Association between psychological well-being, sleep quality, and academic performance among physical therapy students

Sleep, a core health behavior, contributes significantly to psychological well-being, whereas flourishing represents an individual's highest level of mental functioning and emotional health. Although both constructs are important to students' well-being and academic outcomes, their relationship remains insufficiently investigated among physiotherapy students in Saudi Arabia.

This study examined sleep quality, flourishing, and their association with academic performance in undergraduate physiotherapy students.

A descriptive cross-sectional study was conducted among 248 physiotherapy students. Participants completed a sociodemographic form, the Pittsburgh Sleep Quality Index (PSQI), and the Flourishing Scale (FS). Academic performance was measured using self-reported GPA. Data were analyzed using chi-square tests, Spearman's correlation, and ordinal logistic regression.

Females comprised 79.4% of the sample, with GPA distribution differing significantly by gender (p < 0.001). Overall, 70.6% of students reported poor sleep quality. Flourishing scores were moderate (mean = 41.5 ± 8.9) and did not differ significantly between universities (p = 0.124). Correlation analysis showed that sleep efficiency was positively associated with GPA (r = 0.150, p < 0.05), while use of sleep medication was negatively associated (r = -0.130, p < 0.05). Flourishing scores correlated negatively with PSQI daytime dysfunction (r = -0.409, p < 0.001) and global PSQI scores (r = -0.327, p < 0.001). After adjusting for gender, study site, and academic level, regression analysis identified shorter sleep duration (OR = 0.72, p = 0.011) and frequent sleep medication use (OR = 1.48, p = 0.035) as significant predictors of lower GPA. Male gender was also associated with lower GPA (OR = 4.31, p < 0.001), though this may reflect institutional differences given the gender-university confounding.

Poor sleep quality was highly prevalent among physiotherapy students, while flourishing levels remained generally high but unrelated to academic performance. After adjusting for gender and institutional factors, regression analysis demonstrated that sleep duration and frequent use of sleep medication were significant predictors of lower GPA. These findings suggest that sleep health may be associated with academic outcomes among physiotherapy students. Future studies are needed to examine whether sleep-hygiene interventions could support academic performance in this population.