Jurnal Pendukung - Investigation The Relation Between Sleep and Quality of Life For College Student in Taiwan
Jurnal Pendukung - Investigation The Relation Between Sleep and Quality of Life For College Student in Taiwan
Jurnal Pendukung - Investigation The Relation Between Sleep and Quality of Life For College Student in Taiwan
Article
Investigation the Relation between Sleep and Quality of Life
for College Students in Taiwan by Association Rule Mining
Ya-Chi Yang 1 , Jing-Wei Liu 2 , Chung-Pu Chi 3 , Shih-Pei Chang 4, * and Kang-Ming Chang 5,6,7, *
Abstract: Background and objectives: Quality of life and sleep quality of college students were
extensively studied. The present study evaluated sleep quality and quality of life of college students
in Taiwan by using the Pittsburgh Sleep Quality Index (PSQI) and Short-Form Health Survey (SF-36),
respectively. Materials and Methods: Data of 1756 college students aged 20–24 years were collected
in this study. Association rule analysis was also used to provide a graphics-based visualization of the
relationships between data, enabling the rapid identification of data correlations. Results: The results
showed that the average physical component scale (PCS) and average mental component scale (MCS)
Citation: Yang, Y.-C.; Liu, J.-W.; scores were 52.9 and 44.1, respectively. Based on their body mass index (BMI), participants were
Chi, C.-P.; Chang, S.-P.; Chang, K.-M. divided into underweight, normal, overweight, and obese groups. The results of one-way analysis of
Investigation the Relation between variance showed that the p values for the PSQI, PCS, and MCS scores were 3.5 × 10−5 , 1.7 × 10−5 ,
Sleep and Quality of Life for College
and 0.671, respectively. The normal and overweight groups had the lowest PSQI scores. The PCS score
Students in Taiwan by Association
of the obese group was lower than that of normal and overweight groups. The p values of the t-test
Rule Mining. Sustainability 2022, 14,
result among PSQI, BMI, PCS, and MCS groups were 0.002, <2 × 10−16 , and <2 × 10−16 , respectively.
13801. https://doi.org/10.3390/
The good sleep quality group had higher PCS and MCS scores. Conclusions: In this study, the results
su142113801
of association rule analysis indicated two distinct groups: Group 1, with the characteristics of good
Academic Editor: Graça S. Carvalho sleep quality as revealed by the high MCS and PCS scores, and Group 2, with the characteristics of
Received: 30 August 2022 poor sleep quality as revealed by low MCS and PCS scores and underweight BMI.
Accepted: 19 October 2022
Published: 24 October 2022 Keywords: association rule analysis; sleep; quality of life; college student
(i.e., the length of time required to fall asleep), sleep duration, habitual sleep efficiency,
sleep disturbances, use of sleeping medication, and daytime dysfunction. Each of these
items is scored 0–3; a higher score denotes poorer sleep quality. The total score ranges
from 0 to 21, and a total score of ≤5 indicates excellent sleep quality, whereas a total score
of >5 implies poor sleep quality [22]. It is commonly known worldwide that lifestyle can
influence personal health. The college stage is the pivotal period during which a youth
grows into an adult, and this stage shapes his or her health-related behaviors. Applying
assessment tools for college students’ lifestyles and health-related behaviors can help them
establish a healthy lifestyle and warn against unhealthy habits or factors. Consequently,
adequate health-promoting strategies and interventions can be introduced to help them
lead a healthy and positive life. Quality of life is an individual’s perception of well-being
in the cultural or value system he or she is in, and this perception is closely associated
with personal goals, expectations, standards, and values. Lifestyle is a key factor that
governs the life and health of modern people, and it is a key factor that influences the
improvement in quality of life. Thus, a positive improvement in lifestyle will increase
quality of life. Research has indicated that increased physical activities can lead to changes
in lifestyle; thus, exercise is the most straightforward and effective strategy for improving
quality of life [23]. Exercise is known to improve peoples’ satisfaction with the physical,
psychological, social, and environmental aspects of quality of life; although increasing
physical activities can only rectify health-endangering behaviors, it can still improve qual-
ity of life [24]. In terms of health, people with intensive physical activities usually have
higher quality of life than those who are inactive [25]. Regular physical activities have
been proven to exert numerous positive effects that can improve the physiological system,
physical fitness, cardiovascular function, immunity, endocrine system, cognitive function,
and general health [26]. The positive effects of regular exercise on physical and mental
health are positively correlated with life satisfaction. A healthier body and mind contribute
to greater life satisfaction and hence higher quality of life.
The Short-Form Health Survey (SF-36) is a self-rated scale consisting of eight multi-
item subscales plus one additional item for the perceived change in health [27,28]. The eight
subscales can also be divided into two summary measures: the physical component scale
(PCS), which combines physical function, role limitations due to physical health problems,
bodily pain, and general health perceptions subscales, and the mental component scale
(MCS), which combines vitality, social functioning, emotional well-being, and role limita-
tions due to emotional problems subscales. As per the scoring instructions, the scores of
these two scales are calculated as follows: the scores of the eight subscales are standardized;
thereafter, the standardized scores of each subscale is multiplied by a standardized coeffi-
cient derived from factor analysis depending on the scale (PCS or MCS); subsequently, the
scores of the same scale are summed up to provide the composite score. The score of each
subscale ranges from 0 to 100, with 0 denoting the poorest quality of health and 100 the
highest quality of health [29]. The SF-36 has been widely applied to evaluate quality of life,
including that of college students [30].
The recent development of big data analytics has benefited studies investigating sleep
quality and health. Schatz Bruce applied big data analytics techniques for mobile health mon-
itors and showed that complete baseline records can be acquired by using effective National
Surveys of Population Health [31]. Among the numerous big data analytics techniques,
link analysis is an information science approach [32] that uses graphics-based visualization
methods to present related data, enabling the rapid identification of correlations between the
data [33]. Association rule analysis can also be integrated with text analysis; such integration
has been proven to be effective for web document analysis [34]. In the present study, link
analysis was implemented along with conventional statistical analysis to identify significant
factors affecting college students’ sleep quality and quality of life.
Sustainability 2022, 14, 13801 4 of 11
support( X, Y )
li f t( X, Y ) = (4)
support( X ) × support(Y )
2.4. Statistical
Descriptive statistics were calculated for the means, standard deviations, quartiles,
and numbers of participants’ BMI, PSQI, PCS, and MCS data. One-way analysis of variance
(ANOVA) was applied to evaluate the PCS, MCS, and PSQI data of the four BMI groups,
followed by a t test for each group. Because PSQI scores were categorized into only two
types (“good sleep quality” and “poor sleep quality”), a t test was applied to examine the
differences in BMI, PCS, and MCS data between the PSQI groups. Additionally, a two-way
chi-square test was applied to determine differences in the BMI, PSQI, PCS, and MCS
data. To determine the R-squared value of the regression line, a regression analysis was
implemented to examine the paired PCS, MCS, and PSQI data.
Sustainability 2022, 14, 13801 5 of 11
3. Results
The distributions of participants’ BMI, PSQI, PCS, and MCS are shown in Figure 1a–d,
respectively. The bar charts in the figure show that the BMI, PSQI, PCS, and MCS data were
all evenly distributed. The quartiles of these data are listed in Table 2.
Figure 1. Distribution of (a) BMI, (b) PSQI, (c) PCS, and (d) MCS.
For PSQI, the mean score was 5. A score of 5 or higher indicated a diagnosis of sleep
disorder. The mean PCS and MCS scores were 52.9 and 44.1, respectively. Subsequently,
participants were divided into groups based on different parameters. For PSQI, participants
with a PSQI score of ≥5 were classified as “good sleep quality” (N = 925), whereas those
with a PSQI score of <5 were classified as “poor sleep quality” (N = 831). For PCS and
MCS, participants were divided into two groups. Those with a PCS score of <50 were
Sustainability 2022, 14, 13801 6 of 11
classified as “PCS < 50” (N = 449), and “PCS > 50” group were 1307 subjects. Similarly,
“MCS < 50” (N = 1208), and “MCS > 50” (N = 548) were also classified. Participants were
divided into four groups based on their BMI: underweight “BMI < 18.5” (N = 238), normal
“24 > BMI ≥ 18.5” (N = 1197), overweight “27 > BMI ≥ 24”(N = 165), and obese “BMI ≥ 27”
(N = 156). The number of participants in the groups are listed in Table 3. The BMI definition
of the four groups is according to the rule by Ministry of Health and Welfare in Taiwan [36].
Table 4 shows the results of one-way ANOVA for the PSQI, PCS, and MCS scores of
the four BMI groups. Significant differences in PSQI, PCS, and MCS scores were observed
among the four BMI groups. Moreover, the results of the paired t test showed that under-
weight and obese groups exhibited similar PSQI scores (b), with a mean PSQI score ≥ 6.
By contrast, the normal and overweight groups exhibited the similar low PSQI scores, with
a mean PSQI score of ≤5.7 (a). This finding suggests that both obesity and underweight
have negative effects on sleep. The PCS score of the obese and underweight groups was
significantly lower than normal and overweight groups. No statistical difference was
observed in the MCS score among the BMI groups. This finding suggests that BMI is
unrelated with the mental aspect of quality of life.
Table 4. One-way ANOVA results for BMI group. Superscript Letter a,b,c are label for the same
group based on t-test result. The same lettern means the same group. *** denote p value < 0.001.
Table 5 shows the results of t test for the BMI, PCS, and MCS scores of the PSQI
groups. The poor Sleep Quality group had lower PCS and MCS scores, whereas the
PSQI_better group had higher PCS and MCS scores. This finding suggests that PSQI is
highly correlated with PCS and MCS. However, the difference between PSQI and BMI was
found to be nonsignificant.
Table 5. Results of t test for PSQI groups. *** denote p value < 0.001.
Table 6 shows the results of the two-way chi-square test. A statistical difference
was observed between the PSQI groups and PCS and MCS (p < 10−16 ), corroborating the
preceding results. Moreover, statistically significant differences were observed among the
PSQI, PCS, MCS and BMI groups.
The results of link analysis clearly indicated the existence of two patterns (groups),
which are shown in Figure 2, and their parameters are listed in Table 7.
Table 7. Association rule analysis result of two groups. Table 7a–d are result for union, support,
confidence and lifting.
Table 7. Cont.
4. Discussion
In this study, two groups were identified through the association rule analysis of the
data. One group was the healthier group with the characteristics of good sleep quality,
PCS > 50, MCS > 50 and normal BMI level. The other group was the group with poor
quality of life and sleep quality, and PCS and MCS both less than 50. The average SF-36
score is 50. Thus, the healthier group had a higher-than-average PCS and MCS score, and
the less healthy group had a below average PCS and MCS score, accompanied with under-
weight BMI level. Furthermore, this study proposed an interesting approach: association
rule can be used for clustering statistical data. Each data batch contains numerous param-
eters; conventional statistical methods can only determine the existence of correlations
or significant differences among the parameters, but these methods cannot identify the
concurrent characteristics that the groups with parameters exhibiting significant difference
possess. Moreover, for a large number of parameters, conventional statistical methods are
time consuming for making one-by-one comparisons and still fail to provide a complete
result. The association rule can link data batches with the same characteristics, and for a
high number of links, a bold line will be shown as an indication. Moreover, association rule
can rapidly visualize significant clusters among the data batches. This new approach, along
Sustainability 2022, 14, 13801 9 of 11
with the visualization effect, is much faster than conventional statistical approaches for
sorting data. A high significance value also indicates a statistical difference. For example,
in Group 1, the “good sleep quality” group was linked with PCS > 50, MCS > 50 and
normal BMI group. In Group 2, the “poor sleep quality” group was linked with PCS < 50,
MCS < 50 and underweight BMI group. According to the statistical test results, a statistical
difference was observed between the sleep quality groups and the PCS groups and MCS
groups (p < 2.2 × 10−16 ). Therefore, the visualized results of link analysis can provide not
only enables the rapid clustering of data, but also identifies parameters with high statistical
differences through the visualization of direct links. Another benefit of this approach is
the fast computation time, which enables the rapid processing of massive amounts of data.
However, for its effectiveness, highly significant clustering should be present in the data.
Considering that association rule analysis has never been applied in this type of study, its
successful application here can be considered a major contribution of this study.
Other commonly used data clustering methods, such as K-means clustering, require
advance knowledge on the number of clusters or the distribution of data. However, these
methods are ineffective when little difference is present in the data. Moreover, they are
ineffective when little difference is present between data dimensions. For example, when
the MCS and PCS data, which are of similar dimensions, were converted into an x-y two-
dimensional distribution diagram (Figure 3), the two groups could not be distinguished
from the diagram. Moreover, because the R-square of linear regression line was 0.0035,
MCS and PCS were obviously not positively correlated. Thus, previously applied data
analysis methods are unable to show any clearly distinguishable clustering patterns for
the data, which is their limitation. Association rule analysis, however, can identify the
distinction from the links of sample characteristics and can rapidly visualize the links,
which is convenient.
There are several limitations to this article. In the data part, the data were only
collected from single college school, and the amount of data is not very large. The more
schools that can be collected, the better the correlation between the two questionnaires
can be presented. In the method part, association rule analysis may be superior to the
traditional clustering method, judging by the results of this study. This conclusion is only
applied on the correlation between PSQI and Quality of life surveys. If it is applied to
other questionnaires, it may not have similar results. More research is needed to verify.
Sustainability 2022, 14, 13801 10 of 11
In addition, the number of subjects needed to present for association rule analysis to cluster
separate data which have no statistical difference is still unknown. This study can be
treated as it a pilot study, indicating that association rule analysis may be applicable to the
grouping of survey data.
The future direction of this study can be extended from several aspects. The first is to
study the relation between two surveys from before and after a specific health promotion
program. The association rule analysis results may reflect the improvement of sleep quality
and quality of life for college students. The second is to increase the number of data in the
set, including total subject numbers and college numbers to verify whether the findings of
this study are present in other general college student populations. The third is to apply
association rule analysis on other surveys, and to investigate the correlation between the
degree of difference of the data and clustering performance by association rule analysis.
5. Conclusions
Although numerous studies have been conducted on quality of life and sleep quality
of college students, the application of association rule analysis for the clustering and
distribution of a massive sample data is innovative. In this study, this approach enabled
the rapid grouping of participants into the healthier and less healthy groups, and then used
graphics-based visualization to present the links between their quality of life and sleep
quality scores. This is a rapid and effective approach for presenting data and preliminary
analytic results.
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