Daytime Sleepiness, Circadian Preference, Caffeine Consumption and Khat Use among College Students in Ethiopia

Abstract

Objectives To estimate the prevalence of daytime sleepiness and circadian preferences, and to examine the extent to which caffeine consumption and Khat (a herbal stimulant) use are associated with daytime sleepiness and evening chronotype among Ethiopian college students. Methods A cross-sectional study was conducted among 2,410 college students. A self-administered questionnaire was used to collect information about sleep, behavioral risk factors such as caffeinated beverages, tobacco, alcohol, and Khat consumption. Daytime sleepiness and chronotype were assessed using the Epworth Sleepiness Scale (ESS) and the Horne & Ostberg Morningness /Eveningness Questionnaire (MEQ), respectively. Linear and logistic regression models were used to evaluate associations. Results Daytime sleepiness (ESS≥10) was present in 26% of the students (95% CI: 24.4–27.8%) with 25.9% in males and 25.5% in females. A total of 30 (0.8%) students were classified as evening chronotypes (0.7% in females and 0.9% in males). Overall, Overall, Khat consumption, excessive alcohol use and cigarette smoking status were associated with evening chronotype. Use of any caffeinated beverages (OR=2.18; 95%CI: 0.82–5.77) and Khat consumption (OR=7.43; 95%CI: 3.28–16.98) increased the odds of evening chronotype. Conclusion The prevalence of daytime sleepiness among our study population was high while few were classified as evening chronotypes. We also found increased odds of evening chronotype with caffeine consumption and Khat use amongst Ethiopian college students. Prospective cohort studies that examine the effects of caffeinated beverages and Khat use on sleep disorders among young adults are needed.

Excessive daytime sleepiness and its predictors among medical and health science students of University of Gondar, Northwest Ethiopia: institution-based cross-sectional study

“…The prevalence of EDS in this study is similar to other studies from Southern University of United States (31% vs 27%) [39], Universidad San Martin de Porres in Lima, Peru (31% vs 35%) [40], Nigeria (31% vs 32.5%) [41], Southern Taiwan (31% vs 35%) [42], and Ethiopia (31% vs 26%) [17]. High magnitude of EDS in students could be explained by the highly competitive and demanding learning environment that disrupts the regular sleep time [12].…”

“…The role of cortisol on the development of depression could be explained by the neurotoxic effect of cortisol on hippocampus [56]. Other studies reported the association of EDS to stress [45,57], Khat chewing, alcohol consumption and cigarette smoking [17], female sex [20,22] and male sex [21]. However, these factors were not predictors of EDS in our study which might be due to variations in sample size and sociocultural factors.…”

“…As sleepiness is circumstance dependent [12], it also common in educational institutions as reported in high-school students of Korea with 15.9% of EDS [13], Malaysian Medical students (35.5%) [14], and Indian college students (45%) [15]. In Ethiopia, poor sleep quality was observed among 52.7% of university students [16], and 26% daytime sleepiness among college students [17]. University students particularly Medical and Health Science students have a huge academic load which leads to sleep deprivation and daytime sleepiness [18].…”

The Association between Chronotype and Dietary Pattern among Adults: A Scoping Review

“…Evening chronotypes were reported to consume more alcohol and caffeine, which is widely recognised for its stimulant properties that can boost wakefulness and concentration by increasing brain activity [83][84][85]. However, many other studies have demonstrated how an excessive intake of alcohol and caffeine can result in reduced sleep duration and quality, increased fatigue and daytime sleepiness, and delayed sleep onset [85][86][87][88][89][90]. According to Galli et al (2013), each alcoholic drink (contain 14g of alcohol) can reduce sleep duration by 30 min.…”

“…The mechanism underlying this association is still unclear, but it is proposed that both alcohol and caffeine intakes can delay the onset on nocturnal melatonin release, thus suppressing sleepiness [83,91]. Interestingly, some studies revealed how the consumption of alcohol and caffeine can increase the odds of later chronotype [90,92]. It was postulated that evening chronotypes have more chances to engage with 'evening habits' (drinking) due to a delay in sleep time compared to morning chronotypes, who sleep earlier [93].…”