Sleep quality of secondary school students in relation to anxiety, caff eine consumption and mobile phone use –⁠ a cross-sectional study

Czech version

Authors: Tomáš Groh ¹; Matěj Kasal ^2,3
Authors‘ workplace: Gymnázium Arabská, Praha ¹; Centrum duševní rehabilitace, Beroun ²; Lékařská fakulta univerzity Karlovy v Plzni ³
Published in: Čes. a slov. Psychiat., 121, 2025, No. 4, pp. 172-180.
Category: Original Article
doi: https://doi.org/10.48095/cccsp202514

Overview

Summary: Objective: The study aims to analyze the impact of stress, caffeine consumption, and exposure to electronic devices before bedtime on sleep quality among high school students, given the rising concern about sleep deprivation and its negative health and academic implications in adolescents. Methods: A cross-sectional study design involving 200 high school students (93 males, 107 females) aged 15–19 years was used. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI), while anxiety levels were evaluated using the Beck Anxiety Inventory (BAI). Participants reported caffeine intake frequency and timing of mobile phone use before sleep. Data were analyzed using Pearson‘s correlation coefficients and independent t-tests, with significance set at P < 0.05. Results: The analysis revealed a significant positive correlation between anxiety scores (BAI) and sleep quality (PSQI), with a correlation coefficient of 0.66 (P < 0.001). A weak positive correlation was also identified between caffeine consumption and poorer sleep quality (r = 0.26; P = 0.00024), as well as between caffeine consumption and anxiety levels (r = 0.25; P = 0.0003). Sleep quality was further examined in relation to mobile phone use before bedtime: the lowest PSQI scores (5.83) were observed among students who last used their phones more than one hour before sleep, whereas those who did not monitor their phone use or used their phones immediately before sleep had higher scores (~7.3). However, a one-way ANOVA comparing these three groups did not reveal statistically significant differences (F (2,197) = 0.57; P = 0.567; η² = 0.006). Significant differences between genders were observed in both sleep quality (PSQI) and anxiety (BAI). Females reported poorer sleep quality (mean PSQI 8.19) compared to males (5.80), with a highly significant difference (P < 0.001; Cohen’s d = −0.31; 95% CI [−17.63; −1.37]). Similarly, females exhibited substantially higher anxiety levels (mean BAI 21.99) compared to males (mean BAI 10.37), with this difference also being statistically significant (P < 0.001; Cohen’s d = −1.21; 95% CI [−14.27; −8.97]). A linear regression model was subsequently constructed to predict PSQI scores based on BAI, gender, caffeine consumption frequency, and timing of mobile phone use before sleep. The model was statistically significant (R² = 0.29; P < 0.001), with anxiety level emerging as the most significant predictor (P < 0.001), followed by gender (P = 0.002) and mobile phone use (P = 0.045). Caffeine consumption frequency did not reach statistical significance (P = 0.087). Conclusion: The results demonstrate a significant relationship between higher anxiety levels and poorer sleep quality among adolescents. Caffeine consumption also negatively affects sleep quality, though the correlation was weaker. Findings highlight the importance of improving sleep hygiene and reducing stress among adolescents.

Keywords:

sleep – anxiety – adolescent – stress – Caffeine – Sleep deprivation – Pittsburgh Sleep Quality Index – Beck Anxiety Inventory – teenage – youth health

Sources

1. Kohansieh M, Makaryus AN. Sleep deficiency and deprivation leading to cardiovascular disease. Int J Hypertens 2015; 2015 : 615681. doi: 10.1155/2015/615681.

2. Garbarino S, Lanteri P, Bragazzi NL et al. Role of sleep deprivation in immune-related disease risk and outcomes. Commun Biol 2021; 4 (1): 1304. doi: 10.1038/s42003-021-02825-4.

3. Bishir M, Bhat A, Essa MM et al. Sleep deprivation and neurological disorders. Biomed Res Int 2020; 2020 : 5764017. doi: 10.1155/2020/5764017.

4. Kreutzmann JC, Havekes R, Abel T et al. Sleep deprivation and hippocampal vulnerability: changes in neuronal plasticity, neurogenesis and cognitive function. Neuroscience 2015; 309 : 173–190. doi: 10.1016/j.neuroscience.2015.04.053.

5. Scott AJ, Webb TL, James MM et al. Improving sleep quality leads to better mental health: a meta-analysis of randomised controlled trials. Sleep Med Rev 2021; 60 : 101556. doi: 10.1016/j.smrv.2021.101556.

6. Watson AM. Sleep and athletic performance. Curr Sports Med Rep 2017; 16 (6): 413–418. doi: 10.1249/JSR.0000000000000418.

7. Bavafa A, Khazaie H, Khaledi-Paveh B et al. The relationship of severity of symptoms of depression, anxiety, and stress with sleep quality in earthquake survivors in Kermanshah. J Inj Violence Res 2019; 11 (2): 225–232. doi: 10.5249/jivr.v11i2.1203.

8. Almojali AI, Almalki SA, Alothman AS et al. The prevalence and association of stress with sleep quality among medical students. J Epidemiol Glob Health 2017; 7 (3): 169–174. doi: 10.1016/j.jegh.2017.04.005.

9. Parodi KB, Holt MK, Green JG et al. Time trends and disparities in anxiety among adolescents, 2012–2018. Soc Psychiatry Psychiatr Epidemiol 2022; 57 (1): 127–137. doi: 10.1007/s00127-021-02122-9.

10. Wahl S, Engelhardt M, Schaupp P et al. The inner clock-Blue light sets the human rhythm. J Biophotonics 2019; 12 (12): e201900102. doi: 10.1002/jbio.201900102.

11. Watson EJ, Coates AM, Kohler M et al. Caffeine consumption and sleep quality in Australian adults. Nutrients 2016; 8 (8): 479. doi: 10.3390/nu8080479.

12. Mahoney CR, Giles GE, Marriott BP et al. Intake of caffeine from all sources and reasons for use by college students. Clin Nutr 2019; 38 (2): 668–675. doi: 10.1016/j.clnu.2018.04.004.

13. Hirshkowitz M, Whiton K, Albert SM et al. National sleep foundation‘s sleep time duration recommendations: methodology and results summary. Sleep Health 2015; 1 (1): 40–43. doi: 10.1016/j.sleh.2014.12.010.

14. Tarokh L, Saletin JM, Carskadon MA. Sleep in adolescence: physiology, cognition and mental health. Neurosci Biobehav Rev 2016; 70 : 182–188. doi: 10.1016/j.neubiorev.2016.08.008.

15. Mason GM, Lokhandwala S, Riggins T et al. Sleep and human cognitive development. Sleep Med Rev 2021; 57 : 101472. doi: 10.1016/j.smrv.2021.101472.

16. Short M, Bartel K, Carskadon M. Sleep and mental health in children and adolescents. 2019 [online]. Dostupné z: https: //researchnow.flinders.edu.au/en/publications/sleep-and-mental-health-in-children-and-adolescents.

17. Zhang J, Paksarian D, Lamers F et al. Sleep patterns and mental health correlates in US adolescents. J Pediatr 2017; 182 : 137–143. doi: 10.1016/j.jpeds.2016.11.007.

18. Crowley SJ, Acebo C, Carskadon MA. Sleep, circadian rhythms, and delayed phase in adolescence. Sleep Med 2007; 8 (6): 602–612. doi: 10.1016/j.sleep.2006.12.002.

19. Tarokh L, Short M, Crowley SJ et al. Sleep and circadian rhythms in adolescence. Curr Sleep Med Rep 2019; 5 (5): 181–192. doi: 10.1007/s40675-019-00155-w.

20. Suardiaz-Muro M, Ortega-Moreno M, Morante-Ruiz M et al. Sleep quality and sleep deprivation: relationship with academic performance in university students during examination period. Sleep Biol Rhythms 2023; 21 (3): 377–383. doi: 10.1007/s41105-023-00457-1.

21. Mirghani MO, Ahmed MA, Elbadawi AS. Daytime sleepiness and chronic sleep deprivation effects on academic performance among the Sudanese medical students. J Taibah Univ Med Sci 2015; 10 (4): 467–470. doi: 10.1016/j.jtumed.2015.05.003.

22. Chiu NY, Hsu WY. Sleep disturbances in Methadone Maintenance Treatment (MMT) patients. 2016 [online]. Dostupné z: https: //www.researchgate.net/publication/301763555_Sleep_Disturbances_in_Methadone_Maintenance_Treatment_MMT_Patients.

23. Parker G, Brotchie H. Gender differences in depression. Int Rev Psychiatry 2010; 22 (5): 429–436. doi: 10.3109/09540261.2010.492391.

24. Bugueño M, Curihual C, Olivares P et al. Quality of sleep and academic performance in high school students. Rev Med Chil 2017; 145 (9): 1106–1114. doi: 10.4067/s0034-98872017000901106.

25. Tekcan P, ÇaliŞkan Z, KocaÖz S. Sleep quality and related factors in Turkish high school adolescents. J Pediatr Nurs 2020; 55 : 120–125. doi: 10.1016/j.pedn.2020.07.020.

26. CDC. Sleep in middle and high school students. 2020 [online]. Dostupné z: https: //archive.cdc.gov/www_cdc_gov/healthyschools/features/students-sleep.htm.

27. Martire VL, Caruso D, Palagini L et al. Stress & sleep: a relationship lasting a lifetime. Neurosci Biobehav Rev 2020; 117 : 65–77. doi: 10.1016/j.neubiorev.2019.08.024.

28. Matti N, Mauczok C, Eder J et al. Work-related stress and sleep quality –⁠ the mediating role of rumination: a longitudinal analysis. 2024 [online]. Dostupné z: https: //link.springer.com/article/10.1007/s11818-024-00481-4.

29. Yap Y, Slavish DC, Taylor DJ et al. Bi-directional relations between stress and self-reported and actigraphy-assessed sleep: a daily intensive longitudinal study. Sleep 2020; 43 (3): zsz250. doi: 10.1093/sleep/zsz250.

30. Philbrook LE, Macdonald-Gagnon GE. Bidirectional relations between sleep and emotional distress in college students: loneliness as a moderator. J Genet Psychol 2021; 182 (5): 361–373. doi: 10.1080/00221325.2021.1913982.

31. Hartstein LE, Mathew GM, Reichenberger DA et al. The impact of screen use on sleep health across the lifespan: a National Sleep Foundation consensus statement. Sleep Health 2024; 10 (4): 373–384. doi: 10.1016/j.sleh.2024.05.001.

32. Pickard H, Chu P, Essex C et al. Toddler screen use before bed and its effect on sleep and attention: a randomized clinical trial. JAMA Pediatr 2024; 178 (12): 1270–1279. doi: 10.1001/jamapediatrics.2024.3997.

33. Bao C, Han L. Gender difference in anxiety and related factors among adolescents. Front Public Health 2025; 12 : 1410086. doi: 10.3389/fpubh.2024.1410086.

34. Chronister BN, Gonzalez E, Lopez-Paredes D et al. Testosterone, estradiol, DHEA and cortisol in relation to anxiety and depression scores in adolescents. J Affect Disord 2021; 294 : 838–846. doi: 10.1016/j.jad.2021.07.026.

35. Alexander B, David E, Grills N. High prevalence of anxiety disorders among adolescent Tibetan refugees, Asian J Psychiatr 2013; 6 (3): 218–221. doi: 10.1016/j.ajp.2012.12.006.

MUDr. Matěj Kasal

Centrum Duševní Rehabilitace Beroun

prof. Veselého 491

266 01 Beroun 1 –⁠ Závodí

e-mail: kasal@nember.cz