Sleep quality among university students in Lebanon during war conflicts: a cross-sectional study

Sleep is a vital component for cognitive function, emotional well-being, and overall health, yet it is frequently disrupted by external stressors, such as war and conflict. University students, particularly those in conflict zones, face increased risks of poor sleep quality due to academic pressure, psychological stress, and trauma exposure.

This study aims to assess the prevalence of poor sleep quality, sleep latency, and sleep efficiency among university students in Lebanon during the 2023-2024 war conflicts, and the direct and indirect effects of war exposure.

A cross-sectional study was conducted on 631 university students in Lebanon using the Pittsburgh Sleep Quality Index (PSQI) to evaluate sleep quality. Sociodemographic characteristics and the type of war exposure (direct or indirect) were also assessed. Inferential statistical tests were performed to identify correlations between sleep quality and sociodemographic factors, as well as sleep quality and war exposure. The Prevalence Rate Ratio (PRR) was calculated to identify risk and protective factors for poor sleep quality in each socio demographic group. A binary regression model was applied to predict the most significant risk factors for compromised sleep quality.

73.5% of Lebanese university students had poor sleep quality (PSQI > 5), with a mean Global PSQI score of 8.20 (± 3.95). Students with direct war exposure had the highest mean score of 10.57 (p < 0.001), compared to 8.04 for those with indirect exposure. The average sleep latency PSQI score was 1.46 ± 1.04, and the average sleep efficiency PSQI score was 1.00 ± 1.00. Compared to no exposure, indirect exposure resulted in a 22% higher prevalence (PRR = 1.22) of poor sleep, while direct exposure showed a 60% higher prevalence (PRR = 1.60). The binary exposure showed that female gender increased the odds of poor sleep by 2.71 (p = 0.035), and direct war exposure increased the odds by 19.76 times (p = 0.001).

This study highlights the profound impact of war exposure on sleep quality among Lebanese university students, with direct exposure having the greatest risk. Poor sleep quality in war-affected zones can lead to severe disruptions in academic performance, cognitive function, and overall mental and physical health. The findings underscore the need for targeted interventions, including mental health support and stress management programs, to limit sleep disturbances in conflict-affected populations. Further research is warranted to explore effective coping mechanisms and long-term sleep health in similar contexts.