better coping strategies for their university needs. Similar results have been reported in other studies .
This study has some limitations too. First, the study population comprised medical students from Mansoura University who participated in the world sleep day activity, and they do not represent all of the Egyptian university students. Thus, future multicentered studies with participants from several universities would be appealable in the future. Second, we used self-reported questionnaire for detecting variables, which could have been subject to bias. More subjective instrument like sleep diary will give more accurate results. To avoid prolonging the questionnaire, authors did not assess some important variables influencing sleep such as stress, anxiety, and depression.
| Conclusion|| |
Youth and university students are considered a high-risk population for developing sleep disorders and bad practicing of sleep hygiene. These practices affect their lifestyle and also affect their academic performance. Follow-up studies after implementing good hygiene are required to detect any variation in youth behavior and study the effect of these changes on their health and performance.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]
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