Nightmares’ Pattern and Predictors among a Saudi University Students during COVID-19 Pandemic

Abstract

Purpose: During the coronavirus disease 2019 (COVID-19) pandemic quarantine, university students were under various types of stressors, including the exams period, which might have affected their quality and quantity of sleep, and consequently, their quality of life. This study aimed to investigate the pattern and predictors of nightmares among university students and coinvestigate the presence of other types of sleep disturbances, mental disorders, and quarantine-related stressors. Methods: This cross-sectional study included 368 university students who answered a self-completed questionnaire covering their sociodemographic features, nightmare indicators, and associated quarantine stressors. Additionally, sleep disturbances were measured using the Generalized Sleep Disturbance Scale (GSDS), anxiety using the Generalized Anxiety Disorder 2 scale, and depression using the Patient Health Questionnaire-2. Results: The participants’ mean age was 20.4 ± 1.6 years, and male participants represented 35.9% of the sample. Nightmares were experienced by 117 (31.8%) of the participants, of whom 44.4% had new-onset nightmares. The mean GSDS was 45.0 ± 14.9 (min. = 12, max. = 130). This value is associated with elevated odds of the following outcomes: the presence of nightmares (odds ratio [OR] = 1.8; confidence interval [CI] 95% = 1.1–3.0); new-onset nightmares at the time of pandemic (OR = 2.6; CI 95% = 1.3–5.5); and anxiety (OR = 1.74; CI 95% = 1.0–2.9). The presence of nightmares elevated the score of GSDS by 11.3 points (S.E. = 1.6, p < 0.001), elevated the odds of anxiety by 4.1 (CI 95% = 2.5–6.8), and depression by 2.1 (CI 95% = 1.3–3.4). Conclusions: Stressors resulting from both the exams period and the fact that it was conducted during COVID-19 quarantine increased the rate and affected the pattern of nightmares. These stressors also led to other sleep disturbances and mental disorders that were significantly more prevalent among females.

Dreaming during the COVID-19 pandemic: A narrative review

“…Concerning the emotional status during the pandemic, nightmare frequency was associated with anxiety and depressive symptoms ( Scarpelli et al, 2021a ), perceiving a high risk of contracting COVID-19, increased alcohol consumption during the pandemic, and suicidal ideation ( Musse et al, 2020 ). A relationship has been also observed between nightmare frequency and sleep variables, specifically, modification of daytime napping and high intra-sleep wakefulness ( Scarpelli et al, 2021a ) and greater sleep disturbance ( Scarpelli et al, 2021a , Alghamdi et al, 2022 ), while results about the association with sleep duration were contrasting ( Scarpelli et al, 2021a , Solomonova et al, 2021 ).…”

“…Nightmare frequency during the pandemic was associated with (and was more frequent in) the female gender in the general population ( Musse et al, 2020 , Scarpelli et al, 2021a ), and in university students ( Alghamdi et al, 2022 ). Younger age was also related to nightmare frequency ( Musse et al, 2020 , Scarpelli et al, 2021a ).…”

“…Nightmares were widely assessed, but it should be considered that the reviewed literature is characterized by a lack of clarity and uniformity about the operational definitions of “nightmare”, making it difficult to understand if studies on pandemic nightmares actually assessed the same research object. Only one study ( Alghamdi et al, 2022 ) used a clinical definition of nightmares according to Third Edition of the International Classification of Sleep Disorders (ICSD-3) diagnostic criteria. The definition of “nightmare” was mainly left to the participants, and only a few studies distinguished “nightmares” and “bad dreams”.…”

“…Therefore, it is difficult to provide a reliable characterization of dream contents during the pandemic. Despite such heterogeneity, a common observation obtained through the analysis of dream contents/themes is the pandemic-related increase or the frequent presence during the pandemic of distressing, emotionally negative contents in the oneiric activity ( Mota et al, 2020 , Musse et al, 2020 , Iorio et al, 2020 , Kennedy et al, 2022 ; Kilius net al, 2021; Sommantico et al, 2021 ; Pesonen et al, 2020 ; Solomonova et al, 2021 ; Wang et al, 2021 ; Alghamdi et al, 2022 ). The presence of explicit pandemic-related contents and themes has been revealed by several studies but results about their prevalence are not consistent ( MacKay and DeCicco, 2020 , Musse et al, 2020 , Mota et al, 2020 , Iorio et al, 2020 , Sommantico et al, 2021 , Pesonen et al, 2020 , Borghi et al, 2021 , Kennedy et al, 2022 , Solomonova et al, 2021 , Guerrero-Gomez et al, 2021 , Alghamdi et al, 2022 ).…”

“…The influence of sociodemographic and pandemic-related variables has been observed in several studies. The effect of gender on the oneiric activity has been frequently reported using different methods, mainly in the direction of greater dream frequency, emotional (negative) intensity, length, vividness, and pandemic-related contents (Barrett et al, 2020; Iorio et al, 2020 ; Gorgoni et al, 2021a ; Fränkl et al, (2021) ; Scarpelli et al, 2021a ; Sommantico et al, 2021 ; Guerrero-Gomez et al, 2021 ), and nightmare frequency ( Musse et al, 2020 , Scarpelli et al, 2021a , Alghamdi et al, 2022 ). The association between nightmare frequency and female gender has been also observed in narcoleptic patients ( Scarpelli et al, 2021b ).…”