Sleep Habits and Disturbances Among Tunisian Adults: A Cross-Sectional Online Survey

Abstract

Background: Sleep quality and disturbances have gained heightened scholarly attention due to their well-established association with both mental and physical health. This study aims to assess sleep-wake habits and disturbances in Tunisian adults.

Methodology: This cross-sectional study employed an online questionnaire to assess 3074 adults ≥ 18 years. Primary outcomes, including sleep quality, daytime vigilance, mood, and subjective well-being, were measured using validated questionnaires [the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS), the Patient Health Questionnaire (PHQ)-9, and the World Health Organisation-Five Well-Being Index (WHO-5)].

Results: Less than two-thirds (n= 1941; 63.1%) of participants were females and the mean age was 36.25±13.56. The prevalence of poor sleep quality was 53.8% when defined as a PSQI > 5. The prevalence of insomnia, short sleep duration, long sleep duration, EDS, severe depression, and poor well-being were 14.5%, 34.7%, 12.3%, 32.4%, 7.4%, and 40.2%, respectively. Some factors were associated with an increased likelihood of poor sleep quality, including female gender, chronic hypnotics use, internet use close to bedtime, daily time spent on the internet >3 hours, smoking, university- level education, nocturnal work, severe depression, impaired well-being status, insomnia, and EDS.

Conclusion: The high prevalence of sleep-wake disturbances among Tunisian adults emphasizes the need for an appropriate screening strategy for high-risk groups. Individuals with unhealthy habits and routines were significantly more likely to experience these kinds of disturbances. Consequently, there is a pressing need for educational programs on sleep to foster healthier sleep patterns.

Keywords: excessive daytime sleepiness; insomnia; prevalence; risk factors; sleep; sleep quality; wake habits.

Figure 1

Mean sleep onset time by age groups in men (p <0.001), women (p <0.001), and the total sample study (p <0.001). Women had significantly earlier sleep-onset time than men (23:02±1:23 versus 23:17±1:42; p <0.001) and both genders tended significantly to go to bed earlier with increasing age (p <0.001).

Figure 2

Mean rise time by age groups in men, women, and total sample (p <0.001 each). Overall, the mean rise time showed a strong significant U-shaped association with age groups, reached the minimum about age 55–64 years then started to increase again (p < 0.001).

Figure 3

(a–f) Distribution of sleep duration by age groups (a) A U-shaped association was found between mean sleep duration and age groups (p < 0.001). Sleep duration by PSQI (b), ISI (c), ESS (d), PHQ-9 (e) and WHO-5 (f) scores. Participants with poor sleep quality (<0.001), insomnia (p<0.001) EDS (0.001), severe depression (p=0.022) or impaired well-being (<0.001) slept for a much shorter duration. PHQ-9: Patient Health Questionnaire. PSQI: Pittsburgh Sleep Quality Index. ISI: Insomnia Severity Index. ESS: Epworth Sleepiness Scale. World Health Organisation- Five Well-Being Index.

Figure 4

A scatter plot showing a moderate negative correlation between sleep duration and PSQI score. PSQI: Pittsburgh Sleep Quality Index (r=−0.523; p <0.001).

Figure 5

Prevalence rates of high risk of OSA by age groups in men (p=0.008), women (p <0.001) and the total sample study (p<0.001). Overall, the risk of OSA increased in early adulthood, peaked around middle age (45–54 years), and then declined again. OSA: obstructive sleep apnea.

Figure 6

Multivariable binary logistic regression analysis on the association between poor sleep quality, insomnia and EDS with predictors. EDS: excessive daytime sleepiness. World Health Organisation- Five Well-Being Index. PHQ-9: Patient Health Questionnaire. PSQI: Pittsburgh Sleep Quality Index. ISI: Insomnia Severity Index. ESS: Epworth Sleepiness Scale.