This study explored the relationship between sleep quality and psychological stress in college students, focusing on the mediating roles of excessive daytime sleepiness and academic performance. Data from 4633 students were collected between November 2021 and January 2022 using the Epworth Sleepiness Scale and the Simplified Chinese version of the Depression Anxiety Stress Scale. Logistic regression revealed a significant link between sleep quality and psychological stress (p < 0.001). Mediation analysis indicated that excessive daytime sleepiness and academic performance mediated this relationship, with proportional effects of 7.44%, 4.98%, respectively. The findings suggest that psychological stress is prevalent among college students and that sleep quality plays a significant role in stress. Prioritizing sleep and mental health support is essential to reducing future stress in students.
AlbikawiZF (2022) Predictors of anxiety, depression, and stress among female university nursing students during the COVID-19 pandemic: A cross-sectional study in Saudi Arabia. Journal of Personalized Medicine12(11): 1887.
2.
Al-KhaniAMSarhandiMIZaghloulMS, et al. (2019) A cross-sectional survey on sleep quality, mental health, and academic performance among medical students in Saudi Arabia. BMC Research Notes12(1): 665.
3.
Al MarzouqiAMOtimMEAlblooshiA, et al. (2022) State of emotional health disorders of undergraduate students in the United Arab Emirates: A cross-sectional survey. Psychology Research and Behavior Management15: 1423–1433.
4.
Al ShammariMAAl AmerNAAl MulhimSN, et al. (2020) The quality of sleep and daytime sleepiness and their association with academic achievement of medical students in the eastern province of Saudi Arabia. Journal of Family and Community Medicine27(2): 97–102.
5.
AtouiSChevanceGRomainAJ, et al. (2021) Daily associations between sleep and physical activity: A systematic review and meta-analysis. Sleep Medicine Reviews57: 101426.
6.
BarbayannisGBandariMZhengX, et al. (2022) Academic stress and mental well-being in college students: Correlations, affected groups, and COVID-19. Frontiers in Psychology13: 886344.
7.
Cambron-MellottMJMettamSLiVW, et al. (2022) Examining the impact of excessive daytime sleepiness on utility scores in patients with obstructive sleep apnea and/or narcolepsy in five European countries. BMC Neurology22(1): 317.
8.
Caravaca-SánchezFAizpuruaEStephensonA (2021) Substance use, family functionality, and mental health among college students in Spain. Social Work in Public Health36(2): 221–231.
9.
ChungKF (2000) Use of the Epworth sleepiness scale in Chinese patients with obstructive sleep apnea and normal hospital employees. Journal of Psychosomatic Research49(5): 367–372.
10.
CohenSGianarosPJManuckSB (2016) A stage model of stress and disease. Perspectives on Psychological Science11(4): 456–463.
11.
CrawfordJRHenryJD (2003) The depression anxiety stress scales (DASS): Normative data and latent structure in a large non-clinical sample. British Journal of Clinical Psychology42(2): 111–131.
12.
FrazierPGabrielAMeriansA, et al. (2019) Understanding stress as an impediment to academic performance. Journal of American College Health67(6): 562–570.
13.
GandhiKDMansukhaniMPSilberMH, et al. (2021) Excessive daytime sleepiness: A clinical review. Mayo Clinic Proceedings96(5): 1288–1301.
14.
GongZWangHZhongM, et al. (2023) College students’ learning stress, psychological resilience and learning burnout: Status quo and coping strategies. BMC Psychiatry23(1): 389.
15.
GuoKZhangXBaiS, et al. (2021) Assessing social support impact on depression, anxiety, and stress among undergraduate students in Shaanxi province during the COVID-19 pandemic of China. PLoS One16(7): e0253891.
16.
HamaidehSHAl-ModallalHTanashM, et al. (2022) Depression, anxiety and stress among undergraduate students during COVID-19 outbreak and “home-quarantine”. Nursing Open9(2): 1423–1431.
17.
HuangJLiuX (2023) Anxiety, depression, and their comorbidity among Chinese college students during the COVID-19 lockdown in the post-epidemic era: An online cross-sectional survey. BMC Psychiatry23(1): 923.
18.
HuaYJiangWHeY, et al. (2024) Associations of recent stressful life events with anxiety symptoms among Chinese adolescents with a consideration of family functioning. European Journal of Psychotraumatology15(1): 2337577.
19.
HubertyJGreenJGlissmannC, et al. (2019) Efficacy of the mindfulness meditation mobile app “Calm” to reduce stress among college students: Randomized controlled trial. JMIR mHealth and uHealth7(6): e14273.
20.
HuntJEisenbergD (2010) Mental health problems and help-seeking behavior among college students. Journal of Adolescent Health46(1): 3–10.
IsacCAbrahamJ (2020) Daytime sleepiness among Omani nursing students: Estimate of its determinants and impact on perceived stress. Clinical Epidemiology and Global Health8(3): 739–743.
23.
JohnsMW (1991) A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep14(6): 540–545.
24.
LiuXPingSGaoW (2019) Changes in undergraduate students’ psychological well-being as they experience university life. International Journal of Environmental Research and Public Health16(16): 2864.
25.
LiWHuNYangX, et al. (2025) Association between daytime sleepiness and quality of life in Chinese adolescents: A moderated mediation of cognitive dysfunction and depressive symptoms. Neuropsychiatric Disease and Treatment21: 1143–1159.
26.
LópezRBNavarroNMAstorgaAC (2017) Relationship between personality organization and the prevalence of symptoms of depression, anxiety and stress among university students in health careers in the region of Coquimbo, Chile. Rev Colomb Psiquiatr46(4): 203–208.
27.
LovibondPFLovibondSH (1995) The structure of negative emotional states: Comparison of the depression anxiety stress scales (DASS) with the Beck depression and anxiety inventories. Behaviour Research and Therapy33(3): 335–343.
28.
Mac-GintySLiraDLilloI, et al. (2024) Association between socioeconomic position and depression, anxiety and eating disorders in university students: A systematic review. Adolescent Research Review9(3): 435–451.
29.
MasonARapseyCSampsonN, et al. (2025) Prevalence, age-of-onset, and course of mental disorders among 72,288 first-year university students from 18 countries in the world mental health international college student (WMH-ICS) initiative. Journal of Psychiatric Research183: 225–236.
30.
MaX (2025) The relationship between psychological stress and academic performance among college students: The mediating roles of cognitive load and self-efficacy. Acta Psychologica259: 105433.
31.
McIndooCCFileAAPreddyT, et al. (2016) Mindfulness-based therapy and behavioral activation: A randomized controlled trial with depressed college students. Behaviour Research and Therapy77: 118–128.
32.
MeckamalilCBrodieLHogg-JohnsonS, et al. (2022) The prevalence of anxiety, stress and depressive symptoms in undergraduate students at the Canadian memorial chiropractic college. Journal of American College Health70(2): 371–376.
33.
Mirzaei-AlavijehMNajafiFVeisRG, et al. (2025) Psychological distress and its association with gender, socioeconomic status, education and health conditions. Scientific Reports15(1): 29142.
34.
MohammadSAlmakranIWAl-MontashriAS, et al. (2020) Depression, anxiety and stress and their associated social determinants in the Saudi college students. Health Psychology Research8(3): 9263.
35.
PaudelSGautamHAdhikariC, et al. (2020) Depression, anxiety and stress among the undergraduate students of Pokhara metropolitan, Nepal. Journal of Nepal Health Research Council18(1): 27–34.
36.
PetersonECRosenbergBMHoughCM, et al. (2021) Behavioral mediators of stress-related mood symptoms in adolescence & young adulthood. Journal of Affective Disorders294: 94–102.
37.
Ramón-ArbuésEGea-CaballeroVGranada-LópezJM, et al. (2020) The prevalence of depression, anxiety and stress and their associated factors in college students. International Journal of Environmental Research and Public Health17(19): 7001.
38.
RamosJNMuraroAPNogueiraPS, et al. (2021) Poor sleep quality, excessive daytime sleepiness and association with mental health in college students. Annals of Human Biology48(5): 382–388.
39.
RegehrCGlancyDPittsA (2013) Interventions to reduce stress in university students: A review and meta-analysis. Journal of Affective Disorders148(1): 1–11.
40.
RoySBiswasAKSharmaM (2025) Stress, anxiety, and depression as psychological distress among college and undergraduate students: A scoping review of reviews guided by the socio-ecological model. Healthcare13(16): 1948.
41.
SalsabilaRSopiahPRosydaR (2025) Relationship between sleep quality and physical activity to the incidence of excessive daytime sleepiness (EDS) in university students. Jurnal Keperawatan16(1): 98–105.
42.
SameerHMImranNTararTN, et al. (2020) Association of excessive daytime sleepiness with psychological distress in medical students. Primary Care Companion For CNS Disorders22(1): 19m02531.
43.
ScottAJWebbTLJamesM, et al. (2021) Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials. Sleep Medicine Reviews60: 101556.
44.
ShamsuddinKFadzilFIsmailWS, et al. (2013) Correlates of depression, anxiety and stress among Malaysian university students. Asian Journal of Psychiatry6(4): 318–323.
45.
SongHTGeCHChangLX, et al. (2022) Investigation on the psychological status of college students during the coronavirus disease-2019 epidemic. Journal of General Psychology149(4): 456–467.
46.
ŚredniawaADrwiłaDKrotosA, et al. (2019) Insomnia and the level of stress among students in Krakow, Poland. Trends in Psychiatry and Psychotherapy41(1): 60–68.
47.
SukorANAJulianaNAbdul HamidN, et al. (2025) A systematic review of literature on the association among sleep, cortisol level and cardiovascular health within the healthcare shift worker population. Biomedicines13(10): 2539.
48.
VarmaPBurgeMMeaklimH, et al. (2021) Poor sleep quality and its relationship with individual characteristics, personal experiences and mental health during the COVID-19 pandemic. International Journal of Environmental Research and Public Health18(11): 6030.
49.
VergerPGuagliardoVGilbertF, et al. (2010) Psychiatric disorders in students in six French universities: 12-month prevalence, comorbidity, impairment and help-seeking. Social Psychiatry and Psychiatric Epidemiology45(2): 189–199.
50.
WahidMHSethiMRShaheenN, et al. (2023) Effect of academic stress, educational environment on academic performance & quality of life of medical & dental students; gauging the understanding of health care professionals on factors affecting stress: A mixed method study. PLoS One18(11): e0290839.
51.
WangKShiHSGengFL, et al. (2016) Cross-cultural validation of the depression anxiety stress scale–21 in China. Psychological Assessment28(5): e88–e100.
52.
WangYGuangZZhangJ, et al. (2023) Effect of sleep quality on anxiety and depression symptoms among college students in China’s Xizang region: The mediating effect of cognitive emotion regulation. Behavioral Sciences13(10): 861.
53.
WeiHDornAHuttoH, et al. (2021) Impacts of nursing student burnout on psychological well-being and academic achievement. Journal of Nursing Education60(7): 369–376.
54.
YapYTungNYCShenL, et al. (2024) Daily associations between salivary cortisol and electroencephalographic-assessed sleep: A 15-day intensive longitudinal study. Sleep47(9): zsae087.
55.
YoungTB (2004) Epidemiology of daytime sleepiness: Definitions, symptomatology, and prevalence. Journal of Clinical Psychiatry65(16): 12–16.
56.
ZengYWangGXieC, et al. (2019) Prevalence and correlates of depression, anxiety and symptoms of stress in vocational college nursing students from Sichuan, China: A cross-sectional study. Psychology Health & Medicine24(7): 798–811.
57.
ZhangLYangYLuoY, et al. (2022) A longitudinal study of insomnia, daytime sleepiness, and academic performance in Chinese adolescents. Behavioral Sleep Medicine20(6): 798–808.
