The Association Between Sleep Quality and Anxiety in Postsecondary Students: A Systematic Review of the Literature

ABSTRACT

Introduction:Mental health conditions such as anxiety represent a growing health concern for students in institutions of higher education. Postsecondary students are a vulnerable population that is increasingly recognized to be at risk for both mental health problems and significant sleep problems. While it has been hypothesized that poor sleep quality may be a risk factor for developing anxiety, little is known about the frequency and severity of sleep problems and their association with anxiety within the postsecondary student population. The aim of this systematic review was to synthesize the best evidence on the association between sleep quality and anxiety in postsecondary students. Materials and Methods: An experienced librarian developed systematic search strategies in four databases MEDLINE, Embase, APA PsycInfo (through Ovid Technologies Inc.) and CINAHL, Cumulative Index to Nursing and Allied Health Literature (through EBSCOhost). Databases were searched from inception to September 2020. Random pairs of independent reviewers screened titles and s for eligibility and critically appraised all eligible studies. We assessed the quality of studies using the Scottish Intercollegiate Guidelines Network (SIGN) criteria for cohort studies, and the Hoy tool for cross-sectional studies. One author extracted and synthesized the results from all of the low and moderate risk of bias studies. We synthesized our results by study design and population. Results: Once duplicates were removed, a total of 3203 unique citations were screened. Fifty-one articles were eligible and critically appraised. Studies with low and moderate risk of bias were included in our final synthesis of which 24 were cross-sectional studies and four were cohort studies. With the exception of one study, all cross-sectional studies reported a statistically significant association between poor sleep quality and anxiety. All four of the cohort studies found that students who reported poor sleep quality were more likely to develop future anxiety and students with anxiety were more likely to develop future poor sleep quality. Conclusions: Poor sleep quality is associated with anxiety in postsecondary students. Due to the cross-sectional nature of most studies, we cannot determine the direction of this association. Future studies should focus on developing high-quality prospective cohort or longitudinal studies to help understand the impact and direction that this association has in postsecondary populations. This research has the potential to inform the development and design of mental health policies and programs that are created by postsecondary institutions to address the increasing rates of student mental health issues. Acknowledgements Canadian Institutes of Health Research (CIHR) Operating Grant Knowledge synthesis: COVID-19 in Mental Health & Substance Use;University of Ontario Institute of Technology;Institute of Disability and Rehabilitation Research.