Sleep quality and related risk factors among college students in China: a systematic review and meta-analysis

To identify key factors affecting sleep quality among Chinese college students.

Systematic review and meta-analysis (PROSPERO: CRD42023486000) following the 2020 PRISMA guidelines.

Studies related to sleep quality among Chinese college students. Data sources and participants: CNKI, VIP, WanFang, PubMed, Embase, Web of Science, and Scopus were searched from inception to October 2025.

Fifty-four studies (total N = 61,254) were included. Poor sleep quality was positively associated with mobile phone addiction (WMD = 1.85, 95% CI: 1.22-2.48, P < 0.001), presleep electronic device use (OR = 1.59, 95% CI: 1.34-1.89, P < 0.001; prediction interval [PI] 1.29-1.96; low heterogeneity, I² = 0.0%), poor dietary habits - fried foods (RR = 1.43, 95% CI: 1.20-1.71), barbecued foods (RR = 1.27, 95% CI: 1.02-1.60), sugar-sweetened beverages (RR = 1.38, 95% CI: 1.16-1.63), and fatty foods (RR = 1.70, 95% CI: 1.35-2.14; high heterogeneity across diet subgroups, I² = 73.5%), smoking (OR = 1.46, 95% CI: 1.23-1.74; PI 1.11-1.92; I² = 0.0%), and alcohol consumption (OR = 1.47, 95% CI: 1.32). No significant associations were detected for physical inactivity (RR = 0.89, 95% CI: 0.71-1.11, P = 0.301), depression (WMD = 3.61, 95% CI: -3.37-10.59, P = 0.310), or staying up late (RR = 1.28, 95% CI: 0.90-1.82, P = 0.175). Egger's tests suggested small-study effects for physical inactivity, stress, and anxiety/depression but not for the other factors. Trim-and-fill procedures, when applied, did not materially change effect estimates. Leave-one-out analyses identified single influential studies for physical inactivity and mobile phone addiction, yet conclusions remained unchanged after exclusion. The degree of evidence was generally low to moderate, with downgrades for study design (predominantly cross-sectional), heterogeneity, and potential publication bias.

Multiple modifiable factors - including mobile phone addiction, presleep electronic device use, unhealthy diet, smoking and alcohol use, stress, anxiety, and academic stress - are associated with poor sleep quality among Chinese college students. Given the limited certainty and observed heterogeneity/publication bias, longitudinal studies are needed to strengthen causal inference; associations for physical inactivity, depression, and staying up late remain inconclusive.