Hoang Nguyen Nhat Linh et al. Journal of Health and Development Studies (Vol.05, No.

02-2021)

ORIGINAL ARTICLES

Sleep quality among youngster in Danang city, Vietnam: A cross-sectional

study

Hoang Nguyen Nhat Linh1, Doan Vuong Diem Khanh2,3*, Nguyen Thi Dang Thu2, Nguyen
Thi Hong Nhi4

ABSTRACT

Objectives: Sleep is a normal physiological process of the body. Sleep impacts on many aspects of
health and quality of life at all ages. There are many risk factors associated with sleep deprivation or
poor sleep quality: physical health problems such as diabetes and cardiovascular disease; mental health
issues like depression; traffic and occupational accident. The study was conducted with the aims of
understanding the sleep quality situation of youngster aged 16-30 years in Da Nang City, Vietnam, and
determining the factors related to the sleep quality of the study participants.

Methods: A descriptive cross-sectional study was conducted on adolescents living in Da Nang City,
Vietnam. The information was collected by using a structured questionnaire. Multivariate logistic regression
analysis was used to identify the risk factors associated with the sleep quality among adolescents.

Results: The proportion of the adolescents who suffered from poor sleep quality was 31.1%. The results
of multivariate logistic regression analysis indicated that there were the relationships between sleep
quality and living in Hoa Vang District; occupations were student, worker, or officer; finishing working/
studying time after 7 pm; regularly use and dependent on the internet; having stress; having pressure
on study/work, overeating before going to bed, rarely or sometimes staying up late, lying postures were
laying up, lie on the left side and other postures; hand posture when sleeping.

Conclusion: The proportion of adolescents living in Da Nang City with good sleep quality was not
high. The government needs to propagandize and mobilize people, especially young people in terms of
the impacts of sleep quality on health, thereby improving sleep quality to help young people in good
condition, helping the country and defending the country.

Keywords: Sleep quality, adolescents, Da Nang City

INTRODUCTION important processes take place (1). Sleep affects

many aspects of health and quality of life of all
Sleep is the normal physiological process of the ages. There are many risk factors associated
body. It is a quiet time to rest and recover from with sleep deprivation or poor sleep quality:
the stresses of everyday life, but studies have physical health problems such as diabetes and
shown that sleep is an activity in which many cardiovascular disease; mental health issues like

* Corresponding author: Doan Vuong Diem Khanh Submited: 09 October, 2020

Email: dvdkhanh@huemed-univ.edu.vn Revised version received: 03 November, 2020
1
Danang University of Medical Technology and Pharmacy Published: 26 March, 2021
2
Faculty of Public Health, Hue University of Medicine
and Pharmacy, Hue University
3
Health Management Training Institute, Hue
University of Medicine and Pharmacy, Hue University
4
Institute for Community Health Research, Hue University

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Hoang Nguyen Nhat Linh et al. Journal of Health and Development Studies (Vol.05, No.02-2021)

depression; traffic and occupational accident Vietnam” with the following two objectives:
(2). The qualityof sleep is determined by a 1) Describe the quality of sleep of adolescents
person’s satisfaction with their sleep patterns, living in Da Nang City, Vietnam, and 2) Find
including the time at which sleep starts, sleep out some factors related to the sleep quality of
retention, the total of sleep time, and the time research participants.
it takes to actually wake up (3). A decrease in
sleep duration and quality of sleep are related to
METHODS
changes in living habits, abusing of technology,
working a lot, and social needs (4). The above
Study design
reasons are often seen in young people. Studies
on sleep quality among university students This study applied the cross-sectional study
illustrated that rates of poor sleep quality were design
increasingly interest. The proportion of students
Time and location
with poor sleep quality in Nigeria in 2011 was
32.5% (3); in Ethiopia, in 2012 was 55.8% (5); Study from March 2017 to June 2017 among
in Malaysia in 2013 was 32.9% (6); in Iran in youngster aged 16-30 years old living in Da
2016 was 61.7% (7); In Vietnam, the percentage Nang City, Vietnam for at least 12 months.
of students with poor sleep quality was 60%
Sample size and selection of participants
at Hanoi University of Public Health in 2014
(8); 49.4% at Hue University of Medicine and The sample size was calculated by using the
Pharmacy in 2016 (9). formula to estimate population ratios:
There are many reasons lead to the situation of p(1-p)
poor sleep quality, including illness, disability, n = Z2(1 - /2)
d2
hormone levels, negative environmental
influences, physiological disorders, lifestyle With α = 0.05, Z2(1 - /2) = 1.96 , d = 0.05, p =
behaviors... Nowadays, a cause becomeing 0.6. According to similar research by Le Hoang
the highest concern is theInternet addiction, Minh Son et al., the proportion of students who
especially among young people. suffered from bad sleep quality was 60% .

Young people are powerful social workforce Sample-size was: Since the cluster sampling
with great potentials and they would method is used during the sampling process,
contribute to the development of the country. therefore, the sample size is multiplied by a
Every country should not only pay attention design factor of 2. Plus 10% of the sample
to physical health, but it also needs to size to prepare for missing data or case
improve mental health, especially in terms of refusals. Therefore, the minimum sample size
improving the quality of sleep to contribute to for the study was 820 people.In fact, the study
the prevention of serious health consequences was conducted on 856 people.
(1). There have been many studies on sleep
Research variables
quality but most of them are clinical medical
studies, there are still few public health studies The dependent variable: Sleep quality of
on sleep quality, especially among adolescents. adolescents within 1 month followed the
Therefore, we conducted the research: “Sleep PSQI scale including 7 parts based on 19
quality among the adolescents in Da Nang City, questions (10).
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Hoang Nguyen Nhat Linh et al. Journal of Health and Development Studies (Vol.05, No.02-2021)

The independent variables: Data analysis and statistical method

- Socio-demographic characteristics: age, SPSS version 18.0 was used for all statistical
gender, living area, people living with, analyses. The differences between sleep
education level, occupation, marital status, quality and respondents’ features were
part-time job, income. compared by using the Chi-square test. We
conducted multiple regression analyses to
- Internet addiction: Based on IAT (Internet
address factors associated with levels of
addiction Test). Levels of internet addiction
sleep quality.
were divided into 3 levels: normal (20 – 39
scores), mild (40 – 69 scores), severe (70 Ethical consideration
-100 scores).
The ethical approval of our study was
In this study, we divided into 2 levels: obtained from the Ethical Committee of
controlled level and uncontrolled and Hue University of Medicine and Pharmacy
dependent level. (11). in Vietnam (Decision No H2016/047).
Participation in this study was voluntary. All
- Depression, anxiety, and stress: Using
study participants were fully informed about
DASS-21 to assess (3).
the study objectives, the main content, and
- Negative psychological occasion: A their rights to withdraw at any time without
negative situation caused by one or many any threats or disadvantages.
bad events occurring within 1 month RESULTS
such as quarreling with family members,
quarreling with a partner, working/studying Socio-demographic characteristics of the
stress (yes/no). study population

- Others: Habits before sleeping, staying Among 856 participants living in Da Nang
up late, smoking, consuming alcohol, sleep City, the percentages of male and female
posture. were 46.8% and 53.2%, respectively. The
mean age was 21.04 ± 3.96 years old, group
Data collection age of 16-19 years accounted for the highest
Data collection process included 2 stages. In proportion, the youngest was 16 and the
the first stage, a center district was chosen oldest was 30 years old. The number of people
randomly (representative for urban area) living in Hai Chau and Hoa Vang District was
in 6 center districts and an outside district similar. Most of participants attended high
(representative for rural area) in 2 rural school or college, being single and living with
districts. In the second stage, choosing family members. About 45.7% and 40.1% of
randomly 2 wards in each selected district. respondents were supported by family and
We made a list of all the people aged 16- earned their own income respectively. In
30 years and selected subjects in the study terms of occupation, the highest proportion
sample by single random method. was students (58.8%) (Table 1).

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Table1. Social-economic status of study participants

Features n %
16 - 19 370 43.2
Age 20 - 24 282 32.9
25 - 30 204 23.8
Male 401 46.8
Gender
Female 455 53.2
Hai Chau District 430 50.2
Living area
Hoa Vang District 426 49.8
Under primary school 4 0.5
Secondary school 66 7.7
Education Level High school 379 44.3
College 361 42.2
Postgraduate 46 5.4
Single 715 83.5
Marital status Married 136 15.9
Divorced 5 0.6
Alone 61 7.1
Family members (parents
770 90.0
or partner)
People living with
Relatives 12 1.4
Friends 12 1.4
Others 1 0.1
Earn by themselves 343 40.1
Income Support from family 391 45.7
Both 122 14.3
Unemployment 19 2.2
Students 503 58.8
Occupation Workers 158 18.5
Officers 63 7.3
Others 113 13.2

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Sleep quality among adolescents in Da Nang City and the related factors

Figure 1. Sleep quality among youngster aged 16-30 years in Da Nang City

In general, among 856 adolescents living The result also showed the mean score of
in Da Nang City, there were 266 study PSQI was 3.53 ± 2.57.
participants (31.1%) had poor sleep quality.

Table 2. Multivariate logistic regression examined the related factors associated with
sleep quality among adolescents

Independent variables OR 95% CI

Hai Chau District 1
Living area
Hoa Vang District 1.84 1.20 – 2.82
None 1
Students 5.52 1.12 – 27.16
Occupation Workers 2.22 1.33 – 3.72
Officers 2.43 1.32 – 4,48
Others 2.25 0.94 – 5.41
The end time for Before 19:00 1
study/work After 19:00 0.39 0.26 – 0.57
Level of using Control usage 1
Internet Frequent use and dependence 1.57 1.01 – 2.44
Normal 1
Mild 18.36 4.27 – 79.06
Stress
Moderate 12.77 2.80 – 58.17
Severe 7.57 1.58 – 36.27

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No 1
Study/work pressure
Yes 2.04 1.36 – 3.05
Overeating within 2 No 1
hours before sleeping Yes 1,65 1.08 – 2.51
No 1
Rarely 3.34 1.27 – 8.73
Stay up late
Sometimes 2.01 1.16 – 3.48
Always 1.23 0.81 – 1.86
On the stomach 1
Lay up 7.42 1.13 – 48.72
Sleep posture Lie on the left side 7.64 1.25 – 46.76
Lie on the right side 6.09 0.98 – 37.93
Other postures 10.44 1.59 – 68.56
Hands around the head 1
Hands stretching down the body 0.058 0.00 – 0.87
Hand position
Two hands hugging things 0.062 0.00 – 0.93
Other hand positions 0.061 0.00 – 0.91

Overall, there were the relationships up (OR:7.42; 95%CI: 1.13-48.72), lie on

between sleep quality and living area in Hoa the left side (OR:7.64; 95%CI: 1.25-46.76)
Vang District (OR: 1.84; 95%CI: 1.20-2.82); and other postures (OR:10.44; 95%CI: 1.59-
occupations were students (OR: 5.52; 95%CI: 68.56); hand posture when sleeping with
1.12-27.16), workers (OR: 2.22; 95%CI: hands stretching down the body (OR: 0.058;
1.33-4.48), or officers (OR: 2.43; 95%CI: 95%CI: 0.00-0.87), two hands hugging
1.32-4.48); finishing working/studying time things (OR: 0.062; 95%CI: 0.00-0.93), and
after 7 pm (OR: 0.39; 95%CI: 0.26-0.57); other hand positions (OR: 0.061; 95%CI:
regularly use and dependent on internet 0.00-0.91).
(OR: 1.57; 95%CI: 1.01-2.44); having stress
with mild level (OR: 18.36; 95%CI: 4.27-
DISCUSSION
79.06), moderate level (OR: 12.77; 95%CI:
2.8 – 58.17), severe level (OR: 7.57; 95%CI:
Socio-demographic characteristics of
1.58-36.27); having pressure on study/work
research participants
(OR:1.65; 95%CI: 1.36-3.05), overeating
before going to bed (OR: 1.65; 95%CI: 1.08- According to the results, the proportion of
2.51); rarely (OR:3.34; 95%CI: 1.27-8.73) female respondents was higher than that of
or sometimes (OR:2.01; 95%CI: 1.16-3.48) male ones, 53.2% and 46.8%, respectively.
staying up late, lying postures were laying These results were similar to study of Le
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Hoang Minh Son, with 73.6% female and accounting for 90%. Meanwhile, the result
26.4% male. However, Begum Dag’s study of Le Hoang Minh Son’s study showed that a
showed that there was 42.2% females, by large number of respondents lived alone (8).
15.6% lower than males. The average age was
The sleep quality among adolescents in Da
21.04 ± 3.96, the lowest age was 16 and the
Nang City
highest age was 30 years old. Table 1 showed
that 43.2% of research respondents were aged Figure 1 showed the proportion of poor
16-19; the figures for age group 20-24 years sleep quality among adolescents in Danang
and 25-30 years were 32.9% and 23.8%, City was 31.1%. According to other national
respectively. Lemma’s research showed that studies on sleep quality, this number was
the average age was 21 years, the lowest age quite high. Le Hoang Minh Son’s research
was 17 years and the highest age was 35 years; on students of Hanoi University of Public
in which the age group from 20-24 years old Health gave a poor rate of sleep quality in
accounted for the highest proportion (88.6%), this group was 60% (8). Another study on
the group aged 15-19 years accounted for students at Hue University of Medicine
only 5.3% and the group aged 25 and older and Pharmacy by Nguyen Thi Khanh Linh
accounted for 6.2%. There was difference showed that the proportion of unsatisfactory
in terms of living area of research subjects. sleep quality was 49.4% (9). Our research
Table 1 also indicated results for the living results were much lower than the results
area that there were 50.2% of participants of these two studies. The reason for the
lived in Hai Chau district (urban area) and difference was that the studies of other
49.8% lived in Hoa Vang district (rural area). authors focused on students, and specifically
While research respondents in Le Hoang rather than medical students, who are at
Minh Son’s study mostly lived in rural areas high risk and more susceptible to learning
(52.5%), the remaining lived in urban areas pressure that affects their sleep quality.
(35.0%) and mountainous areas (12.5%) (8), With similar studies on sleep quality using the
(9), (12). same PSQI scale of the authors in the world,
In terms of education level, there was we have not found any clear research on 16 to
44.3% of research respondents had high and 30-year-old people. The majority of the studies
secondary education; 42.2% had college also researched on the student group and the
and university degrees; 7.7% had secondary results of the incidence of poor quality were
school education; 5.4% had postgraduate quite high. According to a study by Abdullah
qualifications and 0.5% was illiteracy and I. Almojali on 756 medical students of KSAU
primary education. Regarding marital status, - HS, the rate of students with poor quality
83.5% of research respondents were still of sleep quality was 76% (13). In different
single; 15.9% got married and 0.6% were disciplines at two US universities (Sharjah
separated or divorced. However, this variable and Gulf Medical Universities), 67.2% of
was not specifically described in the author’s students had poor quality of sleep (14). The
rate in the Ethiopian study of 2817 students at
studies because the majority of those studies
the two school campuses was 55.8% (9). This
were done on students.
result was similar to that of Le Hoang Minh
Table 1 also showed that the majority of Son and Nguyen Thi Khanh Linh, but it was
research subjects lived with their families, much higher than our research results with
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the same interpretation when compared with of age and occupational group, the results
two studies in Vietnam, due to differences in of this association also reminded an interest
the study participants. Begum DAG’s study in sleep hygiene and labor time in different
showed that the sleep quality ratio was not professions.
as good as our research with 36.4%. But this
End time for study/work
study was conducted on a group of junior
high school students aged 14-20 years (12). Due to the non-standard distribution results,
we selected the 19-hour score as the cutoff
Factors related to the sleep quality of
point to split into two groups: ≤19 hours
adolescents in Da Nang City
and> 19 hours for multivariate analysis. The
Living area results were given in the multivariate logistic
regression model assessing the relationship
According to the multivariate logistic between the incidence of poor quality of
regression model results in Jinsong Chang’s education and the end time of study or work
study, 26766 participants in Hunan province of recorded a relationship between these two
China lived in rural areas related to insomnia factors (p = 0.000; OR = 0.39; 95% CI: 0.26
(15). This was consistent with our research - 0.57) (Table 2).
results. Similar results from multivariate
analysis (Table 2) showed that people living Although there was still no evidence in
in Hoa Vang District had 1.8 times higher of national and international studies to prove
poor sleep quality compared to those living in this relationship, we believed that the sooner
Hai Chau district (OR = 1.84; 95% CI: 1.20 the study or job ends, the sooner the subject
- 2.82). The main reason for this difference will have time to relax. The extension of time
could be due to the concentration of industrial to study or work can put pressure on and sleep
factories in the city. Therefore, the production quality effect. There should be more studies
in these factories might affect the sleep quality on this factor on the quality of participants in
of the people. different age groups or occupational groups
to be able to have appropriate study/job end
Occupation times to ensure the quality of job quality.
The student group had a high rate of sleep Internet dependency level
unsatisfactory by 5.5 times higher than the
non-working or non-studying group (OR = Table 2 also noted the relationship between
5.52; 95% CI: 1.12 - 27,163) (Table 2). the level of Internet dependence and sleep
quality of the participants. The risk of bad
The results of this association were similar sleep quality was nearly 1.6 times higher
to those of Wenji Sun among 181.616 than the group who could control the use of
participants aged 18-65 years old in China. the Internet (p = 0.046; OR = 1.57; 95%CI:
The study concluded that sleep duration 1.01 - 2.44). A study in Peru showed that
and sleep quality varied among people with sleep quality among Internet addicts was
different careers in China. Farmers had a 30% higher than that of ordinary people.
longer sleep time than government officials Engaging in activities at night will lead to
and also farmers had better sleep quality than an increase in melatonin and lead to mental
workers. While this study was not conducted health problems such as depression, stress,
on a similar group with our study in terms and sleep disorders. According to the
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research results of Melvyn W.B. Zhang about quality. Through the literature review, we had
youth Internet addiction and sleep quality, not found many documents on the relationship
21.2% of the participants was diagnosed between sleeping position and sleep quality.
with Internet addiction; 26.7% of internet Only the study of Cornelia Wrzus was found,
addicts also reported that they had difficult showing the relationship between changing
sleeping; 77.2% of these participants learned the sleeping position by the hour, the average
the direction to seek medical care (16). time of a sleeping position, the number of
sleeping positions in 1 hour (each posture
Stress
lasts more than 15 minutes) (p <0.05) (19).
The results of multivariate analysis noted the While the results of our research were based
relationship between stress and sleep quality on subjective opinions of study subjects
of participants, the participants with mild about their sleeping position, in addition, how
stress were 18 times more likely to be at risk position changed during sleeping, our study
of poor quality than the normal group (p < did not record. However, within the limitation
0.001; OR = 18.36; 95% CI: 4.27 - 79.06). of a cross-descriptive study, we found that this
This relationship was also coincides with result could be suited and used as a reference
Abdullah I. Almojali’s study (p <0.001) (17). for further future studies on this association.

Staying up late The bedtime routine

Le Hoang Minh Son’s study showed that Table 2 showed a statistically significant
the rate of poor quality of sleep in the group relationship between sleep quality and the
who stayed up late (68.9%) was higher habits of participants such as overeating
than the group that did not stay up late (8). within 2 hours before going to bed, using a
Through multivariate analysis, the results mobile phone, listening to soft music, taking
showed that staying up late was related to a warm bath. No link with a mild exercise
sleep quality (p < 0.001; OR = 2.79; 95%CI: routine was found. This was coincides with
1.87 - 4.14). Edward’s study also showed the results of Colette S Kabrita (20).
there was association between staying up
The limitations of this research: The study
late and sleep quality. However, this study
interviewed subjects directly, so it depended
used the ESS scale to evaluate the quality of
participants (18). directly on how to assess sleep quality and
some behavioral factors. However, we believe
Sleeping posture that these factors are reduced by the unnamed
respondents in the questionnaire and proven
There was a statistically significant correlation
toolkit.
between sleep quality and sleeping postures
(lying, hands, legs) (p <0.05). The rate of
participants who had poor sleep quality with CONCLUSIONS AND
lying on the left when sleeping was higher than RECOMMENDATIONS
the remaining positions (39.9%). This may be
explained by the left side-lying affecting the The rate of poor sleep quality among
heart, which can interfere with the metabolism adolescents was 31.1%. The factors related
and other physiological processes that occur to the sleep quality of adolescents included
during sleep, leading to the impact of sleep living area; occupation; end time for study/
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work; Internet usage level; stress level; study/ Sciences. 16, pp. 46-50.
work pressure; overeating within 2 hours ​​ 8. Le Hoang Minh Son et al. (2014), Thực trạng sử
dụng mạng xã hội, chất lượng giấc ngủ của sinh
before going to bed; staying up late; lying viên trường Đại học Y tế Công cộng và một số
posture and hand posture. yếu tố liên quan năm 2014, University of Public
Health.9. Nguyen Thi Khanh Linh (2016),
Recommendation: Young people themselves Nghiên cứu chất lượng giấc ngủ của sinh viên
should proactively and actively devise hệ chính quy trường Đại học Y dược Huế, Hue
appropriate sleep hygiene measures. Families University of Medicine and Pharmacy.
10. Buysse, Daniel and al. (1989), “The Pittsburgh
and relatives need to care, motivate and avoid
Sleep Quality Index: a new instrument for
the pressure on young people, give advice and psychiatric practice and research”, Psychiatry
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A New Clinical Phenomenon and Its
implementation of sleep hygiene measures
Consequences”, AMERICAN BEHAVIORAL
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12. DAĞ, Begüm and KUTLU, Fatma Yasemin
(2017), “The relationship between sleep quality
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