Determinants of Poor Sleep Quality Among Health Profession Students in Iraq: The Role of Physical Activity, Perceived Stress, and Smartphone Use

Abstract

Background: Poor sleep quality is a prevalent public health concern among health professions students and has been associated with adverse academic, psychological, and health outcomes. Identifying modifiable determinants of poor sleep quality is essential for developing targeted interventions in this population.

Aim: This study aimed to determine the prevalence of poor sleep quality and examine the roles of physical activity, perceived stress, and smartphone use as determinants of poor sleep quality among undergraduate health professions students in the Kurdistan Region of Iraq.

Methods and Materials: In this cross-sectional study, 871 undergraduate students from five health professions disciplines at two public universities in Sulaymaniyah, Iraq, participated. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Additional covariates included perceived stress (Perceived Stress Scale-10; PSS-10), physical activity (International Physical Activity Questionnaire–Short Form; IPAQ-SF), and problematic smartphone use (Smartphone Addiction Scale–Short Version; SAS-SV). Data were analyzed using multivariable binary logistic regression to estimate Adjusted Odds Ratios (AOR).

Results: Poor sleep quality was identified in 60.7% of participants (mean PSQI: 7.04 ± 3.45). After multivariable adjustment, nine predictors were independently associated with increased odds of poor sleep quality: moderate perceived stress (AOR = 6.895), high perceived stress (AOR = 6.549), obesity (AOR = 6.773), paid employment (AOR = 4.591), dormitory residency (AOR = 4.188), chronic illness (AOR = 3.855), overweight status (AOR = 3.584), pre-sleep caffeine intake (AOR = 1.677), and problematic smartphone use (AOR = 1.649). High (AOR = 0.208) and moderate (AOR = 0.439) physical activity levels and pre-sleep dairy consumption (AOR = 0.409) were independently associated with reduced odds of poor sleep quality.

Conclusion: The high prevalence of poor sleep quality among health professions students underscores the need for multi-level, evidence-based interventions targeting modifiable lifestyle and environmental factors at the university level.