Sleep Quality and Quality of Life Among Nursing Students in Bangladesh: A Cross‐Sectional Study
ABM Alauddin Chowdhury, Lata Das, Md Monir Hossain Shimul, Shakila Akhter, Fatima Akter, Ittila Ghani Ava, Salamat KhandkerBackground
Sleep quality is an important determinant of health and well‐being. Nursing students may be particularly vulnerable to sleep‐related problems because of demanding academic and clinical responsibilities. This study assessed sleep quality and quality of life (QoL) among nursing students in Bangladesh and explored the association between individual Pittsburgh Sleep Quality Index (PSQI) items (sleep disturbances, sleep‐medication use, and daytime dysfunction) and QoL.
Methods
A cross‐sectional study was conducted among 345 nursing students at Ibn Sina Nursing Institute, Dhaka, Bangladesh, between January 2024 and April 2025. Participants were recruited using purposive sampling. Data were collected using a self‐administered Bengali questionnaire incorporating the PSQI and WHOQOL‐BREF. A PSQI score > 5 was defined as poor sleep quality. Descriptive statistics were used to summarize participant characteristics. Twelve item‐level associations with dichotomized QoL were examined as exploratory analyses using Pearson chi‐square tests, with exact tests, chi‐square tests for linear trend, and Holm‐adjusted p values to account for multiple comparisons. Statistical significance was set at p < 0.05 (adjusted p < 0.05 for item‐level inference).
Results
The participants had a mean age of 20.71 ± 1.663 years, and most were female and unmarried. Overall, 66.6% (95% CI 61.5–71.4) of participants had poor sleep quality, and 49.3% were classified as having poor QoL. Difficulty breathing comfortably was associated with QoL ( χ 2 = 14.50, df = 3, p = 0.002; Holm‐adjusted p = 0.028; trend p = 0.003) and remained significant after correction for multiple comparisons. Trouble staying awake during driving, eating, or socializing showed a nominal association ( χ 2 = 9.11, p = 0.03) that did not remain significant after correction (Holm‐adjusted p = 0.31) and showed no linear trend ( p = 0.21). No other item (nighttime awakenings, sleep‐onset difficulty, bathroom use, coughing or snoring, feeling too cold or hot, bad dreams, pain, sleep‐medication use, or difficulty maintaining enthusiasm) was significantly associated with QoL.
Conclusion
Poor sleep quality was common among nursing students. In this exploratory, unadjusted analysis, difficulty breathing comfortably was the only PSQI item that remained associated with QoL after multiplicity correction, no consistent dose–response pattern was observed, and the relationship between overall PSQI score and QoL domains was not examined; these findings are hypothesis‐generating and do not establish causation. Nursing institutions could consider sleep‐health education, early identification of persistent sleep problems, and appropriate student‐support services as potential implications for student well‐being.