Rev Esp Nutr Hum Diet.

2019; 23(3): 153 - 161

Freely available online OPEN ACCESS 153

Revista Española de
Nutrición Humana y Dietética
Spanish Journal of Human Nutrition and Dietetics
www.renhyd.org

RESEARCH ARTICLE

Sleep disorders and anthropometric measures in Chilean university students

a,* a a
Samuel Durán-Agüero , Ricardo Sepúlveda , Marion Guerrero-Wyss
a
Facultad de Ciencias para el Cuidado de la Salud, Universidad San Sebastián, Santiago, Chile.

*[email protected]
Editor asignado: Eduard Baladia. Comité Editorial de la Revista Española de Nutrición Humana y Dietética. Pamplona, España.

Received: 31/08/2018; accepted: 27/10/2019; published: 27/10/2019.

Sleep disorders and anthropometric measures in Chilean university students

KEYWORDS ABSTRACT
Introduction: To compare sleep habits, insomnia and daytime sleepiness in university students
according to anthropometrics measures.
Nutritional Status; Material and Methods: A cross-sectional study was carried out on university students using
the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index and Insomnia Severity Index. In
Sleep;
addition, anthropometric variables were determined; weight, height and waist circumference.
Sleep Initiation Results: We evaluated 1,275 university students (74% female). Students on average slept at
and Maintenance midnight and slept on average 6.4 hours, 77.9% sleep less than recommended, 34.2% had
Disorders; daytime somnolence and 68.5% had insomnia. Regarding insomnia, it was observed that the
Obesity. low weight group presented the highest insomnia score that significantly contrasted with the
normal weight group (p=0.04). In the case of daytime sleepiness when comparing by nutritional
status, it was observed that obese students are the ones with the greatest daytime somnolence
(p<0.05). Finally, there is an association between fewer sleep hours with higher BMI (OR:1.12
(95%CI:1.01–1.991)) and presence of insomnia (OR:2.734 (95%CI:1.324–5.645)).
Conclusions: University students sleep less than recommended, have a high prevalence of
insomnia and excessive daytime sleepiness, in addition, it is obese women who present this
alteration more frequently and the highest insomnia score is identified in underweight students.
Both a high BMI and insomnia are associated with short-term sleep.

Obra bajo Licencia Creative Commons Reconocimiento-NoComercial-CompartirIgual 4.0 Internacional.

doi: 10.14306/renhyd.23.3.646
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Rev Esp Nutr Hum Diet. 2019; 23(3): 153 - 161

Sleep disorders and anthropometric measures in Chilean university students 154

Alteraciones del sueño y medidas antropométricas en estudiantes universitarios chilenos

PALABRAS CLAVE RESUMEN

Introducción: El objetivo del estudio es comparar los hábitos de sueño, el insomnio y la somno-
lencia diurna en estudiantes universitarios según las medidas antropométricas.
Estado Nutricional; Material y Métodos: Diseño del estudio: un estudio transversal, se llevó a cabo en estudiantes
universitarios utilizando la escala de somnolencia de Epworth, el índice de calidad del sueño de
Sueño;
Pittsburgh y el índice de severidad del insomnio. Además, se determinaron las variables antropo-
Trastornos del Inicio métricas; peso, altura y circunferencia de la cintura.
y del Mantenimiento Resultados: Fueron evaluados 1.275 estudiantes universitarios (74% mujeres). Los estudiantes en
del Sueño; promedio dormían a la medianoche y en promedio 6,4 horas, el 77,9% dormía menos de lo reco-
Obesidad. mendado, el 34,2% tenía somnolencia diurna y el 68,5% tenía insomnio. Con respecto al insom-
nio, se observó que el grupo de bajo peso presentaba la puntuación más alta de insomnio que
contrastaba significativamente con el grupo de peso normal (p=0,04). En el caso de la somnolen-
cia diurna al comparar por IMC, se observa que los estudiantes con obesidad son los que presen-
tan la mayor somnolencia (p<0.01). Hay una asociación entre menos horas de sueño con mayor
IMC (OR:1,12 (IC95%:1,01–1,991)) y presencia de insomnio (OR:2,734 (IC95%:1,324–5,645)).
Conclusiones: Los estudiantes universitarios duermen menos de lo recomendado, tienen una
alta prevalencia de insomnio y somnolencia diurna excesiva, además, son las mujeres con obe-
sidad presentan esta alteración con mayor frecuencia y se identifica el puntaje más alto de
insomnio en estudiantes con bajo peso. Tanto un IMC elevado como el insomnio se asocian a
sueño de corta cantidad.

C ITATIO N
Durán-Agüero S, Sepúlveda R, Guerrero-Wyss M. Sleep disorders and anthropometric measures in Chilean
university students. Rev Esp Nutr Hum Diet. 2019; 23(3): 153-61. doi: 10.14306/renhyd.23.3.646

to university students4. It should be noted that they have

INTRODUCTION extensive academic conferences, concentration of the
studies in the night, reduction of free time allocated to non-
Inadequate diet and low physical activity are factors academic activities, high levels of stress. On the other hand,
associated with the development of obesity in different age students at times have foods that are not recommended,
groups1. particularly at night and high consumption of caffeine and
energy drinks.
However, other factors are emerging that could be involved
in the development of obesity, including sleep1, which is A reduction in sleep hours in university students has been
important for growth, human development, metabolism, associated with a decrease in academic performance,
weight regulation, immune function, learning, memory and depression and can be detrimental to health5. Due to
emotional health, so, studies in children and adolescents the academic demand and high intensity produced by
reveal that up to 70% of students sleep less than the University, it is generally not possible to cover the
recommended for their age2, despite the recommendation recommended hours of sleep, therefore, students are
of the National Sleep Foundation to maintain between 7 and expected to maintain habits, behaviors and a vulnerable and
9 hours of sleep per day in young adults and adults3. irregular meal schedule6.

In relation to the deficit in the quantity and quality of sleep, Authors have suggested that through an unclear
a highly vulnerable group is identified which corresponds mechanism, lack of sleep, would affect cognitive processes,
Rev Esp Nutr Hum Diet. 2019; 23(3): 153 - 161

Sleep disorders and anthropometric measures in Chilean university students 155

it has been suggested that certain stress-associated questionnaires: Epworth Sleepiness Scale, Pittsburgh Sleep
hormones that are secreted in conditions of sleep restriction Quality Index and Insomnia Severity Index.
can affect the physiology of neurons and contribute to the
cognitive impairment7. These reflections might suggest that The study was developed according to the Declaration of
the consequences of exposure to poor sleep quality could be Helsinki regarding work with human beings and previously
long-term. approved by the Ethics Committee by Universidad San
Sebastián.
Previous studies have reported concerning results in
relation to the poor quality of sleep of university students, Epworth Sleepiness Scale
that is how in a group of medical students more than 30%
presented poor and unsatisfactory sleep quality5. In another Likert short questionnaire that determines Daytime
study conducted in nursing students, the prevalence of Sleepiness, by predicting the risk of the interviewee to
insomnia was also close to 30%8. fall asleep on a scale of 0 to 3 for eight different everyday
situations. A score of 0 to 24 points is obtained, which is
Other research in university students indicated that more categorized as normal daytime somnolence (0 to 10 points),
than 92% of students reported poor sleep quality, while 77% mild daytime somnolence (11 to 12 points), moderate
of them reported a very irregular sleep schedule9. daytime somnolence (13 to 15 points), and somnolence
severe diurnal (16 to 24 points)13.
It is important to point out that important researches have
also related in university students the poor quality of sleep
Insomnia or Insomnia Severity Index (ISI) Questionnaire
with an increase in overweight and obesity10, in addition,
diverse studies have shown differences in the amount of It is a self-report questionnaire that aims to evaluate the
sleep, insomnia and daytime somnolence while comparing nature, severity and impact of insomnia; are 5 questions
sexes11,12. ranging from 0 to 4 points, with a final score between 0 to
28 points and is composed of 5 self- minimum score of 0
Due to the aforementioned, it is essential and relevant to
and maximum of 4 per question. The results obtained are
continue investigating associations or consequences that
classified according to the numerical value of the sum of the
involve deficits in the quantity and quality of sleep.
responses performed by the subjects, so that the registers
The objective of the present study is to compare sleep habits, are divided into 4 categories, distributed as follows: absence
insomnia and daytime sleepiness in university students of clinical insomnia (0 to 7 points), subclinical insomnia (8 to
according to anthropometrics measures. 14 points), moderate clinical insomnia (15 to 21 points), and
clinical or severe insomnia (22 to 28 points)14.

Pittsburgh Sleep Quality Index

MATERIAL AND METHODS It evaluates sleep quality through seven components:

subjective quality of sleep, latency (amount of time taken
Cross-sectional study, all university students who were to sleep), duration, habitual efficiency, alterations, use of
present at the time of the evaluation were included; and hypnotic medication and diurnal dysfunction. It consists of 7
who expressed their informed consent through written questions ranging from 0 (no difficulty) and 3 points (severe
documentation, excluded students who presented medical difficulty), with an overall score between 0 (no difficulty) and
leave and did not sign the requested document. 21 points (difficulty in all areas), with a cut-off point in the
Score 5 to differentiate well from bad sleepers15.
For the sample calculation, the total number of Campus
students (6,800), heterogeneity 50%, margin of error Anthropometric variables were determined; weight, height
3%, and confidence level of 95% were used, resulting in a and waist circumference. The determination of weight (kg)
total of 923 students as a minimum sample of the study. was carried out with a mechanical scale (SECA, maximum
The questionnaires were self-administered at the time and capacity of 220kg precision in 50g) with the minimum of
later an anthropometric evaluation was carried out by a clothes possible. The height (cm) was determined with a
professional Nutritionist. Finally, there were 1,275 students built-in height rod, and the waist circumference was obtained
from different careers at the San Sebastian University (Chile), by measuring with a tape measure. Body mass index (BMI)
who formed the study voluntarily, during the 2017 and 2018 was calculated by dividing the weight by the squared
academic years. Sleep quality was determined through the size-IMC=weight(kg)/size2(meters). BMI was categorized
Rev Esp Nutr Hum Diet. 2019; 23(3): 153 - 161

Sleep disorders and anthropometric measures in Chilean university students 156

according to WHO classification BMI, using the following less than the recommended hours, without differences
values: low weight (<18.5), normal (18.5-24.9), overweight due to gender and nutritional status. The average daytime
(≥25-29.9) and Obesity (≥30). sleepiness score was slightly drowsy, a similar situation
occurred with the average insomnia score (subclinical
Statistics insomnia); students on average slept at midnight and sleep
was 6.4 hours.
To evaluate the normality of the data, the Kolmogorov
Smirnov test was performed, as the data was normal, mean Table 2 shows the percentage of daytime sleepiness and
and SD were used. To compare between groups the ANOVA insomnia according to sex, a high prevalence of daytime
test and a Bonferroni post hoc were used, a p<0.05 was sleepiness (34.2%) and insomnia (68.5%) in college students,
considered significant. To determine the association of BMI when comparing daytime sleepiness by sex higher in females
with sleep and insomnia, a multivariate logistic regression (p=0.04). When comparing diurnal somnolence according
analyses is performed. In the raw model associated with to nutritional status, there are no significant differences;
fewer hours of sleep (<7 hours), present a BMI≥25. Presence however, in insomnia, underweight and obese students are
of Insomnia and excessive daytime somnolence were the ones with the highest levels of insomnia (p<0.001).
included in model 2. Model 3 doing physical activity were
added, in addition models 2 and 3 were adjusted by sex and We performed the anthropometric comparison and sleep
tobacco consumption. The statistical program used was habits according to BMI classification (Table 3), there were
SPSS 22.0. differences in weight, BMI and waist among the 4 groups,
with respect to insomnia it was observed that the low
weight group presented the highest insomnia score that
significantly contrasted with the normal weight group
(p<0.05).
RESULTS
Figure 1 shows that obese women present significantly
The sample was represented by 1,275 university students higher scores in daytime sleepiness than those with
(74% female); age, height, weight, and BMI were 21.7±2.4 low weight and normal weight (p<0.01). Obesity in men
years, 63.1±11.5kg, 163.4±8.3cm., 23.5±3.2kg/m2 presented significantly higher scores in daytime sleepiness
respectively (Table 1). 77.9% of university students sleep than men with normal weight (p<0.05).

Table 1. General characteristics of the sample (n=1,275).

Mean SD Minimum Maximum

Age (y) 21.7 2.4 18.0 39.0
Weight (kg) 63.1 11.5 40.0 121.0
Height (cm) 163.4 8.3 144.0 195.0
BMI (k/m )
2
23.5 3.2 16.7 42.0
Waist circumference (cm) 77.5 9.9 60 145
Epworth (score) 8.7 3.8 0 23
Insomnia (score) 10.1 4.8 0.0 27.0
Bedtime (h) 12:10 pm 1:20 8:00 pm 7:00 am
Sleep Latency (min) 27.6 31.6 0.0 360.0
Time to wake up 7:36 am 1:26 1:00 am 2:00 pm
Sleep Duration (h) 6.4 1.5 2 14
Score Pittsburgh 9.1 6.5 0.0 40.0
Rev Esp Nutr Hum Diet. 2019; 23(3): 153 - 161

Sleep disorders and anthropometric measures in Chilean university students 157

Table 2. Percentage of daytime sleepiness and insomnia according to sex and BMI (n=1,275).

Daytime sleepiness Insomnia

Clinical
Clinical
Subthreshold insomnia
Normal Mild Moderade Normal insomnia
insomnia (moderate
(severe)
severity)
Women 63.2 27.2 9.5 32.1 50.1 16.3 1.4
Men 72.7 22.1 5.2 29.3 49.6 19.9 1.0
Chi scuare, p value 0.018 0.669
Underweight 69.7 9.1 21.2 25.0 50.0 18.8 6.2
Normal weight 72.6 12.1 15.3 33.1 49.5 17.0 0.4
Overweight 72.4 14.3 13.3 29.8 49.2 18.3 2.7
Obesity 63.4 17.3 19.3 19.5 60.8 13.0 6.7
Chi scuare, p value 0.547 0.001

Table 3. Anthropometric comparison and sleep habits according to classification of body mass index.

Underweight Normal weight Overweight Obesity

(n=33) (n=860) (n=309) (n=53)
Aged (y) 21.8 (2.8) 21.6 (2.3) 21.9 (2.8) 21.6 (2.4)
Weight (kg) 46.9 (3.7) a,b,c 59.0 (7.7) a,d,e 72.0 (9.4) b,d,f 88.4 (12.4) b,d,f
Height (cm) 161.4 (6.5) 163.3 (7.9) 163.7 (9.4) 165.1 (8.7)
BMI (k/m2) 17.9 (0.4) a,b,c 22.0 (1.7) a,d,e 26.7 (1.3) b,d,f 32.2 (2.7) b,d,f
Waist circunference (cm) 64.1 (4.7) a,b,c 74.3 (6.9) a,d,e 84.5 (8.8) b,d,f 97.7 (11.9) c,e,f
Epworth (score) 9.4 (3.6) 8.7 (3.8) 8.7 (3.9) 9.4 (3.9)
Insomnia (score) 12.0 (5.5) a
9.8 (4.6) a
10.5 (5.1) 11.3 (5.0)
Sleep Latency (min) 29.6 (36.7) 26.4 (27.4) 30.1 (37.2) 31.4 (50.6)
Bedtime 24:3 (1:33) 24:11 (1:0) 24:21 (1:3) 24:13 (1:2)
Time to wake up 7:6 (1:7) 7:6 (1:4) 7:6 (1:5) 7:30 (1:4)
Sleep Duration (h) 6.4 (1.5) 6.3 (1.4) 6.2 (1.4) 6.1 (1.5)
Score Pittsburg 8.3 (4.0) 9.0 (6.4) 9.3 (6.9) 9.6 (6.4)

Values expressed as mean (SD); ANOVA test; post hoc Bonferroni;

equal letters (a,b,c,d,e,f) indicate significant differences (p<0.05).

Table 4 shows the results of the analysis between (95%CI:1.124–1.947)), (OR:1,12 (95%CI:1,01–1,991). There
sleeping less than 7 hours of sleep and nutritional was also association with insomnia in models 2 and 3, no
status, an association was found between a few hours associations were observed with daytime sleepiness and
of sleep with a higher BMI≥25 both in the crude and physical activity, models 2 and 3 were adjusted for sex and
adjusted models (OR:1.36 (95%CI:1.059–1.751)), (OR:1.47 tobacco consumption, performing an analysis with the BMI
Rev Esp Nutr Hum Diet. 2019; 23(3): 153 - 161

Sleep disorders and anthropometric measures in Chilean university students 158

Figure 1. Comparison of daytime sleepiness according to body mass index in women.

*
12
*

10

8
score

0
underweight normal weight overweight obesity

*ANOVA test, post hoc Bonferroni; p value <0.01.

Table 4. Association between fewer hours of sleep (<7 hours).

OR Crude Model OR Model 2 OR Model 3

BMI ≥ 25 1.36 (1.059-1.751) 1.47 (1.124-1.947) 1.120 (1.011-1.991)
BMI ≥ 30 1.469 (1.033-1.897) 1.557 (1.021-2.823) 1.305 (0.988-1.756)
Present Insomnia 2.716 (1.840-4.009) 2.734 (1.324-5.645)
Present excessive daytime sleepiness 1.289 (0.892-1.889) 0.955 (0.475-1.921)
Do physical activity 0.922 (0.509-1.670)

ANOVA test and post hoc Bonferroni, adjusted for sex, consume tobacco;
Odds Ratio.

greater than 30 raw model (OR:1.469 (95%CI:1.033–1.897)) in students. It also observed poor sleep quality of university
and model 2 (OR:1.557 (95%CI:1.021–2.823)) presented students, translated into a high prevalence of insomnia in
associations with less hours of sleep, this did not occur in both sexes of university students and daytime sleepiness
model 3 where only a tendency was observed. (OR:1.305 in women. In addition, when comparing nutritional status,
(95%CI:0.988–1.756)). obese women are those that present greater daytime
sleepiness and the highest insomnia score was presented in
underweight students.

DISCUSSION Insomnia has numerous associated complications such as;

poor sleep quality, anxiety, depression16,17, and even affect
The main result is that there is an association between fewer memory and performance during the day, thus modifying
hours of sleep with a higher BMI and presence of insomnia student performance in university life18.
Rev Esp Nutr Hum Diet. 2019; 23(3): 153 - 161

Sleep disorders and anthropometric measures in Chilean university students 159

There are several factors that could influence these results, and irregular sleep hours. An interesting study in students
such as the large number of hours used in Internet use of the Psychology Degree detected a close relationship
during the day, a strong correlation between Internet use between insomnia and academic performance, concluding
and insomnia has been reported in the literature, affecting that even failing was higher in students with insomnia25.
mainly men19.
Interestingly, in the present study, underweight students
In addition, a high caffeine intake has been significantly have a higher prevalence of insomnia, possibly due to
correlated with mild to severe symptoms of depression and an overestimation in the results, probably due to the
insomnia, however in the present study no caffeine intake low number of students who presented underweight (33
analysis was performed20, because it was beyond the scope subjects). Studies generally show that obesity is associated
of the study. with insomnia24. Obese students ranked second in insomnia
scores.
Also, with the indiscriminate increase of the use of
technology, even late at night, mainly cellular devices, Although there are no significant differences, it is interesting
a study in university students revealed a use of 60% of to note that in daytime somnolence there was a trend in
these during night time, with a significant relationship U-curve, although it did not reach a significant difference,
with insomnia, and consequent lack of energy, fatigue and and the students of greater weight slept less than normal
headache21. weight students, but also did not reach a significant
difference.
Another important result of the present study corresponds
to the high prevalence of daytime sleepiness; in women, One study indicated that daytime somnolence is associated
36.7% were detected, while in men, 27.3% were observed, with a 3.5-fold increased likelihood of presenting common
both mild and moderate drowsiness, thus revealing a mental disorders (CMD), including anxiety, mood
significant difference according to sex. In addition, an disorders and eating disorders, behaviors related to the
association between female gender and BMI was found. aforementioned26.

In a study of medical students, it was found that In addition, an investigation of 2,538 students found that
approximately 40% of them presented excessive daytime 33.4% of them had MCT, and female students were more
sleepiness, in addition the authors describe that the sleep likely to develop MCT (39.2%) than males (24.4%)27.
quality of university students was deficient22.
A recent university study provided evidence that the presence
That women with obesity presented a higher score on of more severe insomnia symptoms was associated with
the daytime sleepiness scales is indicating that their higher levels of suicidal ideation28.
quantity and quality sleep is not adequate; obesity may be
accompanied by disorders ranging from snoring to apnea- Although this study did not evaluate the association between
hypopnea syndrome23. Sleep disorders have increased sleep and obesity, several studies in children and adults
over the last few years. University students, because they have established an association between less sleep and
are constantly confronted with a condition of maintained increased risk of obesity, such as that performed in students
stress, affect the quality of sleep in general, thus increasing of Nutrition and older Chilean subjects29,30. Sleep exerts a
anxiety which in turn is significantly associated with daytime wide range of physiological functions, a short duration of
sleepiness and insomnia17. sleep is associated with a higher total caloric intake, greater
fat intake, and lower protein intake, in addition there is
Interestingly, in the present study, low-weight students who limited evidence that associates short-term sleep with a
present a higher prevalence of insomnia, possibly due to an lower intake of Fruits and vegetables, and lower quality
overestimation as the group was very small (33 subjects), diets31.
studies generally show that obesity is associated with
insomnia24, the obese university students were in second Among the strengths of the present study, it was
place in insomnia score. emphasized that internationally validated surveys were
used and these data can be compared with other studies.
Insomnia is a frequent condition in adolescents and young Regarding limitations, mention should be made of those of
adults, especially in university students8. Frequently, the study design (cross-section), so that causality can not
insomnia is associated with the poor quality of sleep in be established and the data are not representative of all
college students, promoted by extensive days of night study, university students in the country.
Rev Esp Nutr Hum Diet. 2019; 23(3): 153 - 161

Sleep disorders and anthropometric measures in Chilean university students 160

RT, et al. Position statement on pediatric sleep for psychiatrists.

J Can Acad Child Adolesc Psychiatry. 2014; 23(3): 174-95.
CONCLUSIONS (3) National Sleep Foundation Recommends New Sleep Times.
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(7) Meerlo P, Mistlberger RE, Jacobs BL, Heller HC, McGinty D.
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ACKNOWLEDGEMENTS
Casillas-Vaillard GA, Galván-López A, García-Valdés P, et al.
Relación entre trastornos del sueño, rendimiento académico
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Milla P. Insomnio, latencia al sueño y cantidad de sueño en
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The study is self-financing.
clases y exámenes. Salud Uninorte. Barranquilla (Col.) 2017;
33 (2): 75-85
(13) The Epworth Sleepiness Scale (ESS). http://
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