Sleep quality among undergraduate students is primarily influenced by modifiable lifestyle and psychological factors, with anxiety showing the strongest dose-response effect, and evening and bedtime smartphone use predicting worse sleep independent of total usage time.
Demographic variables were not significantly associated with sleep quality among undergraduate students.
Students who exercised less reported significantly worse sleep quality than those who exercised more.
Students who followed an unhealthy diet reported significantly worse sleep quality than those with a healthier diet.
High intake of stimulants including coffee, tea, and soft drinks was associated with poorer sleep quality.
Anxiety showed a clear dose-response relationship with sleep quality, with higher anxiety severity associated with progressively worse PSQI scores.
Evening and bedtime smartphone use predicted worse sleep quality independently of total smartphone usage time.
The overall mean PSQI scores indicated that the majority of students experienced poor sleep quality.
This research surveyed 1,564 undergraduate students at Jazan University in Saudi Arabia during spring 2023 to understand what factors are associated with sleep quality. Students completed an online questionnaire that measured sleep quality using a standardized tool called the Pittsburgh Sleep Quality Index (PSQI), along with questions about their lifestyle habits, anxiety levels, and smartphone use. The study found that demographic factors like age or gender were not meaningfully linked to sleep quality, but several changeable behaviors and psychological factors were strongly associated with how well students slept. Anxiety stood out as the most powerful predictor of poor sleep, with students experiencing more severe anxiety reporting dramatically worse sleep scores — each step up in anxiety severity (mild, moderate, severe) was linked to a progressively larger increase in poor sleep scores. Beyond anxiety, students who exercised less, ate less healthily, or consumed high amounts of caffeinated drinks like coffee, tea, and soft drinks also reported worse sleep. Importantly, it was not just how long students used their smartphones that mattered, but specifically when they used them — using smartphones in the evening or at bedtime was independently associated with worse sleep quality even after accounting for total screen time. This research suggests that improving sleep among college students may be best achieved by targeting modifiable habits rather than focusing on who students are demographically. Interventions that help students manage anxiety, encourage regular physical activity and healthier eating, reduce stimulant consumption, and shift smartphone use away from the hours before bed could meaningfully improve student sleep and, by extension, their overall well-being and academic performance.
Almalki M, Ahmed M, Alzahrani A, Mehmood A, Felix H, Almalki R, et al.. (2026). An Integrative Analysis of Behavioral, Psychological, and Smartphone Use Factors Associated With Sleep Quality: A Cross-Sectional Study of Saudi Undergraduate Students.. Inquiry : a journal of medical care organization, provision and financing. https://doi.org/10.1177/00469580251413526