Disturbi del sonno negli studenti di Infermieristica italiani: uno studio pilota.
10.54103/dn/20574
 




BACKGROUND: The nursing profession is particularly susceptible to sleep disturbances due to altered circadian rhythms, frequent changes in shift patterns, and overtime work, resulting in fewer hours devoted to sleep and an increased risk of errors in care. Sleep disorders, however, seem to start as early as during undergraduate training: in fact, it has been found that the high teaching load and the sudden alternation between theory, exams, and internship can be a source of stress and anxiety, leading to these kinds of disorders even during basic training. This study, therefore, set out to investigate the incidence of sleep disorders and examine the factors associated with them among nursing students in Italy.
METHODS: A cross-sectional web-based study was conducted from January to August 2022, administering the Italian version of the Pittsburgh Sleep Quality Index (PSQI) was administered. The normality of the distribution was assessed using the Kolmogorov-Smirnov test. A binary logistic regression analysis was performed.
RESULTS: The survey was completed by 4898 students. The Kolmogorov-Smirnov test stated that the scores followed a normal distribution. The logistic regression found that being female, suffering from a disease, being a working student, regularly consuming tea or alcohol, and perceiving that sleep disorders impact academic performance are factors influencing the occurrence of sleep disorders.CONCLUSIONS: Our results suggest nurse educators to implement strategies to facilitate the path of nursing students and reduce the risk of errors in nursing. Official studies of individual universities should confirm this pilot study's results.




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Disturbi del sonno negli studenti di Infermieristica italiani: uno studio pilota.
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Terry D, Peck B. Academic and clinical performance among nursing students: What’s grit go to do with it? Nurse Education Today. 2020 May;88:104371.
Sleep disorders in Italian nursing students: a pilot study.
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          ISSN: 2785-7263                                                                                             DOI: 10.54103/dn/20574




  Sleep disorders in Italian nursing students: a pilot study
                       1
Celeste Granziero          , Giorgio Bergesio2, Bartolomeo Rinaldi 2, Ilaria Marcomini3
1 RN, Chieri Hospital, ASL TO 5, Turin, Italy.
2 MSN,  RN, Adjunct Professor, University of Turin, Asti, Italy.
3 Ph.D, MSN, RN, Nurse Tutor, Bachelor School of Nursing, ASST Crema, Crema, Italy




Findings:                                             ABSTRACT
Approximately half of the nursing students
surveyed would appear to suffer from sleep            BACKGROUND: The nursing profession is particularly susceptible to sleep
disturbances, possibly affecting their care           disturbances due to altered circadian rhythms, frequent changes in shift patterns,
during their internship.                              and overtime work, resulting in fewer hours devoted to sleep and an increased risk
                                                      of errors in care. Sleep disorders, however, seem to start as early as during
                                                      undergraduate training: in fact, it has been found that the high teaching load and the
                                                      sudden alternation between theory, exams, and internship can be a source of stress
                                                      and anxiety, leading to these kinds of disorders even during basic training. This
                                                      study, therefore, set out to investigate the incidence of sleep disorders and examine
                                                      the factors associated with them among nursing students in Italy.


                                                      METHODS: A cross-sectional web-based study was conducted from January to
                                                      August 2022, administering the Italian version of the Pittsburgh Sleep Quality Index
                                                      (PSQI) was administered. The normality of the distribution was assessed using the
                                                      Kolmogorov-Smirnov test. A binary logistic regression analysis was performed.


                                                      RESULTS: The survey was completed by 4898 students. The Kolmogorov-
                                                      Smirnov test stated that the scores followed a normal distribution. The logistic
                                                      regression found that being female, suffering from a disease, being a working
                                                      student, regularly consuming tea or alcohol, and perceiving that sleep disorders
                                                      impact academic performance are factors influencing the occurrence of sleep
                                                      disorders.


                                                      CONCLUSIONS: Our results suggest nurse educators to implement strategies to
                                                      facilitate the path of nursing students and reduce the risk of errors in nursing.
                                                      Official studies of individual universities should confirm this pilot study's results.



                              KEYWORDS: Sleep Disorders, Students, Nursing, Nurses, Academic Performance



         Corresponding author:                                            8                                  Submission received: 11/07/2023
         Celeste Granziero: celeste.granziero@hotmail.it                                              End of Peer Review process: 25/07/2023
         via Giovanni de Maria 1,                                                                                      Accepted: 28/07/2023
         10023, Chieri, Torino
                                                                                   This work is licensed under a Creative Commons
                                                                                   Attribution-NonCommercial-NoDerivatives 4.0 nternational
          ISSN: 2785-7263                                                                                              DOI: 10.54103/dn/20574




         Disturbi del sonno negli studenti di Infermieristica
                      italiani: uno studio pilota
                       1
Celeste Granziero          , Giorgio Bergesio2, Bartolomeo Rinaldi 2, Ilaria Marcomini3
1 RN, Ospedale di Chieri, ASL TO 5, Torino
2 MSN,  RN, Professore a Contratto, Università di Torino, Asti
3 Ph.D, MSN, RN, Infermiere Tutor, Corso di Laurea in Infermieristica, ASST Crema, Crema




Riscontri:                                            ABSTRACT
Circa metà degli studenti di infermieristica
                                                      INTRODUZIONE: La professione infermieristica è particolarmente esposta a
presi in esame potrebbe soffrire di disturbi del
sonno,       con    possibili      ripercussioni      disturbi del sonno a causa dell’alterazione dei ritmi circadiani, delle frequenti
sull'assistenza durante il tirocinio.                 variazioni della turnistica e del lavoro straordinario, con riduzione del numero di ore
                                                      dedicate a dormire ed aumentato rischio di errori nell’assistenza. I disturbi del sonno,
                                                      tuttavia, sembrano iniziare già durante la formazione universitaria: l’elevato carico
                                                      didattico e l’alternanza fra teoria, esami e tirocinio possono infatti essere fonte di
                                                      stress e di ansia, portando a questo genere di disturbi. Questo studio si è quindi
                                                      proposto di indagare l’incidenza dei disturbi del sonno ed i fattori ad essi associati fra
                                                      gli studenti di infermieristica in Italia

                                                      METODI: E’ stato condotto uno studio trasversale sul web da gennaio ad agosto
                                                      2022, somministrando la versione italiana del Pittsburgh Sleep Quality Index (PSQI).
                                                      La normalità della distribuzione è stata valutata attraverso il test di Kolmogorov-
                                                      Smirnov. È stata eseguita un'analisi di regressione logistica binaria.

                                                      RISULTATI: La survey è stata completata da 4898 studenti. Il test di Kolmogorov-
                                                      Smirnov ha confermato la normalità della distribuzione. Le analisi hanno rilevato che
                                                      essere di sesso femminile, soffrire di una malattia, essere uno studente lavoratore,
                                                      consumare regolarmente tè o alcol e percepire che i disturbi del sonno hanno un
                                                      impatto sul rendimento accademico, sono fattori che influenzano l'insorgenza dei
                                                      disturbi del sonno.

                                                      CONCLUSIONI: I risultati di questo studio suggeriscono l’attuazione di strategie
                                                      volte ad agevolare il percorso degli studenti di infermieristica e ridurre il rischio di
                                                      errori nell’assistenza. I risultati di questo studio pilota dovrebbero essere confermati
                                                      da studi ufficiali delle singole università



                      KEYWORDS: Distirubi del Sonno, Studenti, Infermieristica, Infermieri, Rendimento Accademico



         Corresponding author:                                             9                                  Submission received: 11/07/2023
         Celeste Granziero: celeste.granziero@hotmail.it                                               End of Peer Review process: 25/07/2023
         via Giovanni de Maria 1,                                                                                       Accepted: 28/07/2023
         10023, Chieri, Torino
                                                                                    This work is licensed under a Creative Commons
                                                                                    Attribution-NonCommercial-NoDerivatives 4.0 nternational
        ISSN: 2785-7263                                                                                      DOI: 10.54103/dn/20574




BACKGROUND                                                            compromising the safety of nurses and that of patients,
It is well known that sleep impairment is capable of                  exposing both to the risk of errors (13,14).
causing physical and psychological alterations. The
literature shows how sleep ineffectiveness has significant            Undergraduate students are also a category at risk for sleep
organic repercussions and can be correlated with                      disorders. Nursing students stand out among them: in
endocrine, metabolic, and neurological dysfunctions; it is            addition to being exposed to the same risk factors as
also a direct cause of a meaningful reduction in quality of           nurses during the clinical internship, it has been found that
life (QoL) (1). In 2014, the American Academy of Sleep                the high teaching load and the sudden alternation between
Medicine (AASM), in collaboration with other                          theory, exams, and internship can be a source of stress and
international societies, compiled the third edition of the            anxiety, altering sleep habits and significantly reducing
International Classification of Sleep Disorders (ICSD), a             sleep quality (15-20). Such issues would appear to harm
now landmark document concerning these issues, which                  students' academic performance (11,16,21-24). In order to
allows the clinical and diagnostic classification of the main         better control the risk, as well as to more correctly and
SDs, dividing them into seven main categories to which                effectively educate nursing personnel, it is therefore of
insomnia,       sleep-related      breathing        problems,         strategic importance to investigate the incidence of sleep
hypersomnolence, circadian rhythm alterations, sleep-                 disorders and the variables that influence the presence of
related movement disorders, parasomnias, and other SDs                such disorders in students in Italian Bachelor School of
belong (2). Through this categorization, it has recently              Nursing programs.
been estimated that approximately 70 million people in the
                                                                      Aims
United States and 45 million in Europe are affected by
chronic sleep disorders (SD) (3,4), an alarming figure when           The primary objective of the study was to investigate sleep
considering the impact this can have on population health             disorders affecting nursing students in Italy. The secondary
and, therefore, on the increase in related spending.                  objective was to examine the factors associated with sleep
                                                                      disorders.
Among the categories of workers at risk of developing
sleep disorders, we find the nursing profession; in
particular, it would seem that the alteration of circadian
rhythms, the frequent variations to the periodicity of shift          METHODS
schedules, and the frequent need to stay at work beyond
                                                                      Study design
regular duty hours (resulting in a reduction in the number
of hours devoted to sleep), may result in insufficient sleep          A cross-sectional web-based study was conducted from
quality and generate an increased release of adrenaline               January to August, 2022. Nursing students were recruited
(5,6), imbalances in emotional regulation and mental well-            through social networks or through student
being. It is also documented how this condition leads                 representatives who volunteered to distribute the survey
nurses to abuse caffeine and benzodiazepines occasionally             among nursing degree courses. The Pittsburgh Sleep
(7,8). In this situation, nurses are often forced to use their        Quality Index (PSQI) was administered. In order to
days off to make up for lost sleep hours (9,10), and the              accomplish the secondary objective of this study, the
end result is a tendency to increase sleep disturbances with          researchers recorded the socio-demographic characteristics
alterations in its architecture and a decrease in the quality         of the sample, including age, gender, course year attended,
and quantity of sleep hours and quality of life (10,11). To           and the localization of the degree program. Additionally,
understand the actual seriousness of the situation,                   the questionnaire explored the following additional
however, it is necessary to take into account how                     variables: suffering from a disease, being a working
insufficient quantity and quality of sleep can lead to a              student, engaging in night work, substance use (such as
decrease in reasoning abilities (12) as well as in levels of          drugs, coffee, tea, alcohol, or soft drink), physical activity,
attention, concentration, and vigilance potentially                   using video terminals before sleep, having a

       Corresponding author:                                     10                                 Submission received: 11/07/2023
       Celeste Granziero: celeste.granziero@hotmail.it                                       End of Peer Review process: 25/07/2023
       via Giovanni de Maria 1,                                                                               Accepted: 28/07/2023
       10023, Chieri, Torino
                                                                          This work is licensed under a Creative Commons
                                                                          Attribution-NonCommercial-NoDerivatives 4.0 nternational
         ISSN: 2785-7263                                                                                     DOI: 10.54103/dn/20574




family/children, sleeping alone or with someone, and                  – Asti Campus approved the survey. The eligible
students' perception of the impact of sleep disorders on              participants were provided with information about the
academic performance.                                                 study objectives, and measures were taken to ensure the
                                                                      confidentiality of the collected data. The students who
Instrument                                                            willingly participated in the survey provided their informed
                                                                      consent.
The PSQI is a self-report questionnaire designed to
evaluate sleep quality over a one-month period. Developed
by researchers at the University of Pittsburgh, the PSQI
serves as a standardized sleep assessment tool for                    RESULTS
clinicians and researchers. It has been widely utilized in
various settings, including research and clinical practice,           Sample characteristics
aiding in the diagnosis of sleep disorders. It comprises 19
                                                                      The survey was completed by 4898 students. Table 1
individual items that assess seven components, resulting in
                                                                      provides a summary of the characteristics of the
a single global score. The questionnaire evaluates seven
                                                                      respondents. The average age of the sample was 22.92 ±
clinically determined domains of sleep difficulties, which
                                                                      4.63. The majority of respondents were female (84.2%)
include sleep quality, sleep latency, sleep duration, habitual
                                                                      and in their third year of the nursing program (37.8%).
sleep efficiency, sleep disturbances, use of sleeping
                                                                      The majority of the sample reported being enrolled in the
medications, and daytime dysfunction. A global score
                                                                      Nursing Degree Course in Northern Italy (59.4%), not
exceeding 5 indicates significant sleep disturbances in at
                                                                      suffering from a disease (87.3%), and not being a working
least two domains or moderate difficulties in more than
                                                                      student (75.5%). Predominantly, the sample did not have a
three domains. Completing the questionnaire typically
                                                                      regular use of drugs (96.9%) or tea (52.8%), but regularly
takes around 5-10 minutes.
                                                                      consumed coffee (78.2%). Most of the sample stated not
Statistical analysis                                                  consuming soft drinks (36.4%), consuming alcohol 1/2
                                                                      times a week (60.3%), and not engaging in physical activity
The mean and standard deviation (SD) were utilized to                 (43.2%). A significant portion of the students used video
describe the continuous variables and the distribution of             terminals before going to sleep (96.0%), did not have a
responses on the Likert scale. For categorical variables and          family/children (84.1%), and slept alone (81.7%). The
professional activities related to distress, frequencies and          majority of the students (51.3%) claimed that their sleep
percentages were analyzed. The normality of the                       disorders had an impact on their academic performance
distribution was assessed using the Kolmogorov-Smirnov                (51.3%)
test, which indicated that the scores followed a normal
distribution. Therefore, to examine the factors associated
with sleep disorders, a binary logistic regression analysis
                                                                                            VARIABLES                      MEAN SD
was performed, with the PSQI score as the dependent
                                                                               Age                                         22.92     4.63
variable (> 5=yes, < or equal to 5=no). The significance
                                                                                                                           N.        %
level was set at p = 0.05. All statistical analyses were
performed using SPSS Version 22 (IBM, Armonk, NY,                              Course year
USA).                                                                          first year                                  1676      34
                                                                               second year                                 1364      27.8
Ethics                                                                         third year                                  1858      37.8
                                                                               Gender
The survey was carried out in compliance with Italian data
                                                                               male                                        776       15.8
protection laws and the principles outlined in the
                                                                               female                                      4122      84.2
Declaration of Helsinki. The Institutional Review Board of
the Bachelor School of Nursing of the University of Turin

       Corresponding author:                                     11                                 Submission received: 11/07/2023
       Celeste Granziero: celeste.granziero@hotmail.it                                       End of Peer Review process: 25/07/2023
       via Giovanni de Maria 1,                                                                               Accepted: 28/07/2023
       10023, Chieri, Torino
                                                                          This work is licensed under a Creative Commons
                                                                          Attribution-NonCommercial-NoDerivatives 4.0 nternational
 ISSN: 2785-7263                                                                                     DOI: 10.54103/dn/20574




  Localization     of     the   degree                                 Having a family/children
  program
                                                                       yes                                         779        15.9
  north                                   2908    59.4
                                                                       no                                          4119       84.1
  central                                 1343    27.4
                                                                       Sleeping alone or with someone
  south                                   440     9.0
                                                                       alone                                       4004       81.7
  island                                  175     3.6
                                                                       with someone                                894        18.3
  undeclared                              32      0.6
                                                                       Students' perception of the
  Suffering from a desease                                             impact of sleep disorders on
  yes                                     622     12.7                 academic performance

  no                                      4276    87.3                 yes                                         2514       51.3

  Being a working student                                              no                                          2384       48.7
  yes                                     1198    24.5
  no                                      3700    75.5                         Table1: Characteristics of the sample
  Engaging in night work
  yes                                     2516    51.4
  no                                      2382    48.6        Sleep disorders and its associated factors
  Substance use: drugs
  yes                                     154     3.1
                                                              A number of 2052 students (41.89%) obtained a score
                                                              higher than 5 on the PSQI scale, indicating the presence of
  no                                      4744    96.9
                                                              sleep disorders.
  Substance use: coffee
                                                              Regarding the binary logistic regression analysis, the
  yes                                     3829    78.2
                                                              backward technique was employed to select the optimal
  no                                      1069    21.8
                                                              model. The Omnibus test of the model's coefficients
  Substance use: tea
                                                              indicated statistical significance, confirming the suitability
  yes                                     2312    47.2
                                                              of the model. Nagelkerke’s R2 showed that the model
  no                                      2586    52.8        explained the 23% of the variance. As shown in Table 2,
  Frequency of consumption of                                 being female, suffering from a disease, being a working
  soft drinks
                                                              student, regularly consuming tea or alcohol, and perceiving
  never                                   1781    36.4
                                                              that sleep disorders have an impact on academic
  ½ times a week                          1603    32.7
                                                              performance are factors influencing the occurrence of
  often                                   1514    30.9
                                                              sleep disorders.
  Frequency          of         alcohol
  consumption                                                                                        Std.
                                                                                              B                Wald df OR            p
                                                                                                     Error
  never                                   1685    34.4
                                                                   Gender: male             -0.48    0.092     26.47      1 0.62 0.000
  ½ times a week                          2954    60.3
                                                                 Suffering from a
  often                                   259     5.3                                       0.43     0.095     20.64      1 1.54 0.000
                                                                   disease: yes
  Frequency of physical activity                                 Being a working
                                                                                            0.218 0.074         8.70      1 1.24 0.003
  never                                   2116    43.2             student: yes

  ½ times a week                          1920    39.2         Consume of tea: yes          0.160 0.064         6.17      1 1.17 0.013
                                                               Consume of alcohol:
  often                                   862     17.6                                      0.14     0.058      5.48      1 1.15 0.019
                                                                     often
  Using video terminals before
  sleeping                                                      Influence of sleep
                                                              disorders on academic         1.75     0.065 712.49 1 5.77 0.000
  yes                                     4703    96.0           performance: yes
  no                                      195     4.0
                                                                         Table 2: Factors connected with sleep disorders

Corresponding author:                                    12                                 Submission received: 11/07/2023
Celeste Granziero: celeste.granziero@hotmail.it                                      End of Peer Review process: 25/07/2023
via Giovanni de Maria 1,                                                                              Accepted: 28/07/2023
10023, Chieri, Torino
                                                                  This work is licensed under a Creative Commons
                                                                  Attribution-NonCommercial-NoDerivatives 4.0 nternational
        ISSN: 2785-7263                                                                                         DOI: 10.54103/dn/20574




DISCUSSIONS                                                              be confirmed with validated instruments suitable for the
                                                                         purpose (such as the Grit-S questionnaire, already used
This study aimed to investigate the incidence of sleep                   among nursing students by Perry & Black(31)).
disorders and the variables influencing the presence of
such disorders in students in Italian Bachelor of Science in             In future studies, it would be interesting to investigate how
Nursing programs. In this pilot study from the sample of                 students deal with this issue after becoming aware of it; if
c.ca 5000 students, it was found that almost one out of                  the occasional abuse of benzodiazepines by nursing staff is
every two students (41.89%) suffered from sleep disorders;               reported in the literature, this study, on the other hand,
this result is in line with the literature where it's stated that        found that 3.1% of the report using drugs and that 5.5%
health professional students seem to be more affected and                frequently use alcohol.
predisposed to the development of SD (15-20). This
finding is significant if we take into account that reduced              In a historical time when the nursing shortage is a severe
sleep hours produce three major safety problems: reduced                 global problem, however, it would be counterproductive
vigilance with a consequent risk of errors in patient care,              for Italian universities to miss the dual opportunity that
increased risk of occupational and commuting injuries                    may arise from this pilot study. On the one hand, the
(including motor vehicle accidents on the way home from                  phenomenon needs to be investigated more broadly and
work), and compromised health of the nurse with                          through official sources in order to define the dependent
increased work absences and health care costs (25).                      variables more punctually and, on the other hand, there is
                                                                         an opportunity to act on some of the factors that affect
The findings support other authors' results stating that                 academic performance, student safety, and patient safety.
sleep disorders increase significantly in the presence of                One possible intervention could be the establishment of
comorbidities (24,26). It should also be considered,                     facilitated educational pathways for student workers, for
however, how some diseases (such as depression, for                      example. It seems clear that if nursing students are already
example) already involve sleep disruption and thus how                   engaged in poor behaviors concerning the management of
the figure, at this juncture, might be overestimated.                    sleep and rest rhythms in the undergraduate setting, they
                                                                         are unlikely to change their habits once they graduate.
In line with the literature, the female sex seems to be more
predisposed to the issue under study with repercussions on
school performance (16); a greater vulnerability to                      Limits
depression, physical and psychological stress, and anxiety
disorders, as well as the complex activity of sex hormones               While this study reports interesting results, it certainly has
(27), could explain this predisposition.                                 its limitations. First, the logistic regression model explains
                                                                         only 23% of the variance; this implies that several
In the survey, sleep quality seems worse in students with                covariates still need to be taken into account and properly
concurrent work activities and is often attributable to                  investigated, suggesting some caution in interpreting the
difficulties reconciling duty hours with learning. This                  reported results. Second, having also disseminated an
hypothesis is also confirmed by other authors' findings                  online survey by unofficial channels (social media and the
relating sleep quality to being a working student (18,28,29).            web in general), the authors need to confirm that the
                                                                         responses were all derived from nursing students or that
In line with the results of previous studies, our results                4898 separate subjects responded. This fact, which needs
confirm that the frequent use of psychotropic substances                 to be taken into necessary consideration, is what most
such as alcohol or tea have an effect on the onset of sleep              connotes the study presented as a "pilot study," having
disorders (30).                                                          drawn its data also from unofficial sources.
Finally, it is interesting to note how students who have
sleep problems perceive the negative influence these have
on their academic performance; such an awareness should

       Corresponding author:                                        13                                 Submission received: 11/07/2023
       Celeste Granziero: celeste.granziero@hotmail.it                                          End of Peer Review process: 25/07/2023
       via Giovanni de Maria 1,                                                                                  Accepted: 28/07/2023
       10023, Chieri, Torino
                                                                             This work is licensed under a Creative Commons
                                                                             Attribution-NonCommercial-NoDerivatives 4.0 nternational
        ISSN: 2785-7263                                                                                      DOI: 10.54103/dn/20574




CONCLUSIONS                                                           Association between Life Satisfaction and the Extent of
                                                                      Depression, Anxiety and Stress among Iranian Nurses: A
This study's results help identify a significant risk for             Multicenter Survey. Iran J Psychiatry. 2016 Apr;11(2):120–
nursing students: nearly one in two students suffer from              7.
sleep disorders, leading to increased physical and
psychological risks, worsened quality of life, and increased          8.      Hsieh ML, Li YM, Chang ET, Lai HL, Wang WH,
risk of errors in patient care. In addition to questioning the        Wang SC. Sleep disorder in Taiwanese nurses: A random
structure of the educational pathway as it currently stands,          sample survey: Sleep survey and nurses. Nursing & Health
universities are now called upon to take up a twofold                 Sciences. 2011 Dec;13(4):468–74.
challenge: to conduct studies that systematically investigate
                                                                      9.      Silva RM da, Costa ALS, Mussi FC, Lopes VC,
the prevalence of the phenomenon highlighted by this
                                                                      Batista K de M, Santos OP dos. Health alterations in
pilot study and to identify pathways to reduce as much as
                                                                      nursing students after a year from admission to the
possible the factors that contribute to its development.
                                                                      undergraduate course. Rev esc enferm USP.
                                                                      2019;53:e03450.

                                                                      10.    Membrive-Jiménez MJ, Gómez-Urquiza JL,
REFERENCES
                                                                      Suleiman-Martos N, Velando-Soriano A, Ariza T, De la
1.     K. Pavlova M, Latreille V. Sleep Disorders. The                Fuente-Solana EI, et al. Relation between Burnout and
American Journal of Medicine. 2019 Mar;132(3):292–9.                  Sleep Problems in Nurses: A Systematic Review with
                                                                      Meta-Analysis. Healthcare. 2022 May 21;10(5):954.
2.     Sateia MJ. International Classification of Sleep
Disorders-Third Edition. Chest. 2014 Nov;146(5):1387–                 11.     Geiger-Brown J, Rogers VE, Trinkoff AM, Kane
94.                                                                   RL, Bausell RB, Scharf SM. Sleep, Sleepiness, Fatigue, and
                                                                      Performance of 12-Hour-Shift Nurses. Chronobiology
3.      Olesen J, Gustavsson A, Svensson M, Wittchen                  International. 2012 Mar;29(2):211–9.
HU, Jönsson B, on behalf of the CDBE2010 study group,
et al. The economic cost of brain disorders in Europe:                12.     Kemper KJ, Mo X, Khayat R. Are Mindfulness
Economic cost of brain disorders in Europe. European                  and Self-Compassion Associated with Sleep and Resilience
Journal of Neurology. 2012 Jan;19(1):155–62.                          in Health Professionals? The Journal of Alternative and
                                                                      Complementary Medicine. 2015 Aug;21(8):496–503.
4.      Sleep Disorders and Sleep Deprivation: An Unmet
Public Health Problem [Internet]. Washington, D.C.:                   13.      d’Ettorre G, Pellicani V, Caroli A, Greco M. Shift
National Academies Press; 2006 [cited 2023 Jul 7].                    work sleep disorder and job stress in shift nurses:
Available from: http://www.nap.edu/catalog/11617                      implications for preventive interventions. La Medicina del
                                                                      Lavoro | Work, Environment and Health. 2020 Jun
5.      Di Muzio M, Diella G, Di Simone E, Pazzaglia M,               26;111(3):195–202.
Alfonsi V, Novelli L, et al. Comparison of Sleep and
Attention Metrics Among Nurses Working Shifts on a                    14.    Eanes L. CE: The Potential Effects of Sleep Loss
Forward- vs Backward-Rotating Schedule. JAMA Netw                     on a Nurse’s Health. AJN, American Journal of Nursing.
Open. 2021 Oct 18;4(10):e2129906.                                     2015 Apr;115(4):34–40.

6.       Huang CLC, Wu MP, Ho CH, Wang JJ. Risks of                   15.     Gallego-Gómez JI, González-Moro MTR,
treated anxiety, depression, and insomnia among nurses: A             González-Moro JMR, Vera-Catalán T, Balanza S,
nationwide longitudinal cohort study. Alameddine M,                   Simonelli-Muñoz AJ, et al. Relationship between sleep
editor. PLoS ONE. 2018 Sep 25;13(9):e0204224.                         habits and academic performance in university Nursing
                                                                      students. BMC Nurs. 2021 Dec;20(1):100.
7.     Yazdanshenas Ghazwin M, Kavian M, Ahmadloo
M, Jarchi A, Golchin Javadi S, Latifi S, et al. The

       Corresponding author:                                     14                                 Submission received: 11/07/2023
       Celeste Granziero: celeste.granziero@hotmail.it                                       End of Peer Review process: 25/07/2023
       via Giovanni de Maria 1,                                                                               Accepted: 28/07/2023
       10023, Chieri, Torino
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       ISSN: 2785-7263                                                                                    DOI: 10.54103/dn/20574




16.      Marta OFD, Kuo SY, Bloomfield J, Lee HC,                  25.      Asta ML, Lo Presti S, Pasetti P, Bonazza V. Il
Ruhyanudin F, Poynor MY, et al. Gender differences in the          legame tra la privazione del sonno e gli errori commessi
relationships between sleep disturbances and academic              dagli infermieri durante il turno di notte. PROFINF. 2022
performance among nursing students: A cross-sectional              Oct 23;75(2):101–5.
study. Nurse Education Today. 2020 Feb;85:104270.
                                                                   26.      Tang Z, Li X, Zhang Y, Li X, Zhang X, Hu M, et
17.     Belingheri M, Pellegrini A, Facchetti R, De Vito G,        al. Psychometric analysis of a Chinese version of the Sleep
Cesana G, Riva MA. Self-reported prevalence of sleep               Hygiene Index in nursing students in China: a cross-
disorders among medical and nursing students.                      sectional study. Sleep Medicine. 2021 May;81:253–60.
Occupational Medicine. 2020 Apr 20;70(2):127–30.
                                                                   27.     Li SH, Graham BM. Why are women so
18.     Salvi CPP, Mendes SS, Martino MMFD. Profile of             vulnerable to anxiety, trauma-related and stress-related
nursing students: quality of life, sleep and eating habits.        disorders? The potential role of sex hormones. The
Rev Bras Enferm. 2020;73(suppl 1):e20190365.                       Lancet Psychiatry. 2017 Jan;4(1):73–82.

19.     Demi̇R G. Daytime sleepiness and related factors           28.      Amaral KV, Galdino MJQ, Martins JT. Sleep
in nursing students. Nurse Education Today. 2017                   quality and work among nursing vocational students. Rev
Dec;59:21–5.                                                       Bras Enferm. 2021;74(6):e20201285.

20.     Najafi Kalyani M, Jamshidi N, Salami J, Pourjam            29.     Ferreira LRC, Martino MMFD. Padrão de sono e
E. Investigation of the Relationship between Psychological         sonolência do trabalhador estudante de enfermagem. Rev
Variables and Sleep Quality in Students of Medical                 esc enferm USP. 2012 Oct;46(5):1178–83.
Sciences. Depression Research and Treatment.
                                                                   30.      Koob GF, Colrain IM. Alcohol use disorder and
2017;2017:1–6.
                                                                   sleep disturbances: a feed-forward allostatic framework.
21.      Gianfredi V, Nucci D, Tonzani A, Amodeo R,                Neuropsychopharmacol. 2020 Jan;45(1):141–65.
Benvenuti AL, Villarini M, et al. Sleep disorder,                  31.     Terry D, Peck B. Academic and clinical
Mediterranean Diet and learning performance among                  performance among nursing students: What’s grit go to do
nursing students: inSOMNIA, a cross-sectional study. Ann           with it? Nurse Education Today. 2020 May;88:104371.
Ig. 2018;30(6):470–81.

22.     Fernández-Medina IM, Ruíz-Fernández MD,
Hernández-Padilla JM, Granero-Molina J, Fernández-Sola
C, Jiménez-Lasserrotte M del M, et al. Adherence to the
Mediterranean Diet and Self-efficacy as Mediators in the
Mediation of Sleep Quality and Grades in Nursing
Students. Nutrients. 2020 Oct 25;12(11):3265.

23.     Angelone AM, Mattei A, Sbarbati M, Di Orio F.
Prevalence and correlates for self-reported sleep problems
among nursing students. J Prev Med Hyg. 2011
Dec;52(4):201–8.

24.      Kayaba M, Matsushita T, Katayama N, Inoue Y,
Sasai-Sakuma T. Sleep–wake rhythm and its association
with lifestyle, health-related quality of life and academic
performance among Japanese nursing students: a cross-
sectional study. BMC Nurs. 2021 Dec;20(1):225.

      Corresponding author:                                   15                                 Submission received: 11/07/2023
      Celeste Granziero: celeste.granziero@hotmail.it                                     End of Peer Review process: 25/07/2023
      via Giovanni de Maria 1,                                                                             Accepted: 28/07/2023
      10023, Chieri, Torino
                                                                       This work is licensed under a Creative Commons
                                                                       Attribution-NonCommercial-NoDerivatives 4.0 nternational
